RESUMEN
PURPOSE: Examine use of office resources by primary care patients who were initially evaluated through telehealth, telephone, or in-person encounters. METHODS: Retrospective electronic health record review on patients seen in March 2020 for evaluation of potential COVID-19 symptoms, to assess the total number of interactions with physicians and office staff. RESULTS: Of 202 patients, 89 (44%) had initial telehealth, 55 (27%) telephone, and 52 (26%) in-person encounters. Patients initially evaluated through telehealth, telephone, and in-person encounters had a mean of 6.1 (S.D. = 3.7), 5.2 (S.D. = 3.6), and 4.5 (S.D. = 3.0) total interactions with the office, respectively (P = .03), and 9%, 12.7%, and 19.2%, respectively, had a subsequent in-person or emergency department visit (P = .22). Multivariable analysis showed no differences in number of office interactions based on initial visit type; older patients (95% CI = 0.00-0.07) and those with subjective fevers (95% CI = 1.01-3.01) or shortness of breath (95% CI = 0.23-2.28) had more interactions with the office. CONCLUSION: Primary care providers used virtual visits to care for most patients presenting with potential COVID-19 symptoms, with many patients choosing telephone over telehealth visits. Virtual visits can successfully limit patient exposure to other people, and consideration could be given to increasing its use for patients with potential symptoms of COVID-19.
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COVID-19/diagnóstico , Atención Primaria de Salud/métodos , Telemedicina/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Teléfono/estadística & datos numéricos , Adulto JovenRESUMEN
AIMS: To evaluate the efficacy and safety of the PROMETA™ Protocol for treating methamphetamine dependence. DESIGN: A double-blind, placebo-controlled 108-day study with random assignment to one of two study conditions: active medication with flumazenil (2 mg infusions on days 1, 2, 3, 22, 23), gabapentin (1200 mg to day 40) and hydroxazine (50 mg to day 10) versus placebo medication (with active hydroxazine only). SETTING: Three substance abuse treatment clinics: two in-patient, one out-patient. PARTICIPANTS: Treatment-seeking, methamphetamine-dependent adults (n = 120). MEASUREMENTS: Primary outcome was percentage of urine samples testing negative for methamphetamine during the trial. FINDINGS: No statistically significant between-group differences were detected in urine drug test results, craving, treatment retention or adverse events. CONCLUSIONS: The PROMETA protocol, consisting of flumazenil, gabapentin and hydroxyzine, appears to be no more effective than placebo in reducing methamphetamine use, retaining patients in treatment or reducing methamphetamine craving.
Asunto(s)
Trastornos Relacionados con Anfetaminas/rehabilitación , Moduladores del GABA/administración & dosificación , Agonistas de los Receptores Histamínicos/administración & dosificación , Metanfetamina , Adulto , Aminas/administración & dosificación , Aminas/efectos adversos , Ácidos Ciclohexanocarboxílicos/administración & dosificación , Ácidos Ciclohexanocarboxílicos/efectos adversos , Método Doble Ciego , Combinación de Medicamentos , Femenino , Flumazenil/administración & dosificación , Flumazenil/efectos adversos , Moduladores del GABA/efectos adversos , Gabapentina , Agonistas de los Receptores Histamínicos/efectos adversos , Humanos , Hidroxizina/administración & dosificación , Hidroxizina/efectos adversos , Infusiones Intravenosas , Masculino , Cumplimiento de la Medicación , Autoinforme , Ácido gamma-Aminobutírico/administración & dosificación , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
Acknowledging the growing disparities in health and health care that exist among immigrant families and minority populations in large urban communities, the UCLA Department of Family Medicine (DFM) sought a leadership role in the development of family medicine training and community-based participatory research (CBPR). Performing CBPR requires that academic medicine departments build sustainable and long-term community partnerships. The authors describe the eight-year (2000-2008) process of building sustainable community partnerships and trust between the UCLA DFM and the Sun Valley community, located in Los Angeles County.The authors used case studies of three research areas of concentration (asthma, diabetes prevention, and establishing access to primary care) to describe how they established community trust and sustained long-term community research partnerships. In preparing each case study, they used an iterative process to review qualitative data.Many lessons were common across their research concentration areas. They included the importance of (1) having clear and concrete community benefits, (2) supporting an academic-community champion, (3) political advocacy, (4) partnering with diverse organizations, (5) long-term academic commitment, and (6) medical student involvement. The authors found that establishing a long-term relationship and trust was a prerequisite to successfully initiate CBPR activities that included an asthma school-based screening program, community walking groups, and one of the largest school-based primary care clinics in the United States.Their eight-year experience in the Sun Valley community underscores how academic-community research partnerships can result in benefits of high value to communities and academic departments.
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Investigación Participativa Basada en la Comunidad/organización & administración , Relaciones Comunidad-Institución , Medicina Familiar y Comunitaria/educación , Atención Primaria de Salud/organización & administración , Facultades de Medicina/organización & administración , Adulto , Asma/prevención & control , Niño , Diabetes Mellitus/prevención & control , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Desarrollo de ProgramaRESUMEN
Bupropion hydrochloride is a dopamine and norepinephrine reuptake inhibitor which may be an effective treatment for cocaine dependence due to its ability to reverse deficits in dopaminergic functioning that occur in chronic cocaine users. We performed a randomized, double-blind, placebo controlled trial comparing outpatient treatment with bupropion (N = 37) and placebo (N = 33) in combination with standard cognitive behavioral therapy. There were no statistically significant differences between bupropion and placebo in treatment outcomes, including aggregate measures of urine drug screen results (Joint Probability Index at 16 weeks: 0.43 for bupropion and 0.38 for placebo), treatment retention, cocaine craving ratings, and assessments of depressive symptoms. The failure to find an effect for bupropion relative to placebo, when combined with standard cognitive behavioral therapy, dampens enthusiasm for future development of bupropion as a cocaine pharmacotherapy.