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Purpose: Current medication-adherence predictive tools are based on patient medication-taking beliefs, but studying past behavior may now be a more explanatory and accessible method. This study will evaluate if past medication-refill behavior for a statin regimen is more predictive of medication adherence than patient medication-taking health beliefs. Patients and methods: This prospective longitudinal study was implemented in a national managed care plan in the United States. A group of 1433 statin patients were identified and followed for 6 months. Medication-taking health beliefs, collected from self-reported mail questionnaires, and past medication-refill behavior, using proportion of days covered (PDC), were collected prior to 6-month follow-up. Outcomes were measured using categorical PDC variable (of adherence, PDC < 85%, versus nonadherence, PDC < 85%), with model fit estimated using receiver operator characteristic analysis. Results: The area under the receiver operator characteristic curve for past behavior (Az = 0.78) was significantly greater (P < 0.05) than for patient health beliefs (Az = 0.69), indicating that past prescription-refill behavior is a better predictor of medication adherence than prospective health beliefs. Among health beliefs, the factor most related to medication adherence was behavioral intent (odds ratio, 5.12; 95% confidence interval, 1.84 to 15.06). The factor most strongly related to behavioral intent was impact of regimen on daily routine (odds ratio, 3.3; 95% confidence interval, 1.41 to 7.74). Conclusion: Electronic medical records and community health-information networks may make past prescription-refill rates more accessible and assist physicians with managing medicationregimen adherence. Health beliefs, however, may still play an important role in influencing medication-taking behaviors. [ABSTRACT FROM AUTHOR]

Researchers at the University of Wisconsin-Madison and George Mason University are conducting a pilot study to develop a Coaching Extender Platform (CEP) that aims to increase the use of medications for opioid use disorder (MOUD) in jail settings. The CEP is an asynchronous communication approach that allows for affordable and effective coaching without live or synchronous communication. The pilot study has two aims: to design and develop the CEP prototype using user-based needs assessment and to conduct a six-month pilot in four jail settings to assess the CEP's ability to increase targeted MOUD use and understand factors that promote or impede CEP implementation. The article discusses the development and implementation of a Coaching Enhancement Platform (CEP) to support the provision of Medications for Opioid Use Disorder (MOUD) in jail settings. The research team conducted interviews with jail staff and coaches to identify barriers and goals for using the CEP. The findings revealed common themes, including the lack of communication between staff, stigma associated with MOUD, limited resources, and inefficient tracking and monitoring of MOUD. Based on these findings, a wireframe of the CEP was created, which included features such as a project management center, a cascade of care performance tracker, a communication center, a resource center, and a skills toolbox. The CEP will be tested in a six-month pilot with four jails to evaluate its effectiveness in expanding coaching access and impact. The pilot will also assess the outcomes of MOUD use, infrastructure, [Extracted from the article]

Background: The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was "Will telehealth ever take hold for SUD services?" Now that social distancing guidelines have been lifted, the question is "Will telehealth remain a commonly used care modality?", Objective: The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth., Methods: An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25-35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed., Results: A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] -0.23; P=.002), but not for video-based telehealth (MD -0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD-0.35; P<.001), but no difference was found for phone-based telehealth (MD -0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth., Conclusions: Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations., (© Adrijana Pusnik, Bryan Hartzler, Olivia Vjorn, Beth A Rutkowski, Michael Chaple, Sara Becker, Thomas Freese, Maureen Nichols, Todd Molfenter. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Background: Substance use disorders (SUDs) in the United States cause many preventable deaths each year. Finding effective ways to manage SUDs is vital to improving outcomes for individuals seeking treatment. This has increased interest in using e-health technologies in behavioral healthcare settings. This research is part of a larger study evaluating the efficacy of the NIATx coaching intervention for implementing RISE Iowa, an e-health patient recovery app, in SUD treatment organizations and seeks to examine clinician perspectives of the barriers and facilitators to its implementation., Method: Semi-structured qualitative interviews were conducted with 13 clinicians from 9 different intervention sites involved in the study., Results: Major barriers to implementing e-health technology include inability to access the technology, lack of time for both patients and clinicians, and a perceived lack of patient motivation to make changes. Facilitators to implementation include collaboration with other staff using e-health technology and integrating technology use into typical workflows., Conclusions: Implementation of e-health technology in SUD treatment will require integrating the technology into clinical workflows and improving patient access to the technology., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Todd Molfenter is a faculty member at CHESS. In addition to his academic affiliation, Dr. Molfenter has a less than .1% ownership with CHESS Health, the organization responsible for making the A-CHESS addiction recovery app commercially available to the public. Dr. Molfenter has worked extensively with his institution to manage any conflicts of interest. An external advisory board approved all survey instruments applied, and the individuals who will conduct the data collection and interpretation for this study will have no affiliation with CHESS Health. Also, parts of the NIATx organizational change model used in part of this trial were developed by the Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin–Madison, where Dr. Molfenter is a faculty member. Dr. Molfenter is also affiliated with the NIATx Foundation, the organization responsible for making the NIATx organizational change model available to the public. For this scenario, Dr. Molfenter also has an institutionally approved plan to manage potential conflicts of interest. The individuals who will conduct the data collection and interpretation for this study manuscript will have no affiliation with the NIATx Foundation. David Gustafson is a part-owner of CHESS Health, devoted to marketing information technologies to agencies that deliver addiction treatment. He is also on the board of directors of the not-for-profit NIATx Foundation, as well as a small consulting company doing business as David H. Gustafson and Associates. These relationships do not carry with them any restrictions on publication, and any associated intellectual property will be disclosed and processed according to his institution’s policies., (© The Author(s) 2021.)

