Outcomes of a mobile medical unit for low-threshold buprenorphine access targeting opioid overdose hot spots in Chicago.

INTRODUCTION: Opioid overdoses in Chicago are unevenly distributed, affecting medically underserved neighborhoods most acutely. Innovations in reaching patients perceived to be hard-to-reach (e.g., unstably housed, marginalized), especially in these underserved neighborhoods, are urgently needed to combat the overdose crisis. This study characterizes the pilot year of a mobile medical unit partnership between a large urban academic center and a community-based harm reduction organization in Chicago. METHODS: This is a retrospective cohort study of all patients who were seen on a mobile medical unit focused on providing low-threshold buprenorphine and primary care in areas with high opioid overdose rates on Chicago's West Side. Treatment episodes were accrued between July 1, 2021, and June 30, 2022 in the first year of operation. The main outcomes were number of patients seen, demographic characteristics of patients, and reason(s) for visit over time. RESULTS: The study saw 587 unique patients on the mobile medical unit between July 1, 2021, and June 30, 2022. Approximately 64.6 % were African American, and more than half lacked active insurance or could not confirm insurance status at the time of visit. The most common reason for initial visit was COVID-19 vaccination (42.4 %), and the most common reason for follow-up visit was buprenorphine treatment (51.0 %). Eleven patients initially presented for other health concerns and later returned to initiate buprenorphine. CONCLUSIONS: The mobile medical unit successfully reached nearly 600 patients in traditionally medically underserved Chicago neighborhoods with the highest overdose rates. The mobile unit's integrated approach met a variety of health needs, including buprenorphine initiation, with a unique opportunity for postoverdose initiation. Several patients initiated buprenorphine after presenting for different health concerns, showing the potential of an integrated approach to build on past mobile outreach programs and reach people with opioid use disorder who are not yet ready to initiate treatment.

Stratification of burnout in health-system pharmacists during the COVID-19 pandemic: A focus on the ambulatory care pharmacist.

Introduction: Burnout is defined as high emotional exhaustion and depersonalization, and low personal accomplishment from work. Prevalence of burnout among health-system and ambulatory care pharmacists is unknown during the COVID-19 pandemic. Objectives: The purpose of this research is to analyze burnout prevalence among health-system pharmacists (HSPs) and ambulatory care pharmacists (ACPs) using the Oldenburg Burnout Inventory and Maslach Burnout Inventory. Methods: An electronic survey was sent to HSPs at two academic health systems in Chicago, IL. Demographics, risk of burnout based on two validated assessments (the Oldenburg Burnout Inventory [OLBI] and the Maslach Burnout Inventory [MBI]), burnout contributors, burnout mitigation strategies, and change in burnout due to COVID-19 were collected. Burnout was defined as meeting any one criterion for high burnout on the following dimensions: exhaustion score and disengagement on the OLBI, and emotional exhaustion and depersonalization on the MBI. The co-primary outcomes were the prevalence of burnout among HSPs, and the comparison of ACP burnout to that of non-ambulatory HSPs. Secondary outcomes were comparison of burnout between the OLBI and MBI assessments, conceptualization of the causes and contributors of burnout and mitigation strategies among HSPs, and the self-perceived effect of COVID-19 on burnout severity. Results: Of the 113 pharmacists included in the study, HSP burnout prevalence as defined above was 87.6%, ACP burnout was 88.4%, and non-ambulatory HSP burnout was 87.1%. There was no statistical difference between ACP and non-ambulatory HSP burnout prevalence, either overall or in any specific burnout dimension. The OLBI and MBI captured similar rates of burnout. The commonly reported burnout causes were staffing and scheduling issues, precepting requirements, and patient needs. Participants' most reported coping strategies were spending time with family/friends, sleep, exercise, and recreational/relaxation activities. A majority of HSPs (78.2%) reported higher levels of burnout due to COVID-19. Conclusion: HSP burnout during COVID-19 pandemic is higher than cited in the pre-COVID literature. Individual coping strategies are poor buffers for work-related burnout.

Predictive Factors of Positive E-Learning Experience.

BACKGROUND AND OBJECTIVES: During the COVID-19 pandemic, medical schools and residencies have utilized electronic learning (e-learning). Factors such as internet access, age, degree of introversion/extroversion, and propensity to adopt new technologies impact attitudes toward e-learning. This study investigates family medicine educators' satisfaction, effectiveness, and feasibility perceptions of e-learning, characterizes demographic factors impacting attitudes, and identifies which aspects of e-learning are important to educators. METHODS: In fall 2020, a cross-sectional survey via the 2020 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) general membership survey was conducted. Members of CAFM-affiliated associations were invited by email to participate. RESULTS: The response rate for the survey was 20.1% (n=862). Of the respondents, 40.4% (n=311) reported satisfaction with e-learning, 47.8% (n=368) found e-learning feasible, and 24.2% (n=186) reported e-learning met their educational goals. No differences were found in satisfaction, feasibility, or effectiveness scores according to generation, introvert/extrovert status, or technology adopter status. Interactive capabilities were the most important factor for e-learning satisfaction (55.9%) and effectiveness (62.0%). Sufficient time was the most frequently selected factor for ease of adoption. Baby Boomer respondents reported platforms not user-friendly, insufficient prior experience as the greatest obstacle more frequently than other generations, and insufficient time less frequently than other generations. Otherwise, rankings of e-learning factors were similar among groups. CONCLUSIONS: Satisfaction with and perceived feasibility and effectiveness of e-learning varies among family medicine educators. No differences were found in satisfaction, feasibility, or effectiveness scores according to generation, introvert/extrovert status, or technology adopter status. Respondents consistently ranked interactive capabilities most important for e-learning satisfaction and effectiveness. More research is needed to compare student and learner perspectives regarding e-learning.

Urban Expansion of the SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness Initiative for Home Health Workers and Older Adults.

The SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness pilot program utilized home health workers (HHWs) in rural settings to educate older adults prescribed opioids on naloxone access and use. This work expands the SAFE-HOME program to urban settings to prepare HHWs to educate community-dwelling older adults on opioid risks and life-saving naloxone. This prospective, interventional cohort study evaluated 60-min synchronous, virtual HHW educational training sessions describing opioid risks in older adults, opioid overdose signs and symptoms, and naloxone access and use. Knowledge assessments were conducted pre- and post-intervention via a pre-developed assessment tool in a repeated measure model. Outcomes included change in total opioid and naloxone knowledge, and baseline total and individual opioid and naloxone knowledge. Six educational sessions were held (n = 154). The average pre- and post-education scores were 62.7% (n = 108) and 83.5% (n = 82), respectively (p < 0.001). Of the 69 participants who completed both pre- and post-education assessments, the average change in total score was +19.6% (p < 0.001), opioid knowledge score -0.4% (p = 0.901), and naloxone knowledge score +32.9% (p < 0.001). At baseline, HHWs were knowledgeable on opioid risks, but lacked familiarity with naloxone access and use. Targeting HHWs with opioid and naloxone training positions them to effectively educate at-risk community-dwelling older adults.