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Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections.

ABSTRACT: INTRODUCTION:Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings. METHODS:This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address deficits in knowledge, perceptions and referral information, and the organizational linkage intervention brought together community corrections and addiction treatment agencies in an interagency strategic planning and implementation process over 12 months. RESULTS:Although training alone was associated with increases in familiarity with pharmacotherapy and knowledge of where to refer clients, the experimental intervention produced significantly greater improvements in functional attitudes (e.g. that MAT is helpful to clients) and referral intentions. Corrections staff demonstrated greater improvements in functional perceptions and intent to refer opioid dependent clients for MAT than did treatment staff. CONCLUSION:Knowledge, perceptions and information training plus interorganizational strategic planning intervention is an effective means to change attitudes and intent to refer clients for medication assisted treatment in community corrections settings, especially among corrections staff.

SUBMITTER: Friedmann PD

PROVIDER: S-EPMC4304936 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections.

Friedmann Peter D PD Wilson Donna D Knudsen Hannah K HK Ducharme Lori J LJ Welsh Wayne N WN Frisman Linda L Knight Kevin K Lin Hsiu-Ju HJ James Amy A Albizu-Garcia Carmen E CE Pankow Jennifer J Hall Elizabeth A EA Urbine Terry F TF Abdel-Salam Sami S Duvall Jamieson L JL Vocci Frank J FJ

Journal of substance abuse treatment 20141014

<h4>Introduction</h4>Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings.<h4>Methods</h4>This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address def ...[more]

PMID: 25456091

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Project description:BackgroundSustainability capacity (SC), which is an organization's ability to implement and maintain change, is influenced by internal attributes, environmental contextual influencers, and intervention attributes. Temporal changes in staff SC perceptions, as well as the influence of quality improvement collaborative (QIC) participation, has generally not been explored. This project addresses this gap, measuring staff SC perceptions at four time points (baseline and every 9 months) for clinics participating in an intervention - the Network for the Improvement of Addiction Treatment QIC initiative (called NIATx200).MethodsA mixed linear model repeated measures analysis was applied to matched staff members (n = 908, representing 2329 total cases) across the evaluation timeframe. Three separate statistical models assessed potential predictors of SC perceptions: Time (Models I-III); NIATx200 intervention, staff job function, and tenure (Models II &III); and NIATx200 participation hours and four organizational variables (Model III).ResultsFor Model I, staff perceptions of total SC increased throughout most of the study (t1,4 = - 6.74, p < .0001; t2,4 = - 3.100, p < .036; t3,4 = - 0.23, p = ns). Model II did not change Model I's overall Time effect, but combined NIATx200 services (t = - 2.23, p = .026), staff job function (t = - 3.27, p = .001), and organizational administrators (t = - 3.50, p = .001) were also significantly associated with greater perceptions of total SC. Inclusion of additional variables in Model III demonstrated the importance of a higher participation level (t = - 3.09, p < .002) and being in a free-standing clinic (t = - 2.06, p < .04) on staff perceptions of total SC.ConclusionAlthough staff exposure to sustainability principals was minimal in NIATx200, staff perceptions about their organization's SC significantly differed over time. However, an organization's participation level in a QIC became the principal predictor of staff SC perceptions, regardless of other factors' influence. Given these findings, it is possible to develop and introduce specific sustainability content within the structure of a QIC to assess the impact on staff SC perceptions over time and the sustainment of organizational change.Trial registrationClinicalTrials.gov , NCT00934141 . Registered July 6, 2009. Retrospectively registered.

Project description:Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services. Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels. Through closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.

Project description:ObjectiveScreening, brief intervention, and referral to treatment (SBIRT) for adolescent alcohol and drug (AOD) use is recommended to occur with adolescents admitted to pediatric trauma centers. Most metrics on SBIRT service delivery only reference medical record documentation. In this analysis we examined changes in adolescents' perception of SBIRT services and concordance of adolescent-report and medical record data, among a sample of adolescents admitted before and after institutional SBIRT implementation.MethodsWe implemented SBIRT for adolescent AOD use using the Science to Service Laboratory implementation strategy and enrolled adolescents at 9 pediatric trauma centers. The recommended clinical workflow was for nursing to screen, social work to provide adolescents screening positive with brief intervention and referral to their PCP for continued AOD discussions with those. Adolescents screening as high-risk also referred to specialty services. Adolescents were enrolled and contacted 30 days after discharge and asked about their perception of any SBIRT services received. Data were also extracted from enrolled patient's medical record.ResultsThere were 430 adolescents enrolled, with 424 that were matched to their EHR data and 329 completed the 30-day survey. In this sample, EHR documented screening increased from pre-implementation to post-implementation (16.3%-65.7%) and brief interventions increased (27.1%-40.7%). Adolescents self-reported higher rates of being asked about alcohol or drug use than in EHR data both pre- and post-implementation (80.7%-81%). Both EHR data and adolescent self-reported data demonstrated low referral back to PCP for continued AOD discussions.ConclusionsImplementation of SBIRT at pediatric trauma centers was not associated with change in adolescent perceptions of SBIRT, despite improved documentation of delivery of AOD screening and interventions. Adolescents perceived being asked about AOD use more often than was documented. Referral to PCP or specialty care for continued AOD discussion remains an area of needed attention.Trial registrationClinicaltrials.gov NCT03297060.

