Availability Of Treatment Services Research Articles

Jail Characteristics and Availability of Opioid Treatment Services: Results from a Nationally Representative Survey.

The current wave of the opioid epidemic has contributed to a record number of drug-related overdoses and a significant proportion of people who experience opioid use disorder are admitted to local jails. These correctional facilities serve as the principal entry point to the criminal justice system as nearly every person who is taken into custody is admitted to a local detention center. Although jails are recognized as primary intervention points for people who may require treatment for opioid use disorder, services in these facilities remain deficient. The absence of jail-based treatment has become a pressing concern as the number of drug-related deaths in custody continues to rise and the risk of post-release overdose also remains high. The present study draws on the opioid-related module of the 2019 Bureau of Justice Statistics' Census of Jails to assess the relationships between the characteristics of 2588 local detention centers and the availability of treatment services. These specific approaches included screening for opioid use disorder, providing medication to manage withdrawal symptoms, administering medication for opioid use disorder (MOUD), providing overdose reversal medication at the time of release, and linking people with community-based care following release from the detention center. The results demonstrate facilities located in the Northeast, larger jails, those in urban areas, and detention centers with higher turnover rates are significantly more likely to provide a wider variety of opioid treatment services. These findings have important implications for the prioritization of policies and the allocation of resources to support the adoption of opioid treatment services in local jails.

Capacity assessment and spatial analysis of cervical cancer services in The Gambia

BackgroundCervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but comprehensive data on currently available services is limited making it challenging to appropriately prioritize the ideal next steps for expanding care. This study aims to describe the current services available for the prevention, screening, and treatment of cervical cancer in The Gambia and provide suggestions for expanding geographic access to care.MethodsA survey aimed at assessing the availability of key cervical cancer-related services was developed and then administered in person by research assistants to all secondary and tertiary health facilities (HFs) in The Gambia. ArcGIS Pro Software and 2020 LandScan population density raster were used to visualize and quantify geographic access to care. Survey results were compared with published targets outlined by the Gambian Ministry of Health in the “Strategic Plan for the Prevention and Control of Cervical Cancer in The Gambia: 2016–2020.”ResultsOne hundred and two HFs were surveyed including 12 hospitals, 3 major health centers, 56 minor health centers, and 31 medical centers/clinics. Seventy-eight of these HFs provided some form of cervical cancer-related service. HPV vaccination was available in all health regions. Two-thirds of the population lived within 10 km of a HF that offered screening for cervical cancer and half lived within 10 km of a HF that offered treatment for precancerous lesions. Ten HFs offered hysterectomy, but nine were located in the same region. Two HFs offered limited chemotherapy. Radiotherapy was not available. If all major health centers and hospitals started offering visual inspection with acetic acid and cryotherapy, 86.1% of the population would live within 25 km of a HF with both services.ConclusionsGeographic access to cervical cancer screening, and precancer treatment is relatively widespread across The Gambia, but targeted expansion in line with the country’s “Strategic Plan” would improve access for central and eastern Gambia. The availability of treatment services for invasive cancer is limited, and establishing radiotherapy in the country should continue to be prioritized.

Delays in cancer care for children in low-income and middle-income countries: development of a composite vulnerability index

Early access to diagnosis and care is essential to improve rates of survival from childhood cancer, particularly in low-income and middle-income countries (LMICs). Composite indices are increasingly used to compare country performance in many health fields. We aimed to develop a composite vulnerability index of risk of mortality associated with delays in care for childhood cancer in LMICs, and to compare the vulnerability index scores across countries. The composite vulnerability index was built in ten steps. A previous systematic review of determinants of delays in cancer care for children guided data selection. We collected exposure variables (determinants of delays in care) and outcome variables (childhood cancer-related mortality) from several large datasets. Data were analysed with regression models to identify determinants of delays in care that contribute to childhood cancer mortality. Significant indicators were aggregated into domains according to the socio-ecological model. We used geospatial tools to summarise and compare the composite vulnerability index scores across countries. We found that life expectancy, maternal education, fertility rate, availability of pathology services, bone marrow transplantation capacity, availability of treatment services (chemotherapy, radiotherapy, or surgery), number of pharmacists per 10 000 population, country income level, and out-of-pocket health expenditure were significantly associated with cancer mortality for children in LMICs. The highest levels of vulnerability were found in sub-Saharan Africa. Our composite vulnerability index can potentially serve as a valuable policy decision tool to help monitor country performance and guide interventions to reduce delays in care for children with cancer in LMICs. None. For the Chinese, Portuguese, Arabic, Spanish and Swahili translations of the abstract see Supplementary Materials section.

