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Research Briefs June 2017

New Mobile App Helps Providers Manage MAT for Opioid Use Disorders

In 2015, nearly 2.4 million Americans had an opioid use disorder, and nearly 80% of them did not receive treatment. To help change those numbers, the Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a free mobile application that supports medication-assisted treatment (MAT). The new app—MATx—is designed to empower health care practitioners to provide effective, evidence-based care for people with opioid use disorder. Features include:

  • Information on treatment approaches and medications approved by the Food and Drug Administration for use in treating opioid use disorders.
  • A buprenorphine prescribing guide, including information on the Drug Addiction Treatment Act of 2000 waiver process and patient limits.
  • Clinical support tools, such as treatment guidelines, ICD-10 coding, and recommendations for working with special populations.
  • Access to critical helplines and SAMHSA’s treatment locators.

For additional information or to download the free app, visit http://store.samhsa.gov/apps/mat..

Source: SAMHSA, April 2017

Monitoring Programs Reduce “Doctor Shopping” for Opioids

Prescription drug monitoring programs (PDMPs), which require physicians to check drug registries before writing prescriptions, dramatically cut the odds of “doctor shopping” behavior for opioid pain relievers, according to researchers from the Substance Abuse and Mental Health Services Administration.

PDMPs are electronic databases that track the prescribing of controlled substances and identify people at high risk of misusing the drugs. The researchers analyzed annual nationwide surveys of drug use and health from 2004 to 2014 when 36 states implemented PDMPs. The paper, published in the June issue of Addictive Behaviors, is the first to examine the effect of PDMPs on individual-level opioid-related outcomes.

Every U.S. state except Missouri now has a PDMP. Some are mandatory; some are voluntary. In states with mandatory checking, the odds that two or more doctors would be giving pain relievers for nonmedical purposes to a single patient were reduced by 80%. In states with voluntary monitoring, the odds dropped by 56%.

PDMPs were also associated with 10 fewer days of use of painkillers for nonmedical purposes in the previous year. Mandatory PDMPs were associated with 20 fewer days.

Source: Addictive Behaviors, January 2017 (online)

Examining How the Body Responds to Ebola

National Institutes of Health (NIH) researchers who analyzed daily gene activation in a single patient uncovered “unprecedented detail” about how a patient’s clinical condition changes in response to Ebola virus infection, treatment, and recovery.

The patient, who was admitted to the NIH Clinical Center on day 7 of the illness, received intensive supportive care, including fluids and electrolytes, but did not receive any experimental Ebola drugs. The researchers took blood samples daily during the patient’s 26-day stay to measure the rise and fall of virus replication and to track the timing, intensity, and duration of expression of numerous immune system genes. They correlated changes in gene expression with subsequent alterations in the patient’s clinical condition, such as development and resolution of blood-clotting dysfunction. The patient ultimately recovered from the infection.

The researchers pinpointed “key transition points” in the response to infection, NIH says. For example, they observed a marked decline in antiviral responses that correlated with clearance of virus from white blood cells. They also found that most host responses shifted rapidly from activating genes involved in cell damage and inflammation toward those linked to promotion of cellular and organ repair—a “pivot” that came before the patient began showing signs of clinical improvement.

While the study centered on only one patient, the researchers say it may help inform the development of treatments designed to boost or accelerate host factors that counter the virus and promote healing.

Source: NIH, April 2017

Indoor Tanning: Turning First-Time Clients Into Repeat Customers

Nearly 10 million people use indoor tanning even though it increases the risk of skin cancer. Young Caucasian women are particularly at risk—almost one in three reports using indoor tanning in the past year, and nearly one in five reports regular use (that is, 10 or more times in the past year), according to researchers from Rutgers University.

Research has already shown that most people use indoor tanning to enhance their appearance. But a tan is not only seen as attractive; it “plays an important part of youth culture,” the researchers note, especially when it comes to special events, such as high school proms. Still, some indoor tanning users might remain “special event” users, not regular clients. What makes the difference? To find out, the researchers conducted six interviews with a salon employee who also used tanning beds. Their purpose was not to produce “generalizable knowledge of the experiences of many users,” they say, but to provide insights into the behavior and to propose working hypotheses for future examination.