Project description:BackgroundTo ensure patient-centered quality care for all citizens, Quality Improvement (QI) teams have been established across all public hospitals in Tanzania. However, little is known about how hospital staff perceive the performance of hospital QI teams in Tanzania. This study assessed the perceptions of hospital staff of the performance of QI teams in selected regional referral hospitals in Tanzania.MethodsThis cross-sectional study was conducted in four selected regional referral hospitals between April and August 2018. A self-administered questionnaire was used to collect data from 385 hospital staff in the selected hospitals. Measures of central tendency, proportions and frequencies were used to assess level of perception of hospital staff. Bivariate and multivariate logistic regression was used to test the association between the perceptions of hospital staff of the performance of QI teams and their socio-demographic factors.ResultsThe overall mean perception score of the performance of QI teams was 4.84 ± 1.25. Hospital staff aged 35 and over (n = 130; 68%), female hospital staff (n = 144; 64%), staff in clinical units (n = 136; 63%) and staff with post-secondary education (n = 175; 63%) perceived that the performance of QI teams was good. Improved hospital cleanliness was viewed as strength of QI teams, whilst inadequate sharing of information and inadequate reduction in patient waiting time were considered as weaknesses of QI team performance. Bivariate and multivariate logistic regression analyses showed that there was no statistical association between the perceptions of hospital staff and their socio-demographic characteristics.ConclusionThe overall perception of hospital staff of the performance of QI teams was good, with the main limitation being sharing of hospital QI plans with hospital staff. Hospital staff should be involved in the development and implementation of hospital QI plans, which would promote a positive perception of staff of the performance of QI teams and enhance sustainability of QI teams.

Project description:ObjectiveTo determine patient perceptions of generic medicines 2 and 6 months after percutaneous coronary intervention (PCI), and to determine whether these perceptions moderate medication adherence.DesignProspective multicentre cohort study with repeated measures of perceptions of generic medicines and medication adherence.SettingThe CONCARDPCI study conducted at seven large referral PCI centres in Norway and Denmark between June 2017 and May 2020.ParticipantsA total of 3417 adults (78% men), using both generic and brand name medicines, with a mean age of 66 years (SD 11) who underwent PCI were followed up 2 and 6 months after discharge from hospital.Main outcome measuresPerceptions of generic medicines were the main outcome. The secondary outcome was medication adherence.ResultsPerceptions of generic medicines were significantly more negative at 2 than at 6 months (1.10, 95% CI 0.41 to 1.79, p=0.002). Female sex (-4.21, 95% CI -6.75 to -1.71, p=0.001), older age (-0.12, 95% CI -0.23 to -0.02, p=0.020), lower education level (overall p<0.001), ethnicity (overall p=0.002), Norwegian nationality (10.27, 95% CI 8.19 to 12.40, p<0.001) and reduced self-reported health status (0.19, 95% CI 0.09 to 0.41, p=0.003) were significantly associated with negative perceptions of generic medicines. There was no evidence to suggest that perceptions of generic medicines moderate the association between sociodemographic and clinical variables and medication adherence (p≥0.077 for all covariates). Moreover, self-reported medication adherence was high, with 99% scoring at or above the Medication Adherence Report Scale midpoint at both time points. There were no substantial correlations between negative perceptions of generic medicines and medication non-adherence at 2 months (r=0.041, 95% CI 0.002 to 0.081, p=0.037) or 6 months (r=0.038, 95% CI -0.005 to 0.081, p=0.057).ConclusionsMistrust and uncertainty about the safety and efficacy of generic medicines remains in a sizeable proportion of patients after PCI. This applies especially to those of lower socioeconomic status, older age, female sex, immigrants and those with poorer mental health. However, this study demonstrated a shift towards more positive perceptions of generic medicines in the longer term.

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Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections.

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Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections.

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