Objectives: Although medications for opioid use disorder (MOUD) save lives, treatment retention remains challenging. Identification of interventions to improve MOUD retention is of interest to policymakers and researchers. On behalf of the Agency for Healthcare Research and Quality, we conducted a rapid evidence review on interventions to improve MOUD retention. Methods: We searched MEDLINE and the Cochrane Library from February 2009 through August 2019 for systematic reviews and randomized trials of care settings, services, logistical support, contingency management, health information technology (IT), extended-release (XR) formulations, and psychosocial interventions that assessed retention at least 3 months. Results: Two systematic reviews and 39 primary studies were included; most did not focus on retention as the primary outcome. Initiating MOUD in soon-to-be-released incarcerated people improved retention following release. Contingency management may improve retention using antagonist but not agonist MOUD. Retention with interventions integrating medical, psychiatric, social services, or IT did not differ from in-person treatment-as-usual approaches. Retention was comparable with XR- compared to daily buprenorphine formulations and conflicting with XR-naltrexone monthly injection compared to daily buprenorphine. Most psychosocial interventions did not improve retention. Discussion: Consistent but sparse evidence supports criminal justice prerelease MOUD initiation, and contingency management interventions for antagonist MOUD. Integrating MOUD with medical, psychiatric, social services, delivering through IT, or administering via XR-MOUD formulations did not worsen retention. Fewer than half of the studies we identified focused on retention as a primary outcome. Studies used different measures of retention, making it difficult to compare effectiveness. Additional inquiry into the causes of low retention would inform future interventions. Registration: PROSPERO: CRD42019134739
Aims. American deaths from opioid overdose now approach 50,000 annually. While evidence shows that medications for addiction treatment (MAT) save lives, retaining patients in MAT programs is challenging. The U.S. Agency for Healthcare Research and Quality, on behalf of the U.S. Department of Health and Human Services, commissioned a rapid evidence review on the effectiveness of interventions to promote a broader understanding of the published literature on MAT retention among adults with opioid use disorder (OUD). Methods. We searched MEDLINE and the Cochrane Library from February 12, 2009, through August 20, 2019, for systematic reviews (SRs) and randomized controlled trials (RCTs). We summarized evidence for six retention intervention types: care settings/services/logistical support, contingency management, health information technology (IT), extended-release (XR) medication-based treatment, psychosocial support, and financial support. Our primary outcome was retention, defined as continued medication engagement for at least 3 months after MAT initiation. Secondary outcomes included mortality and harms. Findings. Key findings from 2 SRs and 39 primary studies include: • Most studies of MAT for OUD do not focus on retention as the primary outcome, are small (e.g., one to two trials per intervention), and have design flaws. • Care setting interventions that initiated MAT in soon-to-be-released incarcerated patients improved retention following release. • Contingency management improved retention when combined with antagonist MAT, but not with agonist forms of MAT. Applicability, however, may be limited due to implementation challenges. • Preliminary trials suggest that retention in MAT supported with health IT approaches may be no worse than in-person approaches. • Early studies suggest no difference in retention with XR-buprenorphine in either injectable or implant formulations compared with daily buprenorphine. There were conflicting results with XR-naltrexone injection compared with daily buprenorphine. • The addition of psychosocial interventions did not improve retention; however, many studies included some form of counseling in the control groups, potentially obscuring evidence of effectiveness. Harms were infrequently reported across studies except in studies of XR formulations. Similarly, few studies reported whether participant characteristics influenced retention. Conclusions. While patients who receive longer-term treatment with MAT have improved outcomes, fewer than half of the identified studies measured treatment retention as a primary outcome. Limited evidence suggests criminal justice prerelease MAT initiation and the use of contingency management for patients on antagonist forms of MAT may aid retention. XR viii and daily buprenorphine formulations appear to be equivalent for treatment retention and comparisons of XR-naltrexone versus daily buprenorphine showed conflicting results. Integrating MAT treatment with medical and social services and the use of health IT did not change retention. Some s...
