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Correction: Educational training to improve opioid overdose response among health center staff: a quality improvement initiative

Stephenson, Audrey; Calvo-Friedman, Alessandra; Altshuler, Lisa; Zabar, Sondra; Hanley, Kathleen
PMID: 37533047
ISSN: 1477-7517
CID: 5618962

Addressing Health-Related Social Needs-Costs and Optimism

Clapp, Jenifer; Calvo-Friedman, Alessandra; Davis, Nichola
PMID: 37252719
ISSN: 2168-6114
CID: 5543212

Educational training to improve opioid overdose response among health center staff: a quality improvement initiative

Stephenson, Audrey; Calvo-Friedman, Alessandra; Altshuler, Lisa; Zabar, Sondra; Hanley, Kathleen
BACKGROUND:There were seven opioid overdoses in this New York City (NYC) federally qualified health center from December 2018 through February 2019, reflecting the rising rate of overdose deaths in NYC overall at the time. In response to these overdoses, we sought to increase the readiness of health center staff to recognize and respond to opioid overdoses and decrease stigmatizing attitudes around opioid use disorder (OUD). METHODS:An hour-long training focusing on opioid overdose response was administered to clinical and non-clinical staff of all levels at the health center. This training included didactic education on topics such as the overdose epidemic, stigma around OUD, and opioid overdose response, as well as discussion. A structured assessment was administered immediately before and following the training to evaluate change in knowledge and attitudes. Additionally, participants completed a feedback survey immediately after the training to assess acceptability. Paired t-tests and analysis of variance tests were used to assess changes in pre- and post-test scores. RESULTS:Over 76% of the health center staff participated in the training (N = 310). There were large and significant increases in mean knowledge and attitudinal scores from pre- to post-test (p < .001 and p < .001, respectively). While there was no significant effect of profession on attitudinal change scores, profession did have a significant effect on knowledge change scores, with administrative staff, non-clinical support staff, other healthcare staff, and therapists learning significantly more than providers (p < .001). The training had high acceptability among participants from diverse departments and levels. CONCLUSIONS:An interactive educational training increased staff's knowledge and readiness to respond to an overdose as well as improved attitudes toward individuals living with OUD. TRIAL REGISTRATION/BACKGROUND:This project was undertaken as a quality improvement initiative at the health center and as such was not formally supervised by the Institutional Review Board per their policies. Further, per the guidelines of the International Committee of Medical Journal Editors, registration is not necessary for clinical trials whose sole purpose is to assess an intervention's effect on providers.
PMCID:10311901
PMID: 37391790
ISSN: 1477-7517
CID: 5538762

Scaling Primary Care Social Needs Screening and Referrals in New York City's Safety-Net Health System

Calvo-Friedman, Alessandra; Clapp, Jenifer; Kumar, Samantha Lily; Adams, Ayrenne; Gogia, Kriti; Davis, Nichola J.
Identifying and addressing patients' social health are essential to addressing health equity. Screening for social needs and connecting patients to resources in clinical settings is one way to identify and address the social factors that contribute to health. Policy makers are increasingly turning to incentivizing and requiring social needs screening and referrals to encourage health systems to identify and address patient social needs. NYC Health + Hospitals implemented and scaled social needs screening and referrals starting in 2017 across primary care clinical sites. The health system's approach was to focus on screening for patients' highest-priority needs for which there were available resources, to prioritize effective screening and referrals over universal screening, and to establish referral workflows. Implementing meaningful social needs screening and referrals requires a significant investment in creating screening workflows and in building key resources to meet patient needs.
SCOPUS:85165471627
ISSN: 2642-0007
CID: 5548702

An Unconditional Cash Transfer Program for Low-Income New Yorkers Affected by COVID-19

Kumar, Samantha Lily; Calvo-Friedman, Alessandra; Freeman, Amy L; Fazio, Daniela; Johnson, Amanda K; Seiferth, Fionnuala; Clapp, Jenifer; Davis, Nichola J; Schretzman, Maryanne; Springer, Bethany; Arcilla, Harmony N; Kaplan, Sue A; Berry, Carolyn A; Doran, Kelly M
Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings.
PMCID:9555690
PMID: 36224486
ISSN: 1468-2869
CID: 5341042

Can residents identify and manage opioid overdose?

