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Addressing Unhealthy Substance Use in Primary Care. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are.
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St-Georges de Beauce. Centre Rockland.

Carrefour l'Estrie. Les Galeries de Terrebonne. Galeries d Anjou. Prix :. Auteur :. Titre :. Date de parution :. Collection :. Sujet :. ISBN :. No de produit :. Suivi de commande. The design of the integrated stepped care model i. Social Worker and Psychologist-delivered manualized counseling focused on enhancing patient motivation to change their alcohol consumption and structured, personalized feedback for patients facilitated its implementation. While the providers found these techniques to be familiar, they found that the integrated stepped care model provided them with new techniques and materials for enhancing patient motivation, which they perceived to be a barrier to promoting treatment.

Indeed, these tools may serve to reinforce motivations to decrease alcohol consumption that have been previously identified as reasons that HIV-infected patients limit their drinking i. Importantly, treating unhealthy alcohol use through clinic-based settings was perceived by providers to be consistent with VA priorities.

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Specifically, there have been extensive efforts to promote evidence-based AUDIT-C screening followed by appropriate intervention i. In contrast, uptake of evidence-based pharmacotherapy for alcohol use disorders has been slow [] despite VA guidelines supporting the use of pharmacotherapy [76]. Addiction Psychiatrists generally recognized accessible pharma-cotherapy as an important treatment option for alcohol use disorders, yet reported variable success in initiating treatment.

This suggests that patient and HIV provider-targeted education and marketing may be important for improving uptake among non-treatment seeking individuals in the setting of shared-decision making after consideration of all available treatment options [77]. Furthermore, providers found that the integrated stepped care model was consistent with VA priorities given recent initiatives to develop and evaluate new models for delivering screening and treatment for unhealthy alcohol use.

Such models. While providers were consistent in their reported beliefs that the integrated stepped care model offered a high quality intervention, there were differences based on provider experience and type regarding the ideal way in which to integrate treatment of unhealthy alcohol use into HIV clinics. For example, while some Social Workers believed it was ideal for social workers to deliver the BNI, other suggested that either Infectious Disease Physicians or nurses might provide these services.

Additionally, they felt they had the requisite skills and experience to provide the MET intervention. Similarly, it was suggested by Addiction Psychiatrists that Infectious Disease Physicians might be best positioned to engage patients in treatment for unhealthy alcohol use.

That a tension exists regarding how to best integrate services is not surprising. On one hand, Infectious Disease and HIV-specialty trained physicians, who increasingly serve as the primary care physician for HIV-infected patients, have an existing relationship with the patient and are managing other treatments. However, prior multi-site studies indicate that HIV providers are often unaware of their patient's alcohol use and often do not discuss it, even with patients with higher levels of drinking [29, 30, 78].

Thus, it is likely that team-based approaches as structured in the integrated stepped care model, which do not rely on HIV providers to deliver treatment for unhealthy alcohol use, are likely to be an important strategy for effectively addressing unhealthy alcohol use. This model is consistent with others developed to treat other substance use disorders i. If effectiveness of integrated stepped care for unhealthy alcohol use in HIV clinics is demonstrated, future studies should focus on determining the optimal role of HIV providers, based on their knowledge and self-efficacy, for delivering such treatments.

In addition, the extent to which such an intervention should target other health behaviors, such as drug use or sexual risk behaviors, warrants investigation. The results of this study should be interpreted in the context of its limitations. First, the providers represented a convenience sample of individuals involved with an ongoing randomized controlled trial. Our results may not reflect the opinions of other providers involved with the randomized controlled trial or apply to other VA-based providers more generally. Second, our interview guides were not piloted in advance of our study.

In retrospect,. Third, these findings may not transfer universally to other HIV clinical settings, particularly settings where Psychologists and Addiction Psychiatrists are less available. If effectiveness is demonstrated, issues of generalizability of this and the main study's findings to other HIV clinical settings will be carefully considered.

Fourth, this qualitative study was conducted during the 1st year of implementation of integrated stepped care in the context of a randomized controlled trial. Whether these findings will apply at later stages is unclear; though this study does provide important insights to inform planning phases and initial implementation of integrated stepped care models.

Fifth, given our small sample size, we are unable to determine whether we had reached thematic saturation. Regardless, this study provides meaningful data given its focus on implementation of a novel model of care for unhealthy alcohol use in HIV clinics based on a robust deductive approach to data analysis, which revealed consistency in findings within and across different groups of providers. Sixth, our study may have been subject to social desirability bias given the proportion of interviewers relative to interventionists; however, we felt that the diverse perspectives of the interviewers served to enhance the richness of the conversation and data collection.

In conclusion, our study represents an important step in identifying key considerations based upon the CFIR constructs when implementing an integrated stepped care model for unhealthy alcohol use in HIV clinics. We found that implementation of this model may be facilitated by tools to help providers enhance patient motivation, close alignment with organizational values and existing models of care, and optimization of provider self-efficacy and roles. Future efforts aimed at obtaining the perspectives of additional providers, as well as patients and HIV providers will be important for developing a comprehensive understanding of factors impacting implementation of integrated stepped care for unhealthy alcohol use in HIV clinics.

In addition, consideration of alternative models involving various providers completing the primary components of the intervention, will be important for informing the development of successful interventions. EJE participated in all aspects of this study, including writing the HIC protocol, leading the data analysis and writing the first draft of the manuscript. CD contributed to the design of the data collection tools and data analysis.

LEF participated in data collection. DAF participated in all aspects of this study, 7. All authors made substantial contributions to the revising of the manuscript. All authors read and approved the final manuscript. Neither NIH nor the VA had a role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Kendall Bryant, a NIAAA employee and scientific collaborator on the project, participated in the analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. J Acquir Immune Defic Syndr. Problem drinking and medication adherence among persons with HIV infection. J Gen Intern Med.

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Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychol Med. National Institute on Alcohol Abuse and Alcoholism. What's "at-risk" or "heavy" drinking? Accessed 18 July American Psychiatric Association. Washington: American Psychiatric Press; Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department. Acad Emerg Med. Development of a scale to measure practitioner adherence to a brief. J Subst Abuse Treat. A brief intervention reduces hazardous and harmful drinking in emergency department patients.

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One question may gauge the severity of unhealthy drug and alcohol use

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Transl Behav Med. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Substance abuse treatment implementation research.


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Addressing Unhealthy Alcohol Use in Older Populations in Primary Care

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Implementation of integrated stepped care for unhealthy alcohol use in HIV clinics Academic research paper on " Clinical medicine ". Similar topics of scientific paper in Clinical medicine , author of scholarly article — E. Jennifer Edelman, Nathan B. Hansen, Christopher J.

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Cutter, Cheryl Danton, Lynn E. Fiellin, et al. Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial. Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions. Contributor s : Saitz, Richard [editor. Tags from this library: No tags from this library for this title.

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