Disparities in Infection-Related Services in Substance Abuse Treatment Programs for Underserved Populations L.S. Brown, MD...
17 Nodes with 116 Community Treatment Agencies Reaching into 26 States! Drug Abuse Treatment Clinical Trials Network Phila...
ACKNOWLEDGEMENTS <ul><li>Research Supported by the National Institute on Drug Abuse (NIDA) as part of a Cooperative Agreem...
RATIONALE: THIS REPORT <ul><li>HIV/HCV/STI: major causes of excess morbidity and mortality in the US </li></ul><ul><li>Sub...
OBJECTIVES: THIS REPORT <ul><li>TO DESCRIBE:   </li></ul><ul><ul><li>Range of Infection-Related Services Available </li></...
STUDY POPULATION <ul><li>319 TREATMENT PROGRAM ADMINISTRATORS FROM 116 AGENCIES IN NIDA CTN </li></ul><ul><li>269 PROGRAMS...
STUDY DESIGN <ul><li>DESCRIPTIVE & OBSERVATIONAL </li></ul><ul><li>CROSS-SECTIONAL SURVEY (Selected Items) </li></ul><ul><...
STATISTICAL ANALYSIS <ul><li>Summary of Number (proportion) of respondents providing various answers </li></ul><ul><li>Cro...
SUBSTANCE ABUSE TREATMENT PROGRAMS (N=269) OFFERING ADDICTION SERVICES FOR VARIOUS POPULATIONS 20.1 4 or More Special Popu...
Percent of Treatment Programs Providing  HIV -Related Health Services With and Without Addiction Services Designed For:  *...
Percent of Treatment Programs Providing  HCV -Related Health Services With and Without Addiction Services Designed For:  *...
Percent of Treatment Programs Providing  STI -Related Health Services With and Without Addiction Services Designed For:  *...
RESULTS:  Treatment Program Characteristics <ul><li>79% of Treatment Programs were not-for-profit; 6% for profit; 13% gove...
RESULTS:  Infection-Related Health Services <ul><li>Non-medical services were provided more frequently than medical servic...
RESULTS:  Infection-Related Health Services (cont’d) <ul><li>Of the 21 infection-related health services (7 services x 3 i...
RESULTS:  Barriers to Providing Infection-Related Health Services <ul><li>In Treatment Programs with addiction services de...
RESULTS:  Barriers to Providing Infection-Related Health Services (cont’d) <ul><li>In Treatment Programs with addiction se...
LIMITATIONS <ul><li>Self-reporting of study population may be biased </li></ul><ul><li>Generalizability of results </li></...
CONCLUSIONS <ul><li>Nearly 80% of treatment programs provide addiction services designed for at least one special populati...
CONCLUSIONS <ul><li>Implications are: </li></ul><ul><li>These health services serve as another mechanism explaining the in...
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Implementation of an Electronic Information System to Enhance Practice at an Opioid Treatment Program

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  • PROTOCOL TEAM MEMBERSHIP TO DATE
  • Implementation of an Electronic Information System to Enhance Practice at an Opioid Treatment Program

    1. 1. Disparities in Infection-Related Services in Substance Abuse Treatment Programs for Underserved Populations L.S. Brown, MD, MPH; S. Kritz, MD; E. Bini, MD, MPH; J. Robinson, MEd, D. Alderson, MS; J. Rotrosen, MD and the NIDA Clinical Trials Network Infections Study (CTN-0012) Team Addiction Research & Treatment Corp, Brooklyn, NY; NYU School of Medicine and VA Hospital, NY, NY; Nathan Kline Institute, Orangeburg, NY; and NYS Psychiatric Institute, NY, NY
    2. 2. 17 Nodes with 116 Community Treatment Agencies Reaching into 26 States! Drug Abuse Treatment Clinical Trials Network Philadelphia Portland Los Angeles Charleston Miami Cincinnati Denver CTN Study Sites Seattle Raleigh/ Durham Long Island Boston San Francisco (CA/AZ Node) New York City Detroit Albuquerque Baltimore/Richmond New Haven