Effectiveness, feasibility, and acceptability of interactive digital interventions for the treatment of sexual difficulties: a systematic review

Sexual difficulties are common in the UK, but availability of treatment services is scarce. Interactive digital interventions (IDIs) have the potential to deliver tailored psychotherapies for the treatment of sexual difficulties. However, more evidence is needed to determine their effectiveness, feasibility, and acceptability, before widespread implementation. Systematic review across 5 databases, following Cochrane review methods. Meta-analysis of functional, cognitive, emotional, and behavioural outcomes associated with sexual experiences, taken from randomised-controlled trials (RCTs) only, were used to measure effectiveness of IDIs for sexual difficulties. Subgroup analysis was carried out, by gender and IDI level of guidance. A thematic analysis of qualitative and quantitative studies was performed to evaluate feasibility and acceptability. 9 RCTs were included in the meta-analysis and 10 studies in the thematic analysis. Guided IDIs improve functional (SMD 0.68; 95%CI 0.21-1.15), cognitive (SMD 0.62; 95%CI 0.17-1.07), and behavioural (SMD 0.35; 95%CI 0.11-0.59) outcomes for women with sexual difficulties. Little data on men meant no significant conclusions could be drawn. Although study attrition and intervention adherence need addressing, IDIs were found to be feasible and acceptable provided content is personalised and relevant to a diverse range of participants. Users appreciated interventions involving partners and valued therapist support. This review strengthens evidence that IDIs can be effective, feasible, and acceptable for people with sexual difficulties. Incorporation of partner involvement, therapist support, and personalisation when developing IDIs is recommended. IDIs offer an alternative to face-to-face treatments, which could help to reduce waiting-lists and increase availability of services for sexual difficulties. None

Effectiveness, feasibility, and acceptability of interactive digital interventions for the treatment of sexual difficulties: a systematic review

Sexual difficulties are common in the UK, but availability of treatment services is scarce. Interactive digital interventions (IDIs) have the potential to deliver tailored psychotherapies for the treatment of sexual difficulties. However, more evidence is needed to determine their effectiveness, feasibility, and acceptability, before widespread implementation. Systematic review across 5 databases, following Cochrane review methods. Meta-analysis of functional, cognitive, emotional, and behavioural outcomes associated with sexual experiences, taken from randomised-controlled trials (RCTs) only, were used to measure effectiveness of IDIs for sexual difficulties. Subgroup analysis was carried out, by gender and IDI level of guidance. A thematic analysis of qualitative and quantitative studies was performed to evaluate feasibility and acceptability. 9 RCTs were included in the meta-analysis and 10 studies in the thematic analysis. Guided IDIs improve functional (SMD 0.68; 95%CI 0.21-1.15), cognitive (SMD 0.62; 95%CI 0.17-1.07), and behavioural (SMD 0.35; 95%CI 0.11-0.59) outcomes for women with sexual difficulties. Little data on men meant no significant conclusions could be drawn. Although study attrition and intervention adherence need addressing, IDIs were found to be feasible and acceptable provided content is personalised and relevant to a diverse range of participants. Users appreciated interventions involving partners and valued therapist support. This review strengthens evidence that IDIs can be effective, feasible, and acceptable for people with sexual difficulties. Incorporation of partner involvement, therapist support, and personalisation when developing IDIs is recommended. IDIs offer an alternative to face-to-face treatments, which could help to reduce waiting-lists and increase availability of services for sexual difficulties. None