They found that the incentive to use indoor tanning mostly comes down—as many health-related decisions do—to how it’s advertised. The first encounter is likely to be the most important one. That’s when the “sell” begins, designed to “guide” the patron into coming back again and again. For instance, the salon employee may be trained to establish rapport, to personalize the interaction, and to ask about “tan goals,” setting the stage for a process, rather than a one-time purchase. The employee describes the steps of creating a “base tan,” maintaining the tan, and deepening the tan. Framing tanning as a process sends the message that frequent visits are needed. (The researchers cite self-regulation theories that posit for a habit to take hold the individual must develop a mental model or plans for how to use the habitual behavior to achieve desired goals.)

The Federal Trade Commission and other agencies have enacted restrictions on indoor tanning industry advertisements, the researchers say, but the policy efforts have not addressed greater regulation at the point of purchase, other than requiring the provision of standardized risk warnings. Their interview findings suggest ways to help reduce indoor tanning use. Pricing controls, for instance: If patrons had to buy single sessions—instead of in bulk—they might feel less pressured to “get their money’s worth.” Restrictions on advertisements might require salon employees to also provide information on unnecessary exposure. The researchers contrast the salon employee to a convenience store clerk who “simply serves as a cashier for purchasing cigarettes or unhealthy food options.”

The researchers suggest that their findings be followed up in larger, more representational samples.

Source: BMC Psychology, April 2017

Case Management Improves QOL for Cancer Survivors

After cancer treatment, a new challenge emerges as patients negotiate re-entry into their everyday lives. They often need multifaceted, simultaneous, and ongoing help with physical, emotional, and psychological issues. And they’re often dealing with a multiplicity of health care providers.

Researchers from the University of Zurich saw similarities between these needs and those of patients with chronic medical conditions. They reasoned that it made sense that case management—like that used for chronic diseases—could work for cancer survivors, perhaps even better than usual care. Among other things, case managers can assess individual needs, identify barriers, ensure coordination among care providers, and—perhaps most importantly—promote empowering self-management skills and self-efficacy, all of which could help cancer survivors cope with the long-term consequences of cancer and improve health-related quality of life (QOL).

The researchers designed an intervention study in which five oncology nurse case managers met with 95 patients at least once a month for three months, then conducted telephone follow-ups for nine months. Questionnaires measured health-related QOL at 12 months via the Functional Assessment of Cancer Therapy–General (FACT–G), self-efficacy, and concordance of received care with the Patient Assessment of Chronic Illness Care (PACIC).

While their study did not show a significant absolute difference between the groups in FACT–G after 12 months, all scores improved in the case management group compared with the usual care group. Overall, case management clearly boosted QOL and self-efficacy, and aligned health care with the chronic care model.

Their study is the first, to their knowledge, to examine the effect of case management on the QOL of early cancer survivors, the researchers say. Several factors help explain the intervention’s success:

  • The case managers provided important information on long-term symptoms and available services and therapies
  • They offered a continuity of care when treatment appointments ceased and medical follow-up visits were less frequent.
  • They offered support to cope with the psychological issues of the re-entry phase.
  • All in all, the researchers say their findings show case management is a practical approach to bridging a “fragmented oncological health care system” and addressing the heterogenic needs of cancer survivors.

    Source: BMC Cancer, April 2017

    Better to Skip Bioresorbable Stents?

    In a New England Journal of Medicine editorial, Debabrata Mukherjee, MD, Chief of Cardiovascular Medicine and Chair of the Department of Internal Medicine at Texas Tech University Health Sciences Center El Paso, encouraged cardiologists to continue using conventional drug-eluting stents instead of the newer bioresorbable option.

    The first bioresorbable stent was approved by the Food and Drug Administration in July 2016. Marketed by Abbott as the Absorb GT1 Bioresorbable Vascular Scaffold System, the device dissolves in the body three years after implant, helping the artery heal more naturally. But this popular device may not live up to expectations, according to Dr. Mukherjee.

    In a recent clinical study, the Absorb system was associated with an increased risk of device thrombosis—a dangerous adverse effect in which a blood clot forms on the stent itself. While thrombosis occurred in eight patients treated with a conventional drug-eluting stent, clots were observed in 31 patients receiving an Absorb implant.

    In his editorial, Dr. Mukherjee wrote: “Because the current generation of metallic drug-eluting stents is associated with excellent outcomes, there is little rationale to use bioresorbable vascular scaffolds at this time.”

    Source: Texas Tech, April 2017