Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain.

When prescribing opioids to treat chronic pain, physicians face the dilemma of balancing effective pain management while avoiding iatrogenic opioid addiction. Through mailed surveys, the current study assessed concerns, perceptions, and practices of primary care physicians related to this dilemma. Of the 35 (43%) physicians that replied, 32 (91.

Prescription opioid use among patients seeking treatment for opioid dependence.

Objective: This study was designed to assess non-medical prescription opioid use among a sample of opioid dependent participants.

Methods: A cross-sectional survey was conducted with a convenience sample of patients hospitalized for medical management of opioid withdrawal. We collected data related to participant demographics, socio-economic characteristics, the age of first opioid use, types of opioids preferred, and routes of administration.

Self-help program components and linkage to aftercare following inpatient detoxification.

Many patients fail to initiate aftercare for addictive disease rehabilitation following detoxification. This study of 136 inpatients compared characteristics of those who initiated aftercare (behavior therapy or self-help programs) during the week following discharge with those who did not. Among this group of patients, 77% (91/119) linked to aftercare.

A randomized trial of extended buprenorphine detoxification for opioid dependency.

Objective: : The objective of this study was to determine whether additional "take-home" medication after inpatient opioid detoxification would lead to improved rates of subsequent treatment initiation and abstinence.

Methods: : We randomly assigned 60 inpatients to a 7-day or 37-day extension of sublingual buprenorphine/naloxone after hospitalization. Follow-up telephone interviews were conducted approximately 5 weeks after discharge.

The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits.

Introduction: Since the 1990s prescriptions for and the non-medical use of opioids have increased. This study examines associations between opioid prescribing, non-medical use, and emergency department (ED) visits.

Methods: Data were abstracted from four federally sponsored, nationally representative, annual surveys (National Hospital Ambulatory Medical Care Survey, National Ambulatory Medical Care Survey, National Survey on Drug Use and Health, and Drug Abuse Warning Network).

Primary care after psychiatric crisis: a qualitative analysis.

Purpose: Patients with serious psychiatric problems experience difficulty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis.

Methods: A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group.

A method for measuring intracellular free magnesium concentration in platelets using flow cytometry.

Magnesium is the fourth most abundant cation in the body and is involved in over 302 enzymatic reactions. Basic science research has implicated magnesium deficiency as a cause of insulin resistance which is related to hypertension, diabetes, hyperlipidemia and increased cardiovascular risk. Research in magnesium deficiency states has been hindered because magnesium is an intracellular ion and difficult to measure.

Linkage to primary medical care following inpatient detoxification.

It is important to address the medical problems of individuals admitted for detoxification by arranging for follow-up with primary care physicians after discharge. This was a prospective cohort study of 119 patients admitted for detoxification. Follow-up data were collected over the telephone one week following discharge.

Facilitating quality improvement in physician management of comorbid chronic disease in an urban minority practice.

Context: Increasing numbers of patients with multiple chronic conditions present in the primary care setting and pose a challenge to physicians who must cope with competing demands while adhering to clinical practice guidelines.

Purpose: We tested a chart audit tool to assess how physicians are managing patients with multiple comorbidities in an inner-city family medicine practice serving minority patients.

Methods: We developed an evidence-based comorbidity chart audit tool that captures the number of diagnosed, coexisting general medical conditions and adherence to key clinical practice guidelines for each condition.

Abstinence and initiation of treatment following inpatient detoxification.

This prospective cohort study compared in-patients who remained abstinent and initiated aftercare treatment following detoxification with those who did not. Of 110 patients enrolled, 58% (46/79) were totally abstinent and 72% (67/93) initiated treatment during the first 30 days following hospital discharge. Patients who relapsed after hospital discharge were more likely than those who remained abstinent to have a primary drug-use disorder (p = 0.

Lay experiences and concerns with asthma in an urban Hispanic community.

Background: National asthma guidelines are often not translated into practice. Barriers to translation impactboth provider and patient adherence.

Purpose: This qualitative study describes how perceptions and experiences of patients with asthma or their caregivers affect disease management in a Puerto Rican community in Buffalo, NY.

Differences among those who complete and fail to complete inpatient detoxification.

Some individuals hospitalized for alcohol or drug detoxification leave against medical advice (AMA). We hypothesized that certain characteristics would be associated with AMA discharges. A case-control study of 1,426 hospital admissions for detoxification (representing 1,080 individuals) was conducted to compare patients leaving the hospital AMA (n=231) with a random sample of those completing detoxification (n=286).

Encouraging a systems approach for adherence to national asthma guidelines.

Purpose: There is a lack of information in the literature reflecting systems effects on adherence to national asthma guidelines. The purpose of this pilot study is to provide a descriptive account of the preparedness of academic primary care sites to follow national asthma guidelines related to spirometry, peak flow meters, standard history forms, severity assessment, follow-up assessment sheets, patient self-assessment sheets, and asthma action plan templates.

Methods: This was a cross-sectional descriptive study.

Connections to primary medical care after psychiatric crisis.

Background: Patients presenting with a psychiatric emergency face a unique set of challenges in connecting to primary care.

Objectives: We tested the hypothesis that, in contrast to usual care, case management will result in higher rates of connection to primary care. We examined variables affecting primary care entry, including insurance status, hospital admission, and concurrent linkages to mental health care.

Estimating impacts on safety caused by the introduction of electronic medical records in primary care.

Context: Primary care is a highly complex environment in which multiple safety problems have been identified. Each primary care practice can be viewed as a complex adaptive system with its own unique characteristics. The introduction of an electronic medical record (EMR) into such a system represents a significant perturbation that can have multiple unpredictable effects.

Self-report and primary care medical record documentation of mammography and Pap smear utilization among low-income women.

Purpose: To determine whether self-report of mammography and Pap smear utilization was accurate and to determine whether racial/ethnic differences existed.

Methods: Face-to-face surveys were administered to 314 consecutively selected women over 40 attending two low-income inner-city family practice sites. Medical records were reviewed for documentation of mammography and Pap smear utilization.

The effects of an outpatient wellness program on subjective quality of life in people with psychiatric disabilities.

The shift in care for individuals with psychiatric disabilities from the psychiatric hospital to the community has been accompanied by an increased emphasis on the measurement of quality of life (QOL) for these clients. It is the goal of this paper to measure the impact of a voluntary outpatient wellness program on individuals' self-reports of QOL over time. QOL for 49 wellness center participants was assessed at baseline, three months, and six months.