Exploring awareness of obstetric fistula in Eastern and Northern Nigeria: perceived causes, symptoms, and availability of treatment services

BackgroundEvidence suggests that there are approximately two female genital fistula cases per 1000 women of reproductive age in sub-Saharan Africa. It is estimated that more than 200,000 women are affected by fistula in Nigeria, primarily due to obstetric causes. Awareness has been indicated as a risk factor for the development of obstetric fistula. This study explored the awareness of obstetric fistula such as causes, symptoms, and availability of and access to treatment services in southeastern and northwestern Nigeria.MethodsAn exploratory qualitative study design was used to conduct this research in Kano and Ebonyi states in northern and eastern Nigeria, respectively. A total of six (6) focus group discussions were conducted with three categories of participants: women who were successfully repaired and discharged (n = 2), community-married men (n = 2), and women (n = 2). Forty-four (44) In-depth interviews were conducted three categories of participants: 18 with women with fistula who were either awaiting repair or had been repaired; 6 family member caregivers accompanying fistula patients, and 20 health service providers at fistula repair centers. We developed a data analysis plan based on the emerging themes. The transcripts and field notes were imported into QSR Nvivo version 11 and coded accordingly. Content and thematic analysis was run by inductively drawing themes based on the elicited information from participants.ResultsThere was lack of knowledge of obstetric fistula and its causes among married men and women in the community, caregivers, and some patients were unaware of what caused their fistula for years. In this study, none of the community men and women nor caregivers correctly identified the causes and symptoms of a fistula or knew where to seek treatment. Knowledge about fistula was more common among women who had undergone repairs. Some repaired women attributed the cause of fistula to the providers who attended to them during delivery.ConclusionsFindings reveal a widespread lack of awareness of obstetric fistula onset and awareness of the availability of repair services at the community level. There is an urgent need to explore multi-pronged strategies for increasing awareness of obstetric fistula and available treatment services among women and other community members.

The Changing Landscape of Community Mental Health Care: Availability of Treatment Services in National Data, 2010-2017.

The authors sought to describe changes in availability of crisis and substance use treatment services in U.S. mental health facilities (including outpatient and inpatient facilities) from 2010 to 2017. Using National Mental Health Services Survey data, the authors of this descriptive study examined changes in the proportion of facilities providing crisis and substance use treatment services during the 2010-2017 period. Although the proportion of outpatient facilities offering treatment for substance use increased significantly during the period studied (adjusted relative risk [ARR]=1.05, 95% confidence interval [CI]=1.01-1.10), the proportion of outpatient facilities offering crisis services significantly decreased, including emergency psychiatric walk-in services (ARR=0.81, 95% CI=0.75-0.88) and crisis intervention (ARR=0.88, 95% CI=0.83-0.93). Mental health facilities are an integral piece of the behavioral health safety net and need to respond to changes in service needs. Findings suggest that mental health facilities have not shifted their services mix to address the ongoing suicide epidemic.

Examining trends in substance use disorder capacity and service delivery by Health Resources and Services Administration-funded health centers: A time series regression analysis.

