Journal of general internal medicine
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Comparative Study
Adherence to clinical guidelines for opioid therapy for chronic pain in patients with substance use disorder.
Patients with chronic non-cancer pain (CNCP) have high rates of substance use disorders (SUD). SUD complicates pain treatment and may lead to worse outcomes. However, little information is available describing adherence to opioid treatment guidelines for CNCP generally, or guideline adherence for patients with comorbid SUD. ⋯ CNCP patients with SUD were more likely to have mental health appointments and receive UDS monitoring, but not more likely to participate in other aspects of pain care compared to those without SUD. Given data suggesting patients with comorbid SUD may need more intensive treatment to achieve improvements in pain-related function, SUD patients may be at high risk for poor outcomes.
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Multicenter Study Comparative Study
Prevalence of practice system tools for improving depression care among primary care clinics: the DIAMOND initiative.
Practice system tools improve chronic disease care, but are generally lacking for the care of depression in most primary care settings. ⋯ Few practice system tools are in place for improving depression care in Minnesota primary care clinics, and these are less well-developed than general chronic disease practice systems. Future research should focus on demonstrating whether implementing these tools for depression care results in much-needed improvements in care for patients with depression.
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Multicenter Study Comparative Study
Low use of opioid risk reduction strategies in primary care even for high risk patients with chronic pain.
Experts recommend close oversight of patients receiving opioid analgesics for chronic non-cancer pain (CNCP), especially those at increased risk of misuse. We hypothesized that physicians employ opioid risk reduction strategies more frequently in higher risk patients. ⋯ Primary care physicians' adoption of opioid risk reduction strategies is limited, even among patients at increased risk of misuse.
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Multicenter Study Comparative Study
Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications.
Food insecurity negatively impacts HIV disease outcomes in international settings. No large scale U.S. studies have investigated the association between food insecurity and severity of HIV disease or the mechanism of this possible association. The objective of this study was to examine the impact of food insecurity on HIV disease outcomes in a large cohort of HIV-infected patients receiving antiretroviral medications. ⋯ Among HIV-infected participants receiving antiretroviral medications, food insecurity is associated with unsuppressed viral load and may render treatment less effective. Longitudinal studies are needed to test the potential causal association between food insecurity, lack of virologic suppression, and additional HIV outcomes.