Abstract:
BACKGROUND:Many opioid-dependent patients do not receive care for addiction issues when hospitalized for other medical problems. Based on 3 years of clinical practice, we report the Transitional Opioid Program (TOP) experience using hospitalization as a "reachable moment" to identify and link opioid-dependent persons to addiction treatment from medical care. METHODS:A program nurse identified, assessed, and enrolled hospitalized, out-of-treatment opioid-dependent drug users based on their receipt of methadone during hospitalization. At discharge, patients transitioned to an outpatient interim opioid agonist program providing 30-day stabilization followed by 60-day taper. The nurse provided case management emphasizing HIV risk reduction, health education, counseling, and medical follow-up. Treatment outcomes included opioid agonist stabilization then taper or transfer to long-term opioid agonist treatment. RESULTS:From January 2002 to January 2005, 362 unique hospitalized, opioid-dependent drug users were screened; 56% (n = 203) met eligibility criteria and enrolled into the program. Subsequently, 82% (167/203) presented to the program clinic post-hospital discharge; for 59% (119/203) treatment was provided, for 26% (52/203) treatment was not provided, and for 16% (32/203) treatment was not possible (pursuit of TOP objectives precluded by medical problems, psychiatric issues, or incarceration). Program patients adhered to a spectrum of medical recommendations (e.g., obtaining prescription medications, medical follow-up). CONCLUSIONS:The Transitional Opioid Program (TOP) identified at-risk hospitalized, out-of-treatment opioid-dependent drug users and, by offering a range of treatment intensity options, engaged a majority into addiction treatment. Hospitalization can be a "reachable moment" to engage and link drug users into addiction treatment.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Shanahan CW,Beers D,Alford DP,Brigandi E,Samet JHdoi
10.1007/s11606-010-1311-3subject
Has Abstractpub_date
2010-08-01 00:00:00pages
803-8issue
8eissn
0884-8734issn
1525-1497journal_volume
25pub_type
杂志文章abstract:BACKGROUND:Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. OBJECTIVE:To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DESIGN:Using a difference-in...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3904-y
更新日期:2017-06-01 00:00:00
abstract::The community of health services researchers in general internal medicine has played an important role in affecting health policy at the national and state levels. Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the loca...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1878-3
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. OBJECTIVE:To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those with...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05325-8
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. OBJECTIVE:Assess the impact of a scribe on physician and pati...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4434-6
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:In response to proposed federal legislation, the Accreditation Council for Graduate Medical Education limited resident work-hours in July 2003. The cost may be substantial but, if successful, the reform might lower preventable adverse event costs in hospital and after discharge. OBJECTIVES:This study sought...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0133.x
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Primary care providers (PCPs) face many system- and patient-level challenges in providing multimodal care for patients with complex chronic pain as recommended in some pain management guidelines. Several models have been developed to improve the delivery of multimodal chronic pain care. These models vary in ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4328-7
更新日期:2018-05-01 00:00:00
abstract::Using survey items from Kern et al. (1985), 192 former residents rated their preparation in, and the importance of, three content areas of their residency training ("basic skill and knowledge areas," "allied medical disciplines," and "areas related to the practice of medicine"). Mean ratings replicated those reported ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02597402
更新日期:1989-07-01 00:00:00
abstract::Initial reports on HemoQuant, a new quantitative test for occult gastrointestinal bleeding, suggest it is more sensitive than Hemoccult. Increased detection of upper gastrointestinal tract bleeding and dietary hemoglobin may reduce HemoQuant's specificity in the screening setting. The authors performed a cost effectiv...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596117
更新日期:1988-03-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness and costs of alternative management strategies for patients infected with the human immunodeficiency virus (HIV) who present with pulmonary symptoms. DESIGN:Decision analysis comparing initial testing (arterial blood gas analysis, induced sputum analysis, or bronchoscopy with b...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02598081
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the comparative effectiveness of antiviral drugs in adults with chronic hepatitis B monoinfection for evidence-based decision-making. METHODS:A systematic review of randomized controlled clinical trials (RCTs) published in English. Results after interferon and nucleos(t)ides analog therapies wer...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1569-5
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:To assess a new technique for the detection of free pleural fluid. DESIGN:118 consecutive inpatients with radiologic evidence of free pleural fluid and a control group of 175 randomly selected inpatients were examined over a three-year period in a prospective blind study by auscultatory percussion (AP) for e...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF02600204
更新日期:1994-02-01 00:00:00
abstract:BACKGROUND:Increasing the use of electronic medical records (EMR) has been suggested as an important strategy for improving healthcare safety. OBJECTIVE:To sequentially measure, evaluate, and respond to safety culture and practice safety concerns following EMR implementation. DESIGN:Safety culture was assessed using ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2153-y