The opioid epidemic and subsequent mortality is a national concern in the U.S. The burden of this problem is disproportionately high among low-income and uninsured populations who are more likely to experience unmet need for substance use services. We assessed the impact of two Health Resources and Services Administration (HRSA) substance use disorder (SUD) service capacity grants on SUD staffing and service use in HRSA -funded health centers (HCs). We conducted cross-sectional analyses of the Uniform Data System (UDS) from 2010 to 2017 to assess HC (n = 1,341) trends in capacity measured by supply of SUD and medication-assisted treatment (MAT) providers, utilization of SUD and MAT services, and panel size and visit ratio measured by the number of patients seen and visits delivered by SUD and MAT providers. We merged mortality and national survey data to incorporate SUD mortality and SUD treatment services availability, respectively. From 2010 to 2015, 20% of HC organizations had any SUD staff, had an average of one full-time equivalent SUD employee, and did not report an increase in SUD patients or SUD services. SUD capacity grew significantly in 2016 (43%) and 2017 (22%). MAT capacity growth was measured only in 2016 and 2017 and grew by 29% between those years. Receipt of both supplementary grants increased the probability of any SUD capacity by 35% (95% CI: 26%, 44%) and service use, but decreased the probability of SUD visit ratio by 680 visits (95% CI: -1,013, -347), compared to not receiving grants. The significant growth in HC specialized SUD capacity is likely due to supplemental SUD-specific HRSA grants and may vary by structure of grants. Expanding SUD capacity in HCs is an important step in increasing SUD access for low income and uninsured populations broadly and for patients of these organizations.

Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial

BackgroundHarmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders.MethodsA parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder.All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data.DiscussionThis trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC.Trial registrationClinicalTrials.gov NCT04345302. Registered on 28 April 2020

Supply control, demand reduction or harm reduction? Developments and directions for drug policy in Nigeria

Nigeria is the most populous country in Africa, and it is a transit country for the passage of drugs to Western countries. This has among other factors, led to an increasing level of illicit drug use despite a long history of punitive measures of drug control. Nigeria boasts of very punitive laws against both drug use and drug trafficking, which has been endorsed by external bodies such as the US DEA, but there are no harm reduction policies or services and very limited availability of treatment services. There is a need to legislate for demand reduction measures in the country to complement possession and trafficking legislation and the develop treatment services nationally before there is a large increase in HIV and other blood borne diseases. A model of community level treatment services is proposed to deliver services at a local accessible level using existing NGOs and volunteers.

Availability of Women-Centered Drug Treatment Services in the United States [1

AIMS: Women who receive gender-specific drug treatment services have improved outcomes. We investigated how the availability of women-centered services has changed over time, geographic variation, and whether treatment availability corresponds to need. We hypothesized that, although treatment availability has increased over time, there are still disparities between treatment need and available services. METHODS: The National Survey of Substance Abuse Treatment Services was used to describe treatment availability from 2002 to 2010. Facilities with specific programs for women were contrasted with programs without these services. Treatment need was captured from the National Survey of Drug Use and Health 2002–2009. Services were compared over time and by geographic variation using STATA 11 and ArcGIS 10.2. RESULTS: There was a decline over time in specific programs reported for women (38% in 2002 compared with 32% in 2010, P<.001). There was an increase in facilities providing transportation (35–38%) and domestic violence counseling (33–36%) and a decline in peripartum and postpartum services. Facilities that reported specific programs for women were more likely to report trauma-related counseling, child care, housing assistance, and domestic violence counseling (P<.001 for all). There was a decline in women-centered services across a geographic gradient, from 41% in urban areas to 20% in small, non–urban-adjacent regions (P<.001). Availability of treatment services was not proportional to need (P<.001). CONCLUSION: There has been minimal change in women-centered services in drug treatment facilities over time. Marked geographic disparities exist for all components of women-centered care, and the availability of treatment services does not match treatment need nationwide.

Delivery models of opioid agonist maintenance treatment in South Asia: a good beginning

Delivery models of opioid agonist maintenance treatment in South Asia: a good beginning

Substance abuse and rehabilitation: responding to the global burden of diseases attributable to substance abuse