    3. 3. ACKNOWLEDGEMENTS <ul><li>Research Supported by the National Institute on Drug Abuse (NIDA) as part of a Cooperative Agreement (1U10DA013046) with the NIDA Clinical Trial Network </li></ul><ul><li>This is the 3 rd report from this study. The others: </li></ul><ul><ul><li>Brown LS , et. al. Characteristics of substance abuse treatment programs providing services for HIV/AIDS, hepatitis C virus infection, and sexually transmitted infections: The National Drug Abuse Treatment Clinical Trials Network. J. Substance Abuse Treatment , 2006;30: 315-321. </li></ul></ul><ul><ul><li>Brown LS , et. al. Health services for HIV/AIDS, hepatitis C virus, and sexually transmitted infections in substance abuse treatment programs. Public Health Reports (in press). </li></ul></ul><ul><li>There are no financial interests or disclosures to report for any authors involved in this project </li></ul>
    4. 4. RATIONALE: THIS REPORT <ul><li>HIV/HCV/STI: major causes of excess morbidity and mortality in the US </li></ul><ul><li>Substance use: a major vehicle for the transmission of infection </li></ul><ul><li>Women and Minorities: over-represented in the consequences of substance use and these infections. </li></ul>
    5. 5. OBJECTIVES: THIS REPORT <ul><li>TO DESCRIBE: </li></ul><ul><ul><li>Range of Infection-Related Services Available </li></ul></ul><ul><ul><li>Treatment Program Characteristics </li></ul></ul><ul><ul><li>Patient Characteristics </li></ul></ul><ul><ul><li>Perceived Barriers to Providing Infection-Related Services </li></ul></ul><ul><li>TO EXAMINE ASSOCIATIONS BETWEEN: </li></ul><ul><ul><li>Availability of Addiction Services Targeted for Women or Minorities and: </li></ul></ul><ul><ul><ul><li>Treatment Program and Patient Characteristics </li></ul></ul></ul><ul><ul><ul><li>Availability of Infection-Related Services </li></ul></ul></ul><ul><ul><ul><li>Perceived Barriers to Providing Infection-Related Services </li></ul></ul></ul>
    6. 6. STUDY POPULATION <ul><li>319 TREATMENT PROGRAM ADMINISTRATORS FROM 116 AGENCIES IN NIDA CTN </li></ul><ul><li>269 PROGRAMS (84%) RETURNED </li></ul><ul><li>ETHICAL REGULATORY </li></ul><ul><ul><li>Expedited IRB Review </li></ul></ul><ul><ul><li>Waiver of Informed Consent </li></ul></ul>
    7. 7. STUDY DESIGN <ul><li>DESCRIPTIVE & OBSERVATIONAL </li></ul><ul><li>CROSS-SECTIONAL SURVEY (Selected Items) </li></ul><ul><ul><li>Treatment Program & Patient Characteristics </li></ul></ul><ul><ul><li>Availability of 7 Infection-related Services: Education, Risk Assessment, Counseling, Medical History & Physical Exam, Biological Testing, Medical Treatment, Medical Monitoring </li></ul></ul><ul><ul><li>For 3 Infections: HIV, HCV, STI </li></ul></ul><ul><ul><li>8 Perceived Barriers to Providing Infection-Related Services: government regulations, treatment program policies, staff training, funding, patient health insurance, patient acceptance, staff acceptance, or other </li></ul></ul>
    8. 8. STATISTICAL ANALYSIS <ul><li>Summary of Number (proportion) of respondents providing various answers </li></ul><ul><li>Cross-tabulations of Availability of Addiction Services for Women or a Minority Population Group and: </li></ul><ul><ul><ul><li>Treatment Program & Patient Characteristics </li></ul></ul></ul><ul><ul><ul><li>Availability of 7 Infection-related Services for each of 3 Infections </li></ul></ul></ul><ul><ul><ul><li>Perceived Barriers to Providing the Infection-related Services </li></ul></ul></ul><ul><li>Chi-square (Fisher’s Exact) Test with Odds ratios and 95% Confidence Intervals </li></ul>
    9. 9. SUBSTANCE ABUSE TREATMENT PROGRAMS (N=269) OFFERING ADDICTION SERVICES FOR VARIOUS POPULATIONS 20.1 4 or More Special Population Groups 25.3 2-3 Special Population Groups 34.5 One Special Population Group 79.9 At Least One Special Population Group 20.1 No Women or Special Population 15.7 Hawaiian/Pacific Islander 18.6 Asian 19.4 American Indian/Alaskan Native 43.3 Latinos 37.5 African Americans 73.9 Women PERCENT OF PROGRAMS WITH TAILORED SERVICES POPULATION