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes. OBJECTIVE:Conduct a national survey of providers who use PPAs to describe the process of administering...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06364-2
更新日期:2021-01-08 00:00:00
abstract::The study examined the relative contribution of caregivers' conduct and physical conditions of the hospital setting to patients' global satisfaction with health care, while controlling for self-assessed health status. The study was performed in the Soroka Medical Center, which is the only inpatient facility for a popu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02598274
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Beta-blockers have been shown to improve survival in patients with congestive heart failure (CHF). However, few studies have looked at the effects of these medications specifically in women. OBJECTIVE:To determine the effectiveness of beta-blockers in women with CHF. PATIENTS:We conducted a retrospective c...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0197-1
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resou...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06007-6
更新日期:2020-12-01 00:00:00
abstract::To understand the effect that termination of an established physician-patient relationship has on patient attendance patterns in a medical clinic, appointment scheduling and patient attendance were measured for 210 patients before and after 11 senior resident physicians left the clinic. There was no significant change...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599811
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:Few patient-centered interventions exist to improve year-end residency clinic handoffs. AIM:Our purpose was to assess the impact of a patient-centered transition packet and comic on clinic handoff outcomes. SETTING:The study was conducted at an academic medicine residency clinic. PARTICIPANTS:Participants...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3009-4
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustain...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-019-04894-y
更新日期:2019-07-01 00:00:00
abstract:PURPOSE:To compare the effects of three methods of values clarification (VCM): balance sheet; rating and ranking; and a discrete choice experiment (DCE) on decision-making about colorectal cancer (CRC) screening among adults in the US and Australia. METHODS:Using online panels managed by a survey research organization...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-013-2701-0
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial. OBJECTIVE:Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission. DESIGN:Retrospective cohort study with overlap pro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06171-9
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Potentially preventable admissions are a target for healthcare cost containment. OBJECTIVE:To identify rates of, characterize associations with, and explore physician decision-making around potentially preventable admissions. DESIGN:A comparative cohort study was used to determine rates of potentially prev...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-017-4285-6
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it. OBJECTIVE:To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates. DESIGN:Observational study....
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-017-4046-6
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Questions persist about how learning healthcare systems should integrate audit and feedback (A&F) into quality improvement (QI) projects to support clinical teams' use of performance data to improve care quality. OBJECTIVE:To identify how a virtual "Hub" dashboard that provided performance data for patients...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06160-y
更新日期:2020-11-01 00:00:00
abstract::The management of patients who have HIV disease, particularly those in early, asymptomatic disease stages, has recently improved. Clinical trials with zidovudine have demonstrated efficacy and greatly reduced toxicity when the drug is used for asymptomatic HIV-infected persons who have fewer than 500 CD4+ cells/mm3. A...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02599251
更新日期:1991-01-01 00:00:00
abstract::Americans are living longer - a mark of success in public health and medical care - but more will live the last few years with progressive illness and disability. The dominant conception of care delivery separates "aggressive" or life-extending care from "palliative" or death-accepting care, with an assumed "transitio...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2001.90901.x
更新日期:2001-05-01 00:00:00
abstract::Chronic eosinophilic pneumonia (CEP) is a rare interstitial lung disease characterized by subacute dyspnea, peripheral infiltrates on imaging, and pulmonary eosinophilia. We report a case of a 48-year-old man who presented to a "minute clinic" with cough and dyspnea. After improvement on a short course of steroids for...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2316-x
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:The coronavirus disease 2019 (COVID-19) emerged in December 2019 and posed numerous challenges to China's health system. Almost 4 million primary care practitioners (PCPs) participated in controlling the outbreak. However, PCPs' barriers to and experience of the epidemic control remain unknown and are essent...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06107-3
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools. OBJECTIVE:To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure. DESIGN:Qualitative item development/quantitative i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-018-4496-5
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To characterize the informed consent process in routine, primary care office practice. DESIGN:Cross-sectional, descriptive evaluation of audiotaped encounters. SETTING:Offices of primary care physicians in Portland, Oregon. PARTICIPANTS:Internists (54%) and family physicians (46%), and their patients. MEA...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.00057.x
更新日期:1997-06-01 00:00:00