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The COVID-19 pandemic has caused global declines in life expectancy; it is therefore critical to understand risk factors related to mortality and morbidity for this infectious disease. Past work indicates that certain pre-existing medical conditions, behavioral patterns, and sociodemographic factors may increase COVID-19-related negative outcomes. Left unexplored, however, is whether COVID-19 outcomes are influenced by exposure to childhood adversity. This is a notable gap given that childhood adversity is associated with lifelong physical health disparities and early mortality. We leverage data from the UK Biobank cohort (N=151,200) to investigate relations between early childhood adversity and COVID-19 mortality and morbidity. As predicted, we show that childhood adversity is associated with a higher risk of COVID-19 hospitalization and mortality, even after adjusting for potential confounding variables. Such results highlight the importance of considering early-life experiences and their impact on COVID-19 outcomes to guide public health intervention and prevention strategies.

Date Presented 04/02/2022 In January 2020, the Patient-Driven Grouping Model (PDGM) was enacted by the Centers for Medicare & Medicaid Services (CMS). A survey research design was used to gather OT practitioners’ impressions of the impact the PDGM had on home care services. Participants (N = 31) were recruited from six states, and the American Occupational Therapy Association reported decreased control of the frequency of home health visits and decreased quality and clinical autonomy. Primary Author and Speaker: Claire M. Mulry Additional Authors and Speakers: Molly G. Dunn, Kristen O’Connor, Blake Jankowski, Ashley Trible

BACKGROUND: People living with HIV (PLWH) frequently experience chronic pain and receive long-term opioid therapy (LTOT). Adherence to opioid prescribing guidelines among their providers is suboptimal. OBJECTIVE: This paper describes the protocol of a cluster randomized trial, Targeting Effective Analgesia in Clinics for HIV (TEACH), which tested a collaborative care intervention to increase guideline-concordant care for LTOT among PLWH. METHODS: HIV physicians and advanced practice providers (n=41) were recruited from September 2015 – December 2016 from two HIV clinics in Boston and Atlanta. Patients receiving LTOT from participating providers were enrolled through a waiver of informed consent (n=187). After baseline assessment, providers were randomized to the control group or the year-long TEACH intervention involving: 1) a nurse care manager and electronic registry to assist with patient management; 2) opioid education and academic detailing; and 3) facilitated access to addiction specialists. Randomization was stratified by site and LTOT patient volume. Primary outcomes (≥2 urine drug tests, early refills, provider satisfaction) were collected at 12-months. In parallel, PLWH receiving LTOT (n=170) were recruited into a longitudinal cohort at both clinics and underwent baseline and 12-month assessments. Secondary outcomes were obtained through patient self-report among participants enrolled in both the cohort and the RCT (n=117). CONCLUSION: TEACH will report the effects of an intervention on opioid prescribing for chronic pain on both provider and patient-level outcomes. The results may inform delivery of care for PLWH on LTOT for chronic pain at a time when opioid practices are being questioned in the US.

We describe HIV providers’ opioid prescribing practices and assess whether belief that chronic opioid therapy (COT) keeps people living with HIV (PLWH) engaged in care is associated with differences in these practices among providers from two HIV clinics. We conducted logistic regression to evaluate the association between the belief that COT keeps PLWH engaged in care and at least one component of guideline-recommended care (i.e., urine drug tests, treatment agreements, and/or prescription monitoring program use). The sample included 41 providers with a median age of 42 years, 63% female, 37% non-white. Routine adherence to guideline-recommended practices was: 34% urine drug tests, 27% treatment agreements, and 17% prescription monitoring program. Over half [54%] agreed that COT keeps PLWH engaged in care. There was no significant association between belief that COT keeps persons living with HIV engaged care and routinely providing any recommended COT care component (aOR 2.38; 95% CI 0.65-8.73). Most HIV providers do not routinely follow guidelines for opioid prescribing. We observed a positive association between belief that COT keeps PLHIV engaged in care and following any guideline-recommended prescribing practices, although the result was not statistically significant. Interventions are needed to improve guideline-concordant care for COT by HIV providers.

The purpose of this study is to assess the current status of the cocaine and heroin markets in Ireland, in order to track changes in the markets, and for comparison to reported European data.

Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines.To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk.Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain. The study was conducted from January 2014 to March 2016 in 4 safety-net primary care practices.Intervention PCCs received nurse care management, an electronic registry, 1-on-1 academic detailing, and electronic decision tools for safe opioid prescribing. Control PCCs received electronic decision tools only.Primary outcomes included documentation of guideline-concordant care (both a patient-PCC agreement in the electronic health record and at least 1 urine drug test [UDT]) over 12 months and 2 or more early opioid refills. Secondary outcomes included opioid dose reduction (ie, 10% decrease in morphine-equivalent daily dose [MEDD] at trial end) and opioid treatment discontinuation. Adjusted outcomes controlled for differing baseline patient characteristics: substance use diagnosis, mental health diagnoses, and language.Of the 985 participating patients, 519 were men, and 466 were women (mean [SD] patient age, 54.7 [11.5] years). Patients received a mean (SD) MEDD of 57.8 (78.5) mg. At 1 year, intervention patients were more likely than controls to receive guideline-concordant care (65.9% vs 37.8%; P .001; adjusted odds ratio [AOR], 6.0; 95% CI, 3.6-10.2), to have a patient-PCC agreement (of the 376 without an agreement at baseline, 53.8% vs 6.0%; P .001; AOR, 11.9; 95% CI, 4.4-32.2), and to undergo at least 1 UDT (74.6% vs 57.9%; P .001; AOR, 3.0; 95% CI, 1.8-5.0). There was no difference in odds of early refill receipt between groups (20.7% vs 20.1%; AOR, 1.1; 95% CI, 0.7-1.8). Intervention patients were more likely than controls to have either a 10% dose reduction or opioid treatment discontinuation (AOR, 1.6; 95% CI, 1.3-2.1; P .001). In adjusted analyses, intervention patients had a mean (SE) MEDD 6.8 (1.6) mg lower than controls (P .001).A multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills.clinicaltrials.gov Identifier: NCT01909076.