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Over-prescription of opioid medications for chronic pain has been a major driver of the opioid abuse epidemic. Arizona has an opioid prescription rate of 50.7/100 persons annually, which is about the average US rate of 51.4/100 persons. Novel approaches to treat chronic pain and reduce opioid overuse are promptly needed. Using analysis of Medicaid prescribing data from across Arizona, Mountain Park Health Center was identified to have the lowest opioid prescribing rates among all Community Health Centers (CHC) in Arizona (14.2/100 persons) using analysis of Medicaid prescribing data from across Arizona. A healthy work culture of patient engagement, behavioral health integration into primary care (BHI), and active case management of SDoH issues were critical to successful opioid prescribing and management. In order to account for the complex systemic contributors towards opioid over-prescription, the underlying theoretical framework, positive deviance (PD), was used to uncover effective practices for notably low opioid prescribing. Focus groups of interdisciplinary provider teams (physicians, nurses, pharmacists, and behavioral health) were structured around the PD inquiry approach. Participants were asked about practice and culture factors that might foster or enable low-prescribing practices. Focus group interviews were audio-recorded and transcribed. Six critical themes were identified after extensive qualitative analysis of focus group transcripts: medication management; non-opioid pain management; service integration; preventive strategies; patient and family engagement; underlying factors (including medical/behavior comorbidity and socioeconomic factors). These findings illustrate that this CHC system has a culture which values a high level of care integration, internal systems, and community partnerships to address patient social determinants of health, and patient engagement and provider norms to provide alternatives to opioid prescription. Behavioral health integration into the care team is another key aspect of the culture. Our findings, if confirmed in other settings, could be useful in planning organizational interventions and training. We anticipate that efforts to implement and spread these approaches may be effective in decreasing opioid overuse, promoting health equity by targeting CHCs with room for improvement, and informing the larger research goals: to inform practice change and opioid prescribing across Arizona CHCs.
ContributorsCheng, Esther (Author) / Doebbeling, Bradley (Thesis director) / Daniulaityte, Raminta (Committee member) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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The social determinants of drug use are critical factors that influence patterns of substance use across urban and rural populations. This paper explores these determinants by comparing the prevalence and types of drug use within these diverse environments, drawing upon data and insights from recent studies. In urban areas, the variety and availability of drugs, coupled with socioeconomic disparities and cultural diversity, lead to distinct patterns of drug use. Conversely, rural areas face challenges like limited healthcare access and higher rates of prescription opioid misuse, often exacerbated by economic and social isolation. Significant differences in the social fabric between urban and rural settings influence drug use behaviors. Urban environments, characterized by dense populations and a wide array of available substances, report higher incidences of cocaine, heroin, and synthetic drug use. These areas often benefit from more extensive healthcare services but also face challenges such as higher levels of homelessness and crime, influencing substance use patterns. In contrast, rural areas deal with issues such as limited healthcare services and greater social stigma, which can deter individuals from seeking help, thus perpetuating cycles of substance abuse. This study underscores the importance of understanding the social determinants of health as they pertain to drug use. Factors like socioeconomic status, education, age, religion, gender, and sexual orientation play significant roles in shaping these patterns. By addressing these root causes through targeted public health interventions and policies, it is possible to effectively mitigate the impact of drug use across both urban and rural landscapes. This approach not only aids in substance abuse prevention but also ensures that interventions are equitable and culturally sensitive, thereby improving public health outcomes for diverse populations. The findings highlight the need for comprehensive strategies that consider both the unique and shared challenges faced by urban and rural communities in managing drug use. This nuanced understanding is crucial for developing interventions that are not only effective but also inclusive, addressing the broader social and economic dynamics that contribute to substance abuse.
ContributorsBahl, Shivani (Author) / Smith, Lisa (Thesis director) / Daniulaityte, Raminta (Committee member) / Barrett, The Honors College (Contributor) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor)
Created2024-05