Alcohol, tobacco, and illegal drug use are pervasive throughout the world. Substance use problems are among the major contributors to the global disease burden, which includes disability and mortality. The benefits of treatment far outweigh the economic costs. Despite the availability of treatment services, however, the vast majority of people with substance use disorders do not seek or use treatment. Barriers to and unmet need for evidence-based treatment are widespread even in the United States. Women, adolescents, and young adults are especially vulnerable to adverse effects from substance abuse, but they face additional barriers to getting evidence-based treatment or other social/medical services. Substance use behaviors and the diseases attributable to substance use problems are preventable and modifiable. Yet the ever-changing patterns of substance use and associated problems require combined research and policy-making efforts from all parts of the world to establish a viable knowledge base to inform for prevention, risk-reduction intervention, effective use of evidence-based treatment, and rehabilitation for long-term recovery. The new international, open-access, peer-reviewed Substance Abuse and Rehabilitation (SAR) journal strives to provide an effective platform for sharing ideas for solutions and disseminating research findings globally. Substance use behaviors and problems have no boundaries. The journal welcomes papers from all regions of the world that address any aspect of substance use, abuse/dependence, intervention, treatment, and policy. The “open-access” journal makes cutting edge knowledge freely available to practitioners and researchers worldwide, and this is particularly important for addressing the global disease burden attributable to substance abuse.

Drug treatment utilization before, during and after pregnancy

This study retrospectively explored drug treatment utilization before, during and after pregnancy for all identified substance‐using women delivering at a county hospital over a 4‐year period (n = 431). Drug treatment data were linked to hospital data to analyse treatment utilization. Fifty‐three per cent received treatment the year before, during, or within the year after delivery, with a significantly higher proportion receiving treatment during and after pregnancy. There were significant increases in methadone and residential treatment services during pregnancy. Women spent significantly more time in treatment after delivery compared with before or during pregnancy. However, 47% of these women did not receive drug treatment. These findings support current literature suggesting that pregnancy presents an opportunity to engage women in treatment. However, there is a need to decrease the institutional, legal, and funding barriers that exist between health care and drug treatment providers. Utilizing available data to track perinatal substance use and treatment utilization are important to plan for adequate availability of treatment services for this population.

An overview of illegal opioid use and health services utilization in Canada

Systematic research on health and treatment services availability for and utilization by illegal opioid users in Canada are very limited. Comparative data across provinces and territories is almost entirely absent. This study was designed to provide an overview of illegal opioid use and health services utilization among illegal opioid users across Canada. A combination of statistical data and key informant data was used. Surveys were sent to key informants in all provinces and territories of Canada. Survey questions covered the number of illegal opioid users in each province, the number of opioid users receiving methadone maintenance treatment (MMT), the number of physicians authorized to prescribe methadone, and the number of opioid users receiving other outpatient and inpatient treatment. In addition, relevant data were collected from several statistical sources, both provincial and federal. The number of substance-use-related overdose deaths was obtained from the provincial coroners' offices. It is estimated that there were more than 80,000 regular illegal opioid users in Canada in 2003. The most prevalent treatment utilized was MMT; about one-quarter (26%) of the estimated opioid users received this type of treatment in 2003. Other forms of outpatient and inpatient treatment were of only minor importance compared with MMT. The number of illegal drug-related overdose deaths in Canada was 958 in 2002. Rates of drug use, health services utilization and overdose deaths showed considerable variation by province. Although the opioid use treatment system in Canada has expanded in recent years, especially with respect to the availability of MMT, the treatment utilization rates are still lower than in most countries in Western Europe. Rates of current treatment utilization as well as the relatively high number of overdose deaths suggest that there is still room for improvement in the Canadian health and social care system with respect to opioid use.

Substance misuse services in secure psychiatric units.

Substance misuse is prevalent amongst patients detained in secure psychiatric hospitals in England, and is associated with more negative outcomes. However, no data has been published on the availability of substance misuse treatment services in secure units. This questionnaire-based study examined staff impressions of the prevalence and impact of substance misuse problems in secure units, and the availability of treatment services. It found that substance misuse was perceived as a major problem with a substantial impact. However, service provision was poor: some units had no access to treatment services at all and, when services were available, they tended to focus on awareness-raising or relapse prevention rather than treatment of current substance misuse. Few units appeared to be able to refer their patients to the local NHS addictions service.

