Abstract Session A3: Health Disparities/Vulnerable Populations - PDF document

Abstract Session A3: Health Disparities/Vulnerable Populations Moderators: Gail Daumit, MD, MHS and Monica E. Peek, MD, MPH **This session is one of two piloting a short abstract presentation style** ILLICIT BUPRENORPHINE USE, AND ACCESS TO AND INTEREST IN BUPRENORPHINE TREATMENT Aaron Fox 1,2 ; Adam Chamberlain 2 ; Taeko M. Frost 3 ; Chinazo Cunningham 1,2 . 1 Montefiore Medical Center, Bronx, NY; 2 Albert Einstein College of Medicine, Bronx, NY; 3 Washington Heights CORNER Project, New York, NY. (Tracking ID #1927780) BACKGROUND: In the United States, the opioid addiction epidemic is escalating; however, there is a large gap (nearly 1.5 million persons) between those in need of treatment and those who receive treatment. Primary care physicians have the opportunity to address this treatment gap by offering buprenorphine maintenance therapy (BMT), but access to treatment may not be adequate to meet the current demand. Recently, diversion of buprenorphine has received major media attention, where concerns were raised about illicit buprenorphine use to get high; however, qualitative studies have suggested that opioid users may use illicit buprenorphine to "self- treat" their opioid addiction, especially if they experience barriers to BMT. This study investigated illicit buprenorphine use among syringe exchange participants, a group with high needs for opioid addiction treatment, and explored whether illicit use was associated with access to BMT and interest in initiating BMT. METHODS: Syringe exchange participants were recruited from the offices of a harm reduction agency in New York City. Computer-based interviews were conducted to determine: 1) prior use of buprenorphine (illicit and prescribed); 2) access to BMT (perceived barriers); and 3) interest in BMT (overall interest in BMT and likelihood of initiating treatment). Overall interest was measured using a 5-point Likert scale; those rating their level of interest as 4 or 5 were considered to be interested in BMT. Access to and interest in BMT were compared between illicit buprenorphine users and non-users using chi square or t-tests. RESULTS: Of 102 opioid users, 57 had used illicit buprenorphine (34 with illicit buprenorphine use only; 23 with illicit and prescribed buprenorphine use). Nine participants had used prescribed buprenorphine only. Overall, 45% of participants were interested in BMT. Regarding access, the most common barrier to BMT was, "did not know where to get treatment," which was reported by 51% of participants. Other common barriers were costs (33%) and transportation (28%). Compared to those who had never used illicit buprenorphine, not knowing where to get treatment was more common among illicit buprenorphine users (64% vs. 36%, p < 0.01), overall interest in BMT was greater among illicit buprenorphine users (mean ± SD; 3.37 ± 1.29 vs. 2.80 ± 1.34, p = 0.03), and more illicit buprenorphine users reported they would be likely to initiate BMT if it were easily accessible (82% vs. 50%, p < 0.01). CONCLUSIONS: Illicit buprenorphine use was common. A majority of illicit buprenorphine users were interested in BMT and reported that they would be likely to initiate treatment, but nearly two-thirds of illicit users did not know where to access BMT. Therefore, relatively simple interventions that address barriers to BMT (e.g. linking illicit buprenorphine users to practices that offer BMT or initiating BMT onsite at harm reduction agencies) could reduce illicit buprenorphine use, narrow the treatment gap, and diminish the tragic consequences of opioid addiction.

IMPACT OF HEALTH COACHING ON PATIENT TRUST IN THEIR PRIMARY CARE PROVIDER: A RANDOMIZED CONTROLLED TRIAL David Thom; Danielle Hessler; Rachel Willard-Grace; Thomas Bodenheimer; Adriana Najmabadi; Christina Araujo; Ellen Chen. UCSF, San Francisco, CA. (Tracking ID #1928972) BACKGROUND: In primary care, there has been a move to share tasks and responsibilities traditionally reserved for the primary care provider (PCP) with other members of the patient care team, including medical assistants, nurses, pharmacists, patent educators and coaches. Concern has been raised regarding the impact o f the ‘team approach' on the quality of the patient -provider relationship. We analyzed data from a randomized controlled trial comparing health coaching to usual care to assess the impact of health coaching on patients' relationship with their primary care provider (PCP). METHODS: Randomized controlled trial comparing health coaching with usual care. Participants were low-income English or Spanish speaking patients age 18 to 75 with poorly controlled type 2 diabetes, hypertension and/or hyperlipidemia. Health coaches were certified medical assistants who attended 40 hours of health coach training over six weeks using a curriculum developed by the study team that included instruction in using active listening and non-judgmental communication; helping with self-management skills including creation of action plans, and providing social and emotional support. Patient trust in their primary care provider measured by the 11-item Trust in Physician Scale, converted to a 0 to 100 scale. Patient satisfaction with their PCP was assessed by a single item, "How likely would you be to recommend your doctor to your friend or relative?" with a response scale from 1='definitely not recommend' to 5= ‘definitely recommend'. Data were analyzed using linear mixed modeling. P -values were two-tailed. RESULTS: A total of 441 patients were randomized to receive 12 months of health coaching (n=224) vs. usual care (n=217). At baseline, there were no significant differences in participant characteristics between the two study arms, including trust in their PCP (Table 1). At 12 months, trust and satisfaction were reported by 203 patients (91%) in the health coaching group and 175 of patients (81%) in the usual care group. Both the mean level of patients' trust in their PCP and the percent of patients who would definitely recommend their primary care provider to family or friends increased significantly more in patients receiving health coaching (Table 2). These differences remained significant after adjustment for number of PCP visits during the study. CONCLUSIONS: Health coaching does not appear to lower, and in fact may increase, patients' trust in their primary care providers. Clinicians should be reassured that working with health coaches does not appear to compromise, and may in fact enhance, their relationships with their patients. Table 1. Participant characteristics at enrollment by study arm (% or mean (sd))* Characteristic Health coaching arm (n=224) Usual care arm (n=217) Age (years) 52.6 (10.7) 52.9 (11.5) Gender (female) 52% 59% Born in the US 26% 25% Years living in US** 18.5 (10.4) 17.9 (11.9) Spanish is primary language 68% 70% Race/Ethnicity: African American 20% 18% Latino or Hispanic 69% 71% White non-Hispanic/Asian/Other 11% 11% Education less than high school 44% 44% Annual household income < $10,000 60% 56% Trust score 72.4 (12.4) 72.7 (12.7) Would definitely recommend PCP 57% 59% * There were no statistically significant differences by study arm. ** For participants born outside the United States Table 2. Change in patient trust in and satisfactions with the primary care provider (PCP) and number of visits to the PCP from baseline to 12 months Change in health coach Change in usual care Difference in p- Adjusted p- Outcome 95% CI group group change value value 0.03 to Patient Trust score (mean) + 3.8 +1.4 2.4 .047 .033* 4.8 Definitely recommend PCP 5% to +16.3% +4.0% 12.3% .002 .015* (%) 24% *Adjusted for number of visits to PCP during 12 month intervention.