Lynn, Meredith; Calvo-Friedman, Alessandra; Hanley, Kathleen; Wilhite, Jeff
PMID: 32951250
ISSN: 1365-2923
CID: 4605312

The COVID-19 Shadow Pandemic: Meeting Social Needs For A City In Lockdown

Clapp, Jenifer; Calvo-Friedman, Alessandra; Cameron, Susan; Kramer, Natalie; Kumar, Samantha Lily; Foote, Emily; Lupi, Jenna; Osuntuyi, Opeyemi; Chokshi, Dave A
Addressing patients' social needs is key to helping patients heal from coronavirus disease 2019 (COVID-19), preventing the spread of the virus, and reducing its disproportionate burden on low-income communities and communities of color. New York City Health + Hospitals (NYC H+H) is the city's single largest healthcare provider to Medicaid and uninsured patients. In response to the COVID-19 pandemic, NYC H+H staff developed and executed a strategy to meet patients' intensified social needs during the COVID-19 pandemic. NYC H+H identified food, housing, and income support as patients' most pressing needs and built programming to quickly connect patients to these resources. While NYC H+H was able to build on its existing foundation of strong social work support of patients, all health systems must prioritize the social needs of patients and their families to mitigate the damage of COVID-19. National and local leaders should accelerate change by developing robust policy approaches to redesign the social and economic system that reinforces structural inequity and exacerbates crises like COVID-19. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].
PMID: 32673101
ISSN: 1544-5208
CID: 4528352

ADDRESSING FOOD INSECURITY THROUGH A PRIMARY CARE/CBO PARTNERSHIP [Meeting Abstract]

Bryan, Alexander; Calvo-Friedman, Alessandra; Mclean, Mireille; Hennessey, Zachariah; Kim, Grace; Rabiee, Lara; Davis, Nichola
ISI:000567143602091
ISSN: 0884-8734
CID: 4799342

RAPID RESPONSE TEAM TO THE CLINIC BATHROOM!: CAN RESIDENTS IDENTIFY AND MANAGE OPIOID OVERDOSE? [Meeting Abstract]

Lynn, Meredith; Hayes, Rachael; Hanley, Kathleen; Zabar, Sondra R.; Calvo-Friedman, Alessandra; Wilhite, Jeffrey
ISI:000567143602366
ISSN: 0884-8734
CID: 4800082

From overdose to buprenorphine in take in under one hour! [Meeting Abstract]

Calvo-Friedman, A; Lynn, M; Arbach, A; Hanley, K; Zabar, S
Learning Objective #1: Recognize and manage opioid overdose in a community health center setting Learning Objective #2: Improve linkage to effective treatment for opioid use disorder after overdose CASE: A 54 yo man was found unresponsive at the door of our community health center. Rapid Response was called and the patient was found to be unresponsive to sternal rub, with 6 breaths per minute, and pinpoint pupils. One dose of 4mg of intranasal naloxone was administered, and soon the patient was alert and oriented. He declined transfer to the ED but was amenable to observation, stating that he had just purchased his usual 3 bags and used them outside of his primary care clinic. His PMH was notable for 36 years of IV/intranasal heroin use, prior stroke, GERD, glaucoma, hyperlipidemia, lumbar radiculopathy, and tobacco use. He had one overdose in the 1990s, attempted detox several times and tried self-treating himself with methadone and buprenorphine. He lived with his girlfriend and was unemployed. His medications included cyclobenzaprine and ranitidine. The medical assistant from our addiction medicine clinic engaged the patient, who reported that the overdose scared him, and offered medication treatment which he accepted. The addiction clinic nurse and physician saw the patient that day and gave an initial buprenorphine prescription, instructions and follow-up appointment. He is now stable on buprenorphine 8mg daily. IMPACT/DISCUSSION: The overdose described in this case represents one of three overdoses in the past month at our NYC health center. Urban health centers often serve as community hubs and may be seen as a safer place to use opioids. Overdoses at community health centers represent an important point of patient engagement in treatment for OUD. Treatment with opioid agonist therapy after overdose has been shown to reduce all-cause and opioid-related mortality. However, only a small percentage of patients receive medication therapy after overdose. (Larochelle et al. Annals of Internal Medicine. 2018) Initiation of medication treatment for OUD at the time of ED presentation has also been shown to improve engagement in treatment. (DOnofrio et al. JAMA 2015.) Institutional commitment to training all providers and staff to recognize the signs of opioid overdose and administer intranasal naloxone has direct impact on patient outcomes. Our experience with this case has demonstrated the importance of immediate engagement in care at the time of overdose. Having a team available at the time of overdose that cares for patients with addiction enabled us to quickly engage this patient in care and start medication therapy when he felt most receptive to treatment.
Conclusion(s): Our case demonstrates two crucial steps for improving outcomes in opioid overdose: widespread availability of and training for intranasal naloxone use, along with community health sites equipped to treat patients with opioid use disorder at the time of overdose
EMBASE:629002504
ISSN: 1525-1497
CID: 4053042