Introduction: Thirty-day hospital readmission rates have become a quality indicator for many regulators and payers, but published accounts of reducing these rates across a patient population are lacking., Objective: This article describes and evaluates the Wisconsin Mental Health Readmissions Project, which aimed to reduce psychiatric inpatient 30-day readmission rates in Wisconsin., Methods: Nineteen county human services boards representing 23 of Wisconsin's 72 counties and 61% of the state's residential admissions participated in a statewide quality improvement collaborative from January 1, 2010 to December 31, 2013. Participants applied a standardized organizational change model, called NIATx, in the context of a multicounty quality improvement collaborative to reduce 30-day readmission rates. Readmission rates were tracked through national and state databases, using 2009 as a baseline, and analyzed using a chi-square analysis to test the proportion of means. The study team compared readmission rates of Wisconsin counties that participated in the statewide collaborative with those that did not., Results: Between 2009 and 2013, the 30-day readmission rates in Wisconsin declined significantly for counties that participated in the project when compared to those that did not (2009-2013) [Χ2(4) = 54.503, P < .001], based on a 2.5% decline for participants vs a 0.7% decline for nonparticipants., Conclusions: Reductions to behavioral health inpatient readmission rates beyond individual case examples have been difficult to document. This analysis evaluates a method that Wisconsin behavioral health providers applied as part of a multicounty program addressing readmission rates. The findings highlight quality improvement program design elements and interventions to consider in reducing inpatient behavioral health readmissions, as well as the need for further research on this complex systems issue.

Objective: Buprenorphine, a medication for treating opioid dependence, is underutilized in specialty addiction treatment organizations. Only physicians who have obtained a buprenorphine prescribing license or "waiver" may administer this medication. A limited number of physicians are pursuing this waiver, and a concern in the substance use disorder treatment field is that the shortage of prescribers could be contributing to the low use of buprenorphine at specialty addiction treatment centers. The objective of this study is to assess Ohio specialty treatment organizations' access to buprenorphine prescribers and the barriers they encounter when seeking new physician prescribing capacity., Methods: Forty-one Ohio specialty addiction treatment organizations were invited to complete a survey of their buprenorphine practices and availability of buprenorphine prescribers during August-October 2014. Data was collected on pharmacotherapies used in the treatment of opioid dependence, arrangements treatment organizations have with prescribing physicians, buprenorphine prescribing capacity, and barriers encountered in recruiting new physician prescribers., Results: Thirty-seven treatment organizations responded, for a response rate of 90.2%. Seventy-eight percent (n=29) of the sample provided buprenorphine therapy. Of those treatment organizations, 48.3% (n=14) reported insufficient prescribing capacity. Of those, 50% (n=7) indicated they had to turn patients away from buprenorphine therapy due to limited physician prescribing capacity., Conclusion: The study suggests that buprenorphine use is constrained by limited physician prescribing capacity, to the degree that 24.1% of the organizations surveyed using buprenorphine therapy had to turn patients away. Potential remedies include encouraging more specialty treatment organizations to have physicians on staff, removing the Drug Addiction Treatment Act (DATA 2000) cap that limits physician buprenorphine caseloads at 100 patients (after year 1), and developing strategies to recruit physicians into addiction treatment practice. Additional research is needed to increase the knowledge of physician prescribing capacity as a barrier to buprenorphine use, how to overcome these barriers, and to understand the extent physician capacity shortages are affecting buprenorphine use.

This study aims to develop a model that describes how physician communication and family hardiness affect medication regimen beliefs and adherence for patients on regimens to control diabetes and hyperlipidemia (high cholesterol). Study participants (n=1356) completed self-report questionnaires on health beliefs. Pharmacy refill records from a health plan in the United States provided data on their medication adherence. Structural equation modeling was used to model variable relationships. A mediation analysis demonstrated that physician communication behaviors had a significant impact on the patients' behavioral intention to adhere to their regimen and medication adherence when they were mediated by the patient's medication taking health beliefs related to perceived benefit of the regimen, impact of side effects, and cost of regimen. Conversely, family hardiness had no effect on medication-taking behaviors. To improve patient medication-taking behaviors, physician communication behaviors should be targeted. The study suggests the physician's initial regimen discussion is important to both regimen initiation and long-term adherence, and should emphasize the regimen's benefits and how to avoid common side effects. Also, establishing a follow-up physician-patient relationship can enhance regimen adherence and reduce the likelihood that a patient will stop taking the medication due to cost concerns. The research supports the important role the physician plays in health behavior maintenance. Future research should study the effect physicians have on other recurring health behaviors.

Innovations adopted through organizational change initiatives are often not sustained leading to diminished quality, productivity, and consumer satisfaction. Research explaining variance in the use of adopted innovations in health care settings is sparse, suggesting the need for a theoretical model to guide research and practice. In this article, we describe the development of a hybrid conjoint decision theoretic model designed to predict the sustainability of organizational change in health care settings. An initial test of the model's predictive validity using expert scored hypothetic profiles resulted in an r-squared value of .77. The test of this model offers a theoretical base for future research on the sustainability of change in health care settings.

An analysis of consumer and organizational perspectives on web design suggests emerging webside functionality, growing patient needs for self-management skills, and mounting corporate accountability will transform web strategies and consumer expectations from the current general health information approach to a value-added paradigm, which is described with a list of eight guiding principles.