Objective: We compared the process of developing searches with and without using text-mining tools (TMTs) for evidence synthesis products.Study Design: This descriptive comparative analysis included seven systematic reviews, classified as simple or complex. Two librarians created MEDLINE strategies for each review, using either usual practice (UP) or TMTs. For each search we calculated sensitivity, number-needed-to-read (NNR) and time spent developing the search strategy.Results: We found UP searches were more sensitive (UP 92% (95% CI, 85-99); TMT 84.9% (95% CI, 74.4-95.4)), with lower NNR (UP 83 (SD 34); TMT 90 (SD 68)). UP librarians spent an average of 12 h (SD 8) developing search strategies, compared to TMT librarians' 5 hours (SD 2).Conclusion: Across all reviews, TMT searches were less sensitive than UP searches, but confidence intervals overlapped. For simple SR topics, TMT searches were faster and slightly less sensitive than UP. For complex SR topics, TMT searches were faster and less sensitive than UP searches but identified unique eligible citations not found by the UP searches.
Background: In an era of explosive growth in biomedical evidence, improving systematic review (SR) search processes is increasingly critical. Text-mining tools (TMTs) are a potentially powerful resource to improve and streamline search strategy development. Two types of TMTs are especially of interest to searchers: word frequency (useful for identifying most used keyword terms, e.g., PubReminer) and clustering (visualizing common themes, e.g., Carrot2). Objectives: The objectives of this study were to compare the benefits and trade-offs of searches with and without the use of TMTs for evidence synthesis products in real world settings. Specific questions included: (1) Do TMTs decrease the time spent developing search strategies? (2) How do TMTs affect the sensitivity and yield of searches? (3) Do TMTs identify groups of records that can be safely excluded in the search evaluation step? (4) Does the complexity of a systematic review topic affect TMT performance? In addition to quantitative data, we collected librarians' comments on their experiences using TMTs to explore when and how these new tools may be useful in systematic review search¬¬ creation. Methods: In this prospective comparative study, we included seven SR projects, and classified them into simple or complex topics. The project librarian used conventional “usual practice” (UP) methods to create the MEDLINE search strategy, while a paired TMT librarian simultaneously and independently created a search strategy using a variety of TMTs. TMT librarians could choose one or more freely available TMTs per category from a pre-selected list in each of three categories: (1) keyword/phrase tools: AntConc, PubReMiner; (2) subject term tools: MeSH on Demand, PubReMiner, Yale MeSH Analyzer; and (3) strategy evaluation tools: Carrot2, VOSviewer. We collected results from both MEDLINE searches (with and without TMTs), coded every citation’s origin (UP or TMT respectively), deduplicated them, and then sent the citation library to the review team for screening. When the draft report was submitted, we used the final list of included citations to calculate the sensitivity, precision, and number-needed-to-read for each search (with and without TMTs). Separately, we tracked the time spent on various aspects of search creation by each librarian. Simple and complex topics were analyzed separately to provide insight into whether TMTs could be more useful for one type of topic or another. Results: Across all reviews, UP searches seemed to perform better than TMT, but because of the small sample size, none of these differences was statistically significant. UP searches were slightly more sensitive (92% [95% confidence intervals (CI) 85–99%]) than TMT searches (84.9% [95% CI 74.4–95.4%]). The mean number-needed-to-read was 83 (SD 34) for UP and 90 (SD 68) for TMT. Keyword and subject term development using TMTs generally took less time than those developed using UP alone. The average total time was 12 hours (SD 8) to create a complete search strategy by UP librarians, and 5 hours (SD 2) for the TMT librarians. TMTs neither affected search evaluation time nor improved identification of exclusion concepts (irrelevant records) that can be safely removed from the search set. Conclusion: Across all reviews but one, TMT searches were less sensitive than UP searches. For simple SR topics (i.e., single indication–single drug), TMT searches were slightly less sensitive, but reduced time spent in search design. For complex SR topics (e.g., multicomponent interventions), TMT searches were less sensitive than UP searches; nevertheless, in complex reviews, they identified unique eligible citations not found by the UP searches. TMT searches also reduced time spent in search strategy development. For all evidence synthesis types, TMT searches may be more efficient in reviews where comprehensiveness is not paramount, or as an adjunct to UP for evidence syntheses, because they can identify unique includable citations. If TMTs were easier to learn and use, their utility would be increased.
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