Satisfaction with group-based appointments among patients with opioid use disorder in an urban buprenorphine clinic.

Background: Successful implementation of group-based appointments can increase capacity to treat patients, reduce costs, and improve productivity. We sought to understand the acceptability of group-based appointments for opioid use disorder (OUD) in an urban clinical setting that treats predominantly ethnic minority populations. Methods: A survey collecting data on demographics, substance use, co-morbid psychiatric conditions, and satisfaction with group-based opioid treatment (GBOT) was conducted among patients 18 years and older with OUD attending an urban buprenorphine clinic between December 2019 and February 2020. Results: Thirty-nine patient surveys were completed. Among participants, 64.1% identified as Black/African American and 76.9% identified as male. The mean age was 51.2 years. Participants reported overall high levels of satisfaction with group-based appointments though GBOT was not strongly preferred over individual visits. On a 5-point Likert scale, 69.2% of participants agreed or strongly agreed that their medical needs were met during group-based appointments. A majority of participants agreed or strongly agreed that medical information received from the clinical team (97.4%) and other patients (82.1%) were valuable. Most participants (82.1%) reported adherence to treatment plans became easier since attending GBOT. Age and self-identified employment status as disabled or retired were positively associated with total satisfaction scores. Conclusions: Patients in a predominantly Black/African American and Hispanic/Latinx community with co-occurring mental health disorders and other substance use reported overall satisfaction with GBOT and would recommend this modality to other patients.

Incremental hospital utilization and mortality associated with co-morbid depression in pediatric hospitalizations.

OBJECTIVE: The objective of this study was to evaluate the association between hospital utilization and mortality and the presence of co-morbid depression in pediatric hospitalizations. METHODS: Using the Kids' Inpatient Database (KID) for 2012, a nationally representative database of all inpatient admissions in the United States of America for patients younger than 21 years of age compiled by the Health Care Utilization Project (HCUP), we obtained hospital records for children aged 6-20 years with any one of the 10 most common diagnoses in this population excluding affective disorders. After using one to one propensity score matching on age, race, gender, obesity, insurance type, hospital location and hospital size to ensure exchangeability between the groups, we compared the Length of Stay (LOS), Total Hospital Costs (THC) and mortality in children with and without reported comorbidity depression. We employed descriptive statistics and linear regression methods in our analyses RESULTS: A total of 667,968 discharges were extracted estimating a total of 937,971 discharges for children aged 6 - 20 with a primary diagnosis of any one of the 10 most common non-affective diagnoses in 2012. The prevalence of comorbid depression was about 2.9%. Propensity score matching produced 17,071 pairs. The mean LOS among patients with comorbid depression (4.63 days) was 0.89 days (95% CI: 0.74-1.05 days) higher than among patients without comorbid depression (3.74 days). The mean THC among patients with comorbid depression ($10,643) was $2,961 (95% CI: $2,401-$3,512) higher than among children without comorbid depression ($7,682). The odds of death as an outcome among the depressed was 1.77 (95% CI 1.13-2.77) times the odds among non-depressed patients. CONCLUSIONS: These findings show that comorbid depression significantly increases hospital utilization and mortality in childhood hospitalizations.

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population.

Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS.

Turkish doctors' cohort: healthy despite low screening.

OBJECTIVES: We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. METHODS: This was an observational, prospective cohort study that enrolled graduates between 1975 and 2004 from six medical schools in Turkey. Data on demographics, disease conditions, and unhealthy lifestyle behaviors were gathered. Preventive care practices were analyzed with regards to age and gender. RESULTS: A total of 7228 doctors participated in the study. Comparison with the national data revealed higher hyperlipidemia and coronary artery disease rates. While 54.5% of the doctors had a doctor visit in the last 12 months, only 31.5% of those over 40 years of age reported a recent blood pressure measurement. Colon cancer screening rate over 50 years of age with any of the acceptable methods was only 3%. One-fourth of the female doctors over 40 years of age underwent mammography within the last two years. Only 7.1% of the doctors over 65 years of age and 10% of the doctors having an indication for a chronic disease had a pneumococcal vaccine, while nearly one-fifth had no hepatitis B vaccine. CONCLUSION: In this cohort of mainly middle-aged Turkish doctors, the age-standardized rates of chronic diseases were lower than the rates in the general population except for the rates of hyperlipidemia and coronary artery disease. However, doctors did show quite low rates of receipt of screening practices. These results might provoke questions about how to use Turkish doctors' health behaviors to further improve doctors' and, relatedly, patients' health.

Linkage to Care for Suburban Heroin Users with Hepatitis C Virus Infection, New Jersey, USA.

We identified a 41.4% prevalence of hepatitis C virus, absence of HIV, and unexpectedly high frequency of hepatitis C virus genotype 3 among suburban New Jersey heroin users 17-35 years of age during 2014-2015. Despite 2 clinicians prepared to engage these users, few were successfully linked to care and treated.