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doi:10.1111/milq.2015.93.issue-3

Cited by 12 publications

(5 citation statements)

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“…Similarly, Stein and colleagues (2015) found an increase nationally in buprenorphine treatment facilities regardless of urbanicity, however this increase was again smallest in rural settings. Of note, this study did identify the greatest increase of 100 patient-waivered providers in rural settings (51). Two studies found a relationship between increases in medication treatment availability and increases in treatment utilization.…”

Section: Consumer-focused Availability Barriersmentioning

confidence: 62%

“…Eighteen studies published between 2004 and 2018 met inclusion criteria for this systematic review. Eleven studies addressed consumer-focused barriers alone (16,40,(42)(43)(44)(48)(49)(50)(51)(52)(53); three studies addressed providerfocused barriers alone (54)(55)(56); and four studies addressed both consumer-and provider-focused barriers (41,(45)(46)(47). This resulted in 15 studies addressing consumer-focused barriers and seven studies addressing provider-focused barriers.…”

Section: Summary Of Overall Searchmentioning

confidence: 99%

“…We identified 15 studies addressing consumer-focused barriers to rural medication treatment (16,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53). For a summary of key findings, see Table 5.…”

Section: Overview Of Studies Targeting Consumer-focused Barriersmentioning

confidence: 99%

“…Ten consumer-focused articles addressed availability barriers (42,(44)(45)(46)(47)(48)(49)(50)(51)53). Nine of these articles examined the availability of medication treatment providers in rural areas.…”

Section: Consumer-focused Availability Barriersmentioning

confidence: 99%

“…As illustration, one study (46) revealed that rural counties represented all of the counties lacking either BMT or MMT in the state of Washington. Four studies highlighted changes over time in medication treatment availability in the rural U.S. (42,48,50,51), all of which found improvements in availability. Dick and colleagues (2015) found an overall increase in the availability of opioid specialty clinics, waivered buprenorphine practitioners, or either option, throughout the U.S. between 2002 and 2011.…”

Section: Consumer-focused Availability Barriersmentioning

confidence: 99%

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A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States

Lister

Weaver

Ellis

et al. 2019

The American Journal of Drug and Alcohol Abuse

157

112

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Background: Opioid-related deaths have risen dramatically in rural communities. Prior studies highlight few medication treatment providers for opioid use disorder in rural communities, though literature has yet to examine rural-specific treatment barriers. Objectives: We conducted a systematic review to highlight the state of knowledge around rural medication treatment for opioid use disorder, identify consumer-and provider-focused treatment barriers, and discuss rural-specific implications. Methods: We systematically reviewed the literature using PsycINFO, Web of Science, and PubMed databases (January 2018). Articles meeting inclusion criteria involved rural samples or urban/rural comparisons targeting outpatient medication treatment for opioid use disorder, and were conducted in the U.S. to minimize healthcare differences. Our analysis categorized consumer-and/or providerfocused barriers, and coded barriers as related to treatment availability, accessibility, and/or acceptability. Results: Eighteen articles met inclusion, 15 which addressed consumer-focused barriers, while seven articles reported provider-focused barriers. Availability barriers were most commonly reported across consumer (n = 10) and provider (n = 5) studies, and included the lack of clinics/providers, backup, and resources. Acceptability barriers, described in three consumer and five provider studies, identified negative provider attitudes about addiction treatment, and providers' perceptions of treatment as unsatisfactory for rural patients. Finally, accessibility barriers related to travel and cost were detailed in four consumer-focused studies whereas two provider-focused studies identified time constraints. Conclusions: Our findings consistently identified a lack of medication providers and rural-specific implementation challenges. This review highlights a lack of rural-focused studies involving consumer participants, treatment outcomes, or barriers impacting underserved populations. There is a need for innovative treatment delivery for opioid use disorder in rural communities and interventions targeting provider attitudes.

