Publications
Department of Medicine faculty members published more than 3,000 peer-reviewed articles in 2022.
2017
BACKGROUND
Improving the safety of prescribed opioids in clinical settings is a national priority. While co-prescribing naloxone is increasingly recommended, there is little understanding of the optimal way to implement this practice.
METHODS
We developed and delivered an academic detailing intervention to 40 randomly selected opioid-prescribing primary care providers in San Francisco from February to May 2015. Process outcomes were tracked and included provider demographics, number and type of contact attempts, reason for refusal (if applicable), name of detailer, duration of intervention, topics covered, provider concerns, and follow-up plan. Outcome evaluation included changes in the rate of naloxone prescriptions 4 months before and after academic detailing by provider based on de-identified Medi-Cal claims data. Using a difference-in-differences approach, we developed a negative binomial regression model to compare changes in naloxone prescribing to Medi-Cal patients between providers that did and did not receive the intervention.
RESULTS
Eighty-three percent of 48 providers contacted accepted the intervention after a mean of 2.6 contacts. Detailing lasted a mean of 28 minutes (range 5-60 minutes) and most frequently covered indications for naloxone, examples of naloxone prescriptions, language to use with patients, and pharmacy outreach. Those who received the academic detailing had a significantly greater increase in naloxone prescriptions compared to those who did not receive the intervention (IRR=11.0, 95%CI=1.8-67.8, P=.010).
CONCLUSIONS
Academic detailing addressing opioid safety and naloxone prescribing was well-received by primary care providers and associated with an increase in naloxone prescriptions filled by Medi-Cal patients.
View on PubMed2017
2017
OBJECTIVES
The study compared health care utilization and costs among homeless veterans randomly assigned to peer mentors or usual care and described contacts with peer mentors.
METHODS
Homeless patients at four Department of Veterans Affairs clinics were randomly assigned to a peer mentor (N=195) or to usual care (N=180). Administrative data on utilization and costs over a six-month follow-up were combined with peer mentors' reports of patient contacts.
RESULTS
Most patients (87%) in the peer mentor group had at least one peer contact. Patients in this group spent the largest proportions of time discussing housing and health issues with peer mentors and had more outpatient encounters than those in usual care, although differences were not significant. No other between-group differences were found in utilization or costs.
CONCLUSIONS
Although significant impacts of peer mentors on health care patterns or costs were not detected, some patients had frequent contact with peer mentors.
View on PubMed2017
2017
2017
2017