Approximately 16.0 million U.S. adults used prescription stimulants in the preceding year (annual average), 5.0 million misused prescription stimulants, and 0.4 million had use disorders. Cognitive enhancement was the most commonly reported reason for misusing prescription stimulants. Patients who are using their medication for cognitive enhancement or diverting their medication to others present a high risk.
Background
Despite increasing opioid overdose mortality, problems persist in the
availability and quality of treatment for opioid use disorder (OUD). Three
FDA-approved medications (methadone, buprenorphine, and naltrexone) have
high quality evidence supporting their use, but most individuals with OUD do
not receive them and many experience relapse following care episodes.
Developing and organizing quality measures under a unified framework such as
a Cascade of Care could improve system level practice and treatment
outcomes. In this context, a review was performed of existing quality
measures relevant to the treatment of OUD and the literature assessing the
utility of these measures in community practice.
Methods
Systematic searches of two national quality measure clearinghouses
(National Quality Forum and Agency for Healthcare Research and Quality) were
performed for measures that can be applied to the treatment of OUD. Measures
were categorized as structural, process, or outcome measures. Second stage
searches were then performed within Ovid/Medline focused on published
studies investigating the feasibility, reliability, and validity of
identified measures, predictors of their satisfaction, and related clinical
outcomes.
Results
Seven quality measures were identified that are applicable to the
treatment of OUD. All seven were process measures that assess patterns of
service delivery. One recently approved measure addresses retention in
medication-assisted treatment for patients with OUD. Twenty-nine published
studies were identified that evaluate the quality measures, primarily
focused on initiation and engagement in care for addiction treatment
generally. Most measures and related studies do not specifically incorporate
the evidence base for the treatment of OUD or assess patient level outcomes
such as overdose.
Conclusion
Despite considerable progress, gaps exist in quality measures for OUD
treatment. Development of a unified quality measurement framework such as an
OUD Treatment Cascade will require further elaboration and refinement of
existing measures across populations and settings. Such a framework could
form the basis for applying strategies at clinical, organizational, and
policy levels to expand access to quality care and reduce opioid-related
mortality.
The educational transition process experienced by adolescents with disabilities and their parents was examined in this study. The results of the qualitative study can be interpreted to conclude that students rarely were engaged in transition planning, and when they were engaged, it came too late in their high school careers. Students with disabilities and their parents described dissatisfaction in the following areas: inadequate communication from school staff, frustration with assumptions made about the student, funneling of the student into traditional adult service programs, and a lack of accountability from the schools. Even those students who reported being engaged in the transition process experienced inadequate transition planning. Strategies to improve transition planning are presented.
Adolescent sexually transmitted infection (STI) and birth rates indicate a need for effective middle school HIV/STI, and pregnancy prevention curricula to delay, or mitigate consequences of, early sexual activity. Individual and organizational barriers to adoption, implementation, and maintenance, however, can hamper dissemination of evidence-based sexual health curricula, adversely impacting fidelity and reach. Internet-based approaches may help mitigate these barriers. This paper describes the development and feasibility testing of It’s Your Game (IYG)-Tech, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing effective sexual health curriculum—It’s Your Game… Keep it Real (IYG). IYG-Tech development adaptation steps were to: 1) Select a suitable effective program and gather the original program materials; 2) Develop “proof of concept” lessons and test usability and impact; 3) Develop the program design document describing the core content, scope, and methods and strategies; and 4) produce the new program. Lab- and school-based tests with middle school students demonstrated high ratings on usability parameters and immediate impact on selected psychosocial factors related to sexual behavior—perceptions of friends’ beliefs, reasons for not having sex, condom use self-efficacy, abstinence intentions, negotiating with others to protect personal rules, and improved knowledge about what constitutes healthy relationships (all p < .05). Youth rated IYG-Tech is favorably compared to other learning channels (>76.2% agreement) and rated the lessons as helpful in making healthy choices, selecting personal rules, detecting challenges to those rules, and protecting personal rules through negotiation and refusal skills (89.5% – 100%). Further efficacy testing is indicated for IYG-Tech as a potential strategy to deliver effective HIV/STI, and pregnancy prevention to middle school youth.
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