Vulnerable Populations

Suicide prevention has been named a national priority and much work has been done to review existing evidence and identify gaps in how our nation’s mental health and health care systems address this public health challenge. A national task force that was part of the effort to update the national suicide prevention strategy reviewed research and best practices from the field and
concluded that suicide prevention could be improved in health care. The task force found three common characteristics among successful suicide prevention programs in health care settings. Health care staff in these organizations:
Believed that suicide can be prevented in the population they serve through improvements in service access and quality, and through systems of continuous improvement;
Created a culture that finds suicide unacceptable and sets and monitors ambitious goals to prevent suicide; and
Employed evidence-based clinical care practice, including standardized risk stratification, evidence-based interventions, and patient engagement approaches1.

The task force’s recommendations formed the foundation of the Zero Suicide Approach for health care organizations. The recommendations contained in this guide are based on those offered in the comprehensive Zero Suicide in Health and Behavioral Health Care Toolkit [http://zerosuicide.sprc.org/toolkit]. Here they have been adapted specifically for primary care organizations and clinicians who care for underserved populations.
The guide focuses on two core components:
1. Screening and assessment
2. Care management and referral processes
The final section contains some additional information on administrative and legal issues providers and leaders may find helpful to support integration of safer suicide care in practice. Many providers and clinical leaders erroneously assume if they discuss suicide with a patient they open up themselves to liability. Utilizing a patient safety approach, primary care organizations can
establish safer suicide care practices that deliver high quality care to patients and reduce risk to the organization.
In each section of this guide you will find:
Information summarized for providers, including some helpful provider communication tips.
A list of recommended trainings and resources to learn more.
Leadership actions organizations may wish to undertake to help providers reduce suicide in their organization’s
patient population, and
Relevant tools, templates and case studies.
This toolkit begins with a brief background on the impact of suicide and offers a case study illustrating how one federally qualified health center adopted a safer suicide care model.

Author/s:

Institute of Family Health, Little, V.

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection A State-of-the-Art Review

Saige Blanchard — Sat, 18 Sep 2021 05:00:00 +0000

Date Added:

September 18, 2021

Journal/Publication:

Journals of the American College of Cardiology: Basic to Translational Science

Publisher:

Elsevier

Publication Date:

September 15, 2021

Pages:

1-16

URL:

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection A State-of-the-Art Review

Format:

Article

DOI (1):

10.1016/j.jacbts.2021.07.002

Keywords

COVID-19

coronavirus

Postacute Secuelae

Acute Respiratory Syndrome

Infection

MeSH

SARS-CoV-2

Coronavirus

Vulnerable Populations

preexisting condition coverage

Musculoskeletal System

COVID-19

A literature-review-based summary of the frequency and duration of post-acute COVID-19 signs and symptoms. The results are biased toward patients with severe disease initially. James W. Mold, MD, MPH

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The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection
but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021,
found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC)
affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and
complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified
over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents.
Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed
to better understand and mitigate the long-term effects of PASC on individual and population health.
(J Am Coll Cardiol Basic Trans Science 2021;-:-–-) © 2021 The Authors. Published by Elsevier on behalf of the American
College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license

Author/s:

Jiang, D. H., Roy, D. J., Gu, B. J., Hassett, L. C., McCoy, R. G.

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1001/jamanetworkopen.2021.18487

A report and description of the use of telemedicine and mobile services to help people in rural areas with substance abuse challenges.

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Importance
The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated.

Objective
To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area.

Design, Setting, and Participants
This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020.

Intervention
Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine.

Main Outcomes and Measures
The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients’ travel distance to treatment.

Results
A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients’ data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%) were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fifty-five patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients.

Conclusions and Relevance
These data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from office-based TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved populations who are less likely to reach traditional medical settings, with critical relevance in the context of the COVID-19 pandemic.

Author/s:

Weintraub, E., Seneviratne, C., Anane, J.

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

Brian Desmarais — Tue, 10 Mar 2020 15:03:15 +0000

Date Added:

March 10, 2020

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

March 9, 2020

Issue:

Volume:

192

Pages:

E240-E254

URL:

Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.190777

MeSH

Vulnerable Populations

Income

Comprehensive Health Care

primary health care

opioid-related disorders

This article summarizes what is known about how to provide primary care for homeless and vulnerably housed patients. James W. Mold, MD, MPH

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KEY POINTS

Clinical assessment and care of homeless and vulnerably housed populations should include tailoring approaches to a person’s gender, age, Indigenous heritage, ethnicity and history of trauma; and advocacy for comprehensive primary health care.
As initial steps in the care of homeless and vulnerably housed populations, permanent supportive housing is strongly recommended, and income assistance is also recommended.
Case-management interventions, with access to psychiatric support, are recommended as an initial step to support primary care and to address existing mental health, substance use and other morbidities.
Harm-reduction interventions, such as supervised consumption facilities, and access to pharmacologic agents for opioid use disorder, such as opioid agonist treatment, are recommended for people who use substances.

Author/s:

Pottie, K."