Linking Opioid Use Disorder & High Levels of Out-patient Care Prior to Diagnosis

Research Paper Title

The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada.

Background

The ‘cascade of care’ framework, measuring attrition at various stages of care engagement, has been proposed to guide the public health response to the opioid overdose public health emergency in British Columbia, Canada.

The researchers estimated the cascade of care for opioid use disorder and identified factors associated with care engagement for people with opioid use disorder (PWOUD) provincially.

Methods

Retrospective study using a provincial-level linkage of four health administrative databases.

All PWOUD in BC from 01 January 1996 to 30 November 2017.

The eight-stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT and retained on OAT: ≥ 1, ≥ 3, ≥ 12 and ≥ 24 months).

Health-care use, homelessness and other demographics were obtained from physician billing records, hospitalisations, and drug dispensation records. Receipt of income assistance was indicated by enrolment in Pharmacare Plan C.

Results

A total of 55 470 diagnosed PWOUD were alive at end of follow-up. As of 2017, a majority of the population (n = 39 456; 71%) received OAT during follow-up; however, only 33% (n = 18 519) were currently engaged in treatment and 16% (n = 8960) had been retained for at least 1 year.

Compared with those never on OAT, those currently engaged in OAT were more likely to be aged under 45 years [adjusted odds ratio (aOR) = 1.75, 95% confidence interval (CI) = 1.64, 1.89], male (aOR = 1.72, 95% CI = 1.64, 1.82), with concurrent substance use disorders (aOR = 2.56, 95% CI = 2.44, 2.70), hepatitis C virus (HCV) (aOR = 1.22, 95% CI = 1.14, 1.33) and either homeless or receiving income-assistance (aOR = 4.35, 95% CI = 4.17, 4.55).

Regular contact with the health-care system-either in out-patient or acute care settings-was common among PWOUD not engaged in OAT, regardless of time since diagnosis or treatment discontinuation.

Conclusions

People with opioid use disorder in British Columbia, Canada show high levels of out-patient care prior to diagnosis.

Younger age, male sex, urban residence, lower income level and homelessness appear to be independently associated with increased opioid agonist treatment engagement.

Reference

Piske, M., Zhou, H., Min, J.E., Hongdilokkul, N., Pearce, L.A., Homayra, F., Socias, M.E., McGowan, G. & Nosyk, B. (2020) The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada. Addiction (Abingdon, England). doi: 10.1111/add.14947. [Epub ahead of print].

Children: Foster Care & Mental Health

Research Paper Title

A Comparison Study of Primary Care Utilisation and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid.

Background

The purpose of this study was to compare the utilisation of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system.

Methods

The data for this study were analysed from a clinical database of a multi-practice paediatric health system in Houston, Texas.

The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period.

Results & Conclusions

The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis.

Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Reference

Keefe, R.J., Van Horne, B.S., Cain, C.M., Budolfson, K., Thompson, R. & Greeley, C.S. (2020) A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics. doi: 10.1177/0009922819898182. [Epub ahead of print].

Identifying Mental Illness

Mental illness cannot always be clearly differentiated from normal behaviour.

For example, distinguishing normal bereavement from depression may be difficult in people who have had a significant loss, such as the death of a spouse or child, because both involve sadness and a depressed mood.

In the same manner, deciding whether a diagnosis of anxiety disorder applies to people who are worried and stressed about work can be challenging because most people experience these feelings at some time.

The line between having certain personality traits and having a personality disorder can be blurry.

Thus, mental illness and mental health are best thought of as being on a continuum.

Any dividing line is usually based on the following:

  • How severe the symptoms are;
  • How long symptoms last; and
  • How much symptoms affect the ability to function in daily life.

Use Your Smartphone to Spot Schizophrenia, Soon

Speaking into your smartphone for two minutes could reveal whether you have a mental health condition!

That is according to the developers of an app that analyses facial expressions and speech to diagnose schizophrenia.

The company behind the app, AICure, hopes it could be used to better support and monitor people with schizophrenia, and eventually those who have other mental health conditions.

The current version was developed to measure symptoms of schizophrenia like low mood and difficulty thinking, which are normally harder to measure than symptoms like hallucinations and delusions.

To do this, the app tracks facial movements, as well as the content, tone and pitch of a person’s speech. Some people with schizophrenia move more slowly, and show less emotion on their faces. The app can then send a score to the person’s doctor, rating these symptoms.

However, it is not designed to spot other symptoms associated with the condition, such as hallucinations.

AICure tested the app with 21 people who have schizophrenia and nine people who do not. The participants made weekly recordings over 12 weeks. Each person was also evaluated by a clinician at Mount Sinai Hospital in New York at the start and end of the study.

The results of this small trial suggest that the app’s ratings “are highly correlated” with those of a clinician, states AICure. However, AICure does not yet have enough data to prove its app works, because the sample size is very small. The results can be viewed more as a proof of concept than as a diagnostic tool, which is a little way off.

Reference

Hamzelou, J. (2019) Smartphone App Could Spot Signs of Schizophrenia. New Scientist. 28 September 2019, pp.7.