Clinical Assistant Professor, Medicine - Primary Care and Population Health
Opioid misuse and dependence are prevalent and rising problems in the United States. Treatment with buprenorphine is a successful treatment option for individuals with opioid dependence. This study describes and preliminarily evaluates a unique delivery system that provides buprenorphine treatment via a shared medical appointment.A retrospective medical record review on all 77 opioid-dependent patients referred for a buprenorphine shared medical appointment in a homeless clinic from 2010 to 2012.Most patients were currently homeless (61%), unemployed (92%), had an Axis I psychiatric diagnosis (81%), and had recent polysubstance use (53%). Of the 77 patients, 95% attended at least 1 shared medical appointment. Treatment retention at 12 and 24 weeks was 86% and 70%, respectively.In a patient population with complex social and mental health histories, buprenorphine treatment via a shared medical appointment had high retention rates. Findings can help guide the development of unique delivery systems to serve real-world complex patients with opioid dependence.
View details for DOI 10.1080/08897077.2016.1264535
View details for PubMedID 27897918
Individuals with psychiatric disease, substance abuse, and/or housing instability have a high prevalence of chronic hepatitis C virus (HCV) infection. However, such individuals are often excluded from treatment for HCV infection because of a perceived inability to adhere to the rigorous medication regimen required.A pilot program using a multidisciplinary group medical visit model to treat HCV infection in the aforementioned population was created. Medication adherence and virologic response rates were prospectively followed.Approximately 80% of patients were adherent to their HCV infection treatment regimen, as measured by attendance at group medical visits and by medication adherence. A sustained virologic response rate of 55% among individuals with genotype 1 infection and 80% among individuals with genotype 2 or 3 infections was observed. These results compare favorably with those seen in large, randomized controlled trials. Rates of discontinuation and adverse effects were similar to those seen in other studies.An intensive, multidisciplinary treatment approach toward HCV infection treatment can achieve favorable results even in persons traditionally considered to be "poor treatment candidates." Programs aimed at bringing HCV infection treatment to this population are needed.
View details for DOI 10.1097/ADM.0b013e31829b1a6c
View details for PubMedID 23896750