    10. 10. Percent of Treatment Programs Providing HIV -Related Health Services With and Without Addiction Services Designed For: * p<0.05; # p<0.001 47% 60% 47% 58% 47% 60% 39% # 63% 38% # 67% 37% 53% Medical Monitoring 41% 53% 40% 56% 40% 56% 33% # 58% 30% # 64% 33% 45% Medical Treatment 54% 47% 54% 45% 53% 52% 50% 57% 48% 60% 51% 54% Biological Testing 61% 61% 61% 60% 61% 65% 57% 66% 55% * 72% 57% 62% Medical History & Physical Exam 70% 81% 71% 82% 70% 84% 66% * 82% 64% * 86% 64% 75% Counseling 89% 92% 88% 93% 88% 95% 88% 91% 88% 92% 85% 90% Risk Assessment 90% 95% 90% 98% 91% 95% 89% 94% 88% 95% 85% 92% Education n=232 n=37 n=225 n=44 n=223 n=46 n=163 n=106 n=171 n=91 n=79 n=190 Without With Without With Without With Without With Without With Without With TYPES OF HEALTH SERVICES HAWAIIANS/ PACIFIC ISLANDERS ASIANS AMERICAN INDIANS/ ALASKAN NATIVES LATINO AMERICANS AFRICAN AMERICANS WOMEN
    11. 11. Percent of Treatment Programs Providing HCV -Related Health Services With and Without Addiction Services Designed For: * p<0.05; # p<0.001 37% 47% 36% 51% 35% * 57% 31% * 49% 29% # 56% 34% 39% Medical Monitoring 29% 44% 28% * 47% 28% * 48% 23% # 42% 21% # 51% 28% 32% Medical Treatment 37% 36% 37% 37% 35% 48% 33% 43% 30% # 49% 38% 37% Biological Testing 53% 58% 53% 58% 52% 63% 48% 59% 47% # 65% 49% 55% Medical History & Physical Exam 62% 69% 61% 74% 60% * 77% 58% 70% 56% # 76% 56% 66% Counseling 77% 78% 76% 84% 76% 86% 75% 81% 75% 82% 66% * 81% Risk Assessment 79% 83% 79% 86% 79% 89% 79% 81% 78% 84% 74% 82% Education n=232 n=37 n=225 n=44 n=223 n=46 n=163 n=106 n=171 n=91 n=79 n=190 Without With Without With Without With Without With Without With Without With TYPES OF HEALTH SERVICES HAWAIIANS/ PACIFIC ISLANDERS ASIANS AMERICAN INDIANS/ ALASKAN NATIVES LATINO AMERICANS AFRICAN AMERICANS WOMEN
    12. 12. Percent of Treatment Programs Providing STI -Related Health Services With and Without Addiction Services Designed For: * p<0.05; # p<0.001 40% 56% 39% * 58% 39% 58% 33% # 55% 31% # 63% 36% 44% Medical Monitoring 34% 49% 32% * 55% 33% 53% 28% # 49% 24% # 57% 29% 38% Medical Treatment 43% 41% 40% 55% 42% 50% 39% 48% 35% # 56% 39% 44% Biological Testing 52% 51% 52% 55% 52% 56% 47% 59% 44% # 65% 48% 54% Medical History & Physical Exam 63% 72% 61% * 79% 61% 76% 57% * 73% 54% # 81% 60% 66% Counseling 77% 84% 77% 86% 77% 84% 74% 83% 73% * 86% 71% 79% Risk Assessment 81% 86% 81% 84% 81% 87% 76% * 87% 77% * 89% 76% 82% Education n=232 n=37 n=225 n=44 n=223 n=46 n=163 n=106 n=171 n=91 n=79 n=190 Without With Without With Without With Without With Without With Without With TYPES OF HEALTH SERVICES HAWAIIANS/ PACIFIC ISLANDERS ASIANS AMERICAN INDIANS/ ALASKAN NATIVES LATINO AMERICANS AFRICAN AMERICANS WOMEN
    13. 13. RESULTS: Treatment Program Characteristics <ul><li>79% of Treatment Programs were not-for-profit; 6% for profit; 13% governmental </li></ul><ul><li>Almost 80% of Treatment Programs had addiction services tailored to women or one minority population group </li></ul><ul><li>Treatment Programs with addiction services tailored to women or one minority population group were more likely to provide: </li></ul><ul><ul><li>outpatient addiction services (86% versus 57%, p<0.001) </li></ul></ul><ul><ul><li>support services (92% versus 70%, p=0.01) </li></ul></ul>
    14. 14. RESULTS: Infection-Related Health Services <ul><li>Non-medical services were provided more frequently than medical services </li></ul><ul><li>Treatment Programs with addiction services tailored to women or one minority population group were more likely to provide: </li></ul><ul><ul><li>HIV-related patient education (94% versus 85%, p=0.05) </li></ul></ul><ul><ul><li>HIV-related counseling (76% versus 60%, p=0.03) </li></ul></ul><ul><li>Treatment Programs with addiction services tailored to women were more likely to provide: </li></ul><ul><ul><li>HIV-related medical monitoring (53% versus 37%, p=0.03); odds ratio: 1.93 (95% CI: 1.07-3.49) </li></ul></ul><ul><ul><li>HCV-related risk assessment (81% versus 66%, p=0.01); odds ratio: 2.23 (95% CI: 1.18-4.20) </li></ul></ul>