Rural and Urban Similarities and Differences in Private Substance Abuse Treatment Centers

Although previous research has considered the unique treatment needs of rural residents, little research has investigated the potential differences in the availability of treatment services in rural and urban areas. Using three waves of longitudinal data from a nationally representative sample of privately-funded substance abuse treatment centers, this research compared rural and urban treatment centers with regard to the availability of clinical levels of care, the offering of specialty treatment tracks, the adoption of treatment innovations, and the average costs of care. Results indicate that rural and urban centers were similar in their increasing provision of inpatient psychiatric levels of care and their decreasing offering of more intensive levels of chemical dependency services between 1995 and 2001. Rural and urban centers were increasingly likely to offer specialty treatment tracks for women, adolescents, clients with HIV/AIDS, and relapsing clients over time, but rural centers were less likely to offer a treatment track tai lored to substance-abusing women. The use of treatment innovations was similar at rural and urban treatment centers with the exception of lesser use of acupuncture at rural centers. Rural and urban centers did not differ in their average charges for treatment services.

Consumer involvement in the appraisal of treatments for people with eating disorders: a neglected area of research?

AbstractRecent British government initiatives have placed an increasing emphasis on the involvement of patients, carers and relatives in the evaluation of services. Such ‘consumer involvement’ raises several theoretical and methodological issues. Previous research in this area has been limited. The perceptions of people with eating disorders of the perceived efficacy of treatment have been described for a limited range of treatments, though there has been little standardization of methodology. There has been less assessment of the perceived availability of treatment services. The public's view of the acceptability of treatments has been described, again for a limited range of treatments. There is a need for fundamental research devising methods for determining the perceived quality of treatment amongst people with eating disorders, their carers and relatives, and for applied research describing how such information can be incorporated into clinical management and service planning. Copyright © 2001 John Wiley &amp; Sons, Ltd and Eating Disorders Association.

The social ecology of syphilis

Factors affecting the transmission of syphilis can be categorized into those acting at the level of individuals (e.g., number of sex partners) and others at the level of the sociophysical environment (e.g., availability of treatment services for curable infections). In a prior study, we identified several sociophysical factors correlated with the ten-year mean syphilis rate in a regression analysis of United States counties. In the present study we used qualitative methods to investigate additional aspects of some factors in the regression, as well as to identify entirely new factors. Twelve counties with populations less than 100,000 and ten-year mean syphilis rates that were greater or less than expected by the regression model were selected for a three to five day visit. The case study protocol included observations, unstructured interviews with care providers and county residents, and a standardized questionnaire completed by state and local sexually transmitted disease control personnel pertaining to characteristics and practices of the local health department. Comparisons of the field notes and questionnaires revealed patterns of factors of the sociophysical environment that potentially affect county syphilis rates. These included access to the health department STD clinic, race relations, employment opportunities for minorities, interagency coordination, STD outreach activities, the social acceptability of discussing STDs, and intercommunity dynamics. In addition we noted the disproportionate influence of particular individuals on these factors. Some of the factors identified are readily quantifiable and could enhance the predictive power of multivariable models of county syphilis rates. The hypotheses generated by this study may also lead to a better measurement and understanding of potentially important environmental determinants of community syphilis rates, and the development of new or enhanced prevention strategies.

Using health status measures with the seriously mentally ill in health services research.

Changes in the delivery of mental health care have prompted interest in using generic health status measures to test the effect of system change on those receiving treatment. Of special concern are those with serious and persistent mental illness who may be neglected when cost containment efforts reduce the availability of treatment services. This population may be affected by these changes, which might go undetected if investigators use scales that measure only pathology and not the full spectrum of well-being. The purpose of this study was to test the feasibility of using self-report health status measures with this population, to describe the psychometric properties of the scales, and to report the health status scores of a random sample of the Medicaid psychiatrically disabled population. We found that the four health status scales had adequate psychometric properties, that score variability was high, the distributions normal, and that patterns of association with more traditional clinical measures were of the expected size and direction. One scale, General Health Perceptions, had reliability and item-to-score correlation below acceptable levels.