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].

Depression: Obstetric Mental Health Clinics & Outpatient Psychiatric Services

Research Paper Title

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

Background

A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression.

The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences.

Methods

A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale.

Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness.

A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service.

Results

The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit.

Patients taking three or more psychiatric medications attended more OBMHC visits.

Trend analysis indicated that women with the highest levels of depression had the best response to the intervention.

Three qualitative themes emerged:

  • Safe Place;
  • Mental/Emotional Stability; and
  • Integrated Personalised Approach.

Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care.

Conclusions

OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service.

Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms.

The longevity of this clinic’s experience serves as a role model for other centres to replicate this successful integrated model of care.

Reference

Goedde, D., Zidack, A., Li, Y.H., Arkava, D., Mullette, E., Mullowney, Y. & Brant, J.M. (2020) Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. Journal of the American Psychiatric Nurses Association. doi: 10.1177/1078390319897311. [Epub ahead of print].

Clinical Characteristics of OCD in Children & Adolescents: Developing vs Developed Countries

Research Paper Title

Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India.

Background

Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading.

However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents.

To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD.

Methods

This was a cross-sectional study, conducted in outpatient treatment setting, across six centres in India.

Methods

Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children’s Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children’s Depression Rating Scale, and Family Interview for Genetic Studies.

Results

The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years.

Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms.

CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness.

Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample.

Conclusions

This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.

Reference

Sharma, E., Tripathi, A., Grover, S., Avasthi, A., Dan, A., Srivastava, C., Goyal, N., Manohari, S.M. & Reddy, J. (2019) Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India. Indian Journal of Psychiatry. 61(6), pp.564-571. doi: 10.4103/psychiatry.IndianJPsychiatry_128_19.