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Section: Consumer-focused Availability Barriersmentioning

confidence: 62%

Section: Summary Of Overall Searchmentioning

confidence: 99%

Section: Overview Of Studies Targeting Consumer-focused Barriersmentioning

confidence: 99%

Section: Consumer-focused Availability Barriersmentioning

confidence: 99%

Section: Consumer-focused Availability Barriersmentioning

confidence: 99%

See 3 more Smart Citations

A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States

Lister

Weaver

Ellis

et al. 2019

The American Journal of Drug and Alcohol Abuse

157

112

View full text Add to dashboard Cite

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Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018

Donohue

Jarlenski

Kim

et al. 2021

JAMA

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The Medicaid Outcomes Distributed Research Network (MODRN)IMPORTANCE There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.OBJECTIVE To examine the use of medications for OUD and potential indicators of quality of care in multiple states. DESIGN, SETTING, AND PARTICIPANTS Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses. EXPOSURES Calendar year, demographic characteristics, eligibility groups, and comorbidities. MAIN OUTCOMES AND MEASURES Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines). RESULTSIn 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290 628 of 8 737 082) in 2014 to 5.0% (527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (−0.01 prevalence difference, 95% CI, −0.03 to 0.02) with state variability in trend (90% prediction interval, −0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P < .001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P < .001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P < .001; 90% prediction interval, 1.06-1.22) than did other eligibility groups.CONCLUSIONS AND RELEVANCE Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.

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Changes in Migration and Mortality Among Patients With Kidney Failure in Puerto Rico After Hurricane Maria

et al. 2022

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ImportanceOn September 20, 2017, one of the most destructive hurricanes in US history made landfall in Puerto Rico. Anecdotal reports suggest that many persons with kidney failure left Puerto Rico after Hurricane Maria; however, empirical estimates of migration and health outcomes for this population are scarce.ObjectiveTo assess the changes in migration and mortality among patients with kidney failure in need of dialysis treatment in Puerto Rico after Hurricane Maria.Design, Setting, and ParticipantsThis cross-sectional study used an interrupted time-series design of 6-month mortality rates and migration of 11 652 patients who received hemodialysis or peritoneal dialysis care in Puerto Rico before Hurricane Maria (before October 1, 2017) and/or during and after Hurricane Maria (on/after October 1, 2017). Data analyses were performed from February 12, 2019, to June 16, 2022..Main Outcomes and MeasuresNumber of unique persons dialyzed in Puerto Rico per quarter; receipt of dialysis treatment outside Puerto Rico per quarter; and 6-month mortality rate per person-quarter for all persons undergoing dialysis.ExposuresHurricane Maria.ResultsThe entire study sample comprised 11 652 unique persons (mean [SD] age, 59 [14.7] years; 7157 [61.6%] men and 4465 [38.4%] women; 10 675 [91.9%] Hispanic individuals). There were 9022 patients with kidney failure and dialysis treatment before and 5397 patients after Hurricane Maria. Before the hurricane, the mean quarterly number of unique persons dialyzed in Puerto Rico was 2834 per quarter (95% CI, 2771-2897); afterwards it dropped to 261 (95% CI, −348 to −175; relative change, 9.2%). The percentage of persons who had 1 or more dialysis sessions outside of Puerto Rico in the next quarter following a previous dialysis in Puerto Rico was 7.1% before Hurricane Maria (95% CI, 4.8 to 9.3). There was a significant increase of 5.8 percentage points immediately after the hurricane (95% CI, 2.7 to 9.0). The 6-month mortality rate per person-quarter was 0.08 (95% CI, 0.08 to 0.09), and there was a nonsignificant increase in level of mortality rates and a nonsignificant decreasing trend in mortality rates.Conclusions and RelevanceThe findings of this cross-sectional study suggest there was a significant increase in the number of people receiving dialysis outside of Puerto Rico after Hurricane Maria. However, no significant differences in mortality rates before and after the hurricane were found, which may reflect disaster emergency preparedness among dialysis facilities and the population with kidney failure, as well as efforts from other stakeholders.

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Untitled

Cited by 12 publications

References 0 publications

A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States

A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States

Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018

Changes in Migration and Mortality Among Patients With Kidney Failure in Puerto Rico After Hurricane Maria

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