Background The National Institute on Drug Abuse has identified a persistent research-to-practice gap in the implementation of evidence-based prevention and treatment programs for substance use disorder. To identify mechanisms to close this gap, we sought to obtain and characterize the range of policy makers’ perspectives on the use of research in substance use disorder treatment and coverage decisions. Methods We conducted open-ended, semi-structured interviews with a purposive sample of eighteen policy makers involved in the delivery of health services. The aim was to identify barriers and facilitators, attitudes, beliefs, and experiences surrounding the use of research related to the treatment and economics of substance use disorder. Results The analysis generated four themes: 1) policy maker engagement with evidence and researchers; 2) strategic use and usefulness of research; 3) scientific rigor versus relevance; and 4) communication of evidence. Within each theme, the participants identified barriers, facilitators, current practice, and gave their perspectives on “ideal conditions” for research design, conduct and communication. Conclusions Recommendations for investigators are the following actionable steps: 1) partner with policy makers early in the research process, 2) formulate and use research designs to meet the strategic goals of end-users; 3) systematically test alternative phrasing of scientific terminology – particularly in the realm of cost effectiveness research – that allow end users to better understand and repurpose the data; 4) incorporate qualitative research methods to uncover the narratives that explain the context and relevance of evidence; 5) incorporate study designs that prioritize timeliness of results; and 6) promote and reward researcher involvement in policy discussions. Electronic supplementary material The online version of this article (10.1186/s13011-019-0199-0) contains supplementary material, which is available to authorized users.
Drug overdose deaths involving opioids have surged in recent years and the economic cost of the opioid epidemic is estimated to be over $500 billion annually. In the midst of calls for declaring a national emergency, health policy decision makers are considering the best ways to allocate resources to curb the epidemic. On June 9, 2017, 116 invited health researchers, clinicians, policymakers, health system leaders, and other stakeholders met at the University of Pennsylvania to discuss approaches to address the gaps in evidence-based substance use disorder policy and practice, with an emphasis on the opioid epidemic. The conference was sponsored by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH), a NIDA-funded National Center of Excellence, and hosted by the Leonard Davis Institute of Health Economics of the University of Pennsylvania. The conference aims were to: (1) foster new relationships between researchers and policymakers through a collaborative work process and (2) generate evidence-based policy recommendations to address the opioid epidemic. The conference concluded with an interactive work session during which attendees self-identified as researchers or policymakers and were divided equally among 13 tables. These groups met to develop and present policy recommendations based on an opioid use disorder case study. Thirteen policy recommendations emerged across four themes: (1) quality of treatment, (2) continuity of care, (3) opioid prescribing and pain management, and (4) consumer engagement. This conference serves as a proposed model to develop equitable, working relationships among researchers, clinicians, and policymakers.
Introduction There is growing support for the use of integrated measurement-based care to capture symptom data in real time so treatment providers can make informed decisions about intervention strategies for mental health problems, such as depression and anxiety, both of which are known to increase suicide. We examined the potential scalability and effectiveness of a mobile health (mHealth) application with integrated behavioral health functions to capture remote patient-reported measurement of suicidal ideation and overall symptoms of depression and anxiety. Methods This study was an observational retrospective review of deidentified patient data, including symptoms of suicidal ideation, depression, and anxiety as measured by the Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder 7 (GAD-7) scale, which were administered to and completed by patients on a smartphone or desktop application. After controlling for age, sex, and the presence of moderate versus severe symptoms at baseline, mean scores were analyzed with the Student's t-test. Results Of patients who took the PHQ-9 assessment at baseline and 8 weeks later (n = 764), the proportion who endorsed suicidal thinking decreased from 25% to 14.66% (p < 0.001) over 8 weeks. The mean PHQ-9 score was reduced from 14.69 (standard error [SE], 4.09) to 10.50 (SE, 5.94; p < 0.001), and a subset of individuals who continued use and took the PHQ-9 again at 24 weeks (n = 185) had a further decrease to 9.03 (SE, 7.09, p < 0.01). Although 21.62% of this subset still had suicidal thinking, the frequency of suicidal thoughts decreased. Of patients who took the GAD-7 at baseline and 8 weeks (n = 797) the mean score decreased from 14.20 (SE, 3.31) to 10.08 (SE, 5.55; p < 0.001) at 8 weeks and to 7.48 (SE, 6.54; p < 0.001) for a subset (n = 278) who continued use and took a GAD-7 at 24 weeks (n = 278). The sum of subgroup samples is larger than the whole because of instances of comorbid depression and anxiety. Conclusion Remote assessments within technology-supported integrated behavioral health care were feasible at scale. Change in symptoms could be observed at the individual and group level in real time, which may allow clinical teams to adjust treatments and improve outcomes. Prospective controlled studies are needed to determine what factors contribute to reductions in symptom severity.
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