    15. 15. RESULTS: Infection-Related Health Services (cont’d) <ul><li>Of the 21 infection-related health services (7 services x 3 infections): </li></ul><ul><ul><li>16 of 21 were more available in treatment programs with addiction services designed for African Americans </li></ul></ul><ul><ul><li>9 of 21 were more available in treatment programs with addiction services designed for Latino Americans </li></ul></ul><ul><ul><li>5 of 21 were more available in treatment programs with addiction services designed for American Indians/Alaskan Natives </li></ul></ul><ul><ul><li>4 of 21 were more available in treatment programs with addiction services designed for Asian Americans </li></ul></ul>
    16. 16. RESULTS: Barriers to Providing Infection-Related Health Services <ul><li>In Treatment Programs with addiction services designed for special populations: </li></ul><ul><li>Funding was the most cited barrier; especially for medical services as compared to non-medical services </li></ul><ul><li>Health Insurance was the 2 nd most cited barrier: </li></ul><ul><ul><li>for 19 of 21 infection services in programs designed for women </li></ul></ul><ul><ul><li>for all infection services in programs designed for African Americans </li></ul></ul><ul><ul><li>for 16 of 21 infection services in programs designed for Latino Americans </li></ul></ul><ul><ul><li>for 10 of 21 infection services in programs designed for American Indians/Native Alaskans </li></ul></ul><ul><ul><li>for 5 of 21 infection services in programs designed for Asians </li></ul></ul><ul><ul><li>for 6 of 21 infection services in programs designed for Hawaiians/Pacific Islanders </li></ul></ul>
    17. 17. RESULTS: Barriers to Providing Infection-Related Health Services (cont’d) <ul><li>In Treatment Programs with addiction services designed for special populations: </li></ul><ul><li>Patient Acceptance was the 3 rd most cited barrier: </li></ul><ul><ul><li>for 11 of 21 infection services in programs designed for American Indians/Native Alaskans </li></ul></ul><ul><ul><li>for 16 of 21 infection services in programs designed for Asians </li></ul></ul><ul><ul><li>for 15 of 21 infection services in programs designed for Hawaiians/Pacific Islanders </li></ul></ul>
    18. 18. LIMITATIONS <ul><li>Self-reporting of study population may be biased </li></ul><ul><li>Generalizability of results </li></ul><ul><li>No information about utilization, costs, efficiency, or effectiveness </li></ul>
    19. 19. CONCLUSIONS <ul><li>Nearly 80% of treatment programs provide addiction services designed for at least one special population </li></ul><ul><li>Treatment programs offer an array of infection-related health services </li></ul><ul><li>Infection-related health services were more available in treatment programs with minority-tailored addiction services </li></ul><ul><li>Funding, patient health insurance, and patient acceptance were the most cited barriers </li></ul>
    20. 20. CONCLUSIONS <ul><li>Implications are: </li></ul><ul><li>These health services serve as another mechanism explaining the infection-related benefits of substance abuse treatment </li></ul><ul><li>Despite barriers, treatment programs provide access to infection-related health services, more so in treatment programs with addiction services designed for women and minorities </li></ul><ul><li>Removing these barriers may enhance the availability of infection-related health services especially important in treatment programs serving populations sustaining a greater burden of the consequences associated with these infections </li></ul>

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