cording to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Results: Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881).

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/208954/ioi70602.pdf

The AUDIT Alcohol consumption questions (AUDIT-C) : An effective brief screening test for problem drinking

Background Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P Conclusions Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482282/yoa60081_566_576.pdf

Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Alcohol Abuse and Dependence in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Despite efforts to recruit and retain more women, a stark gender disparity persists within academic science. Abundant research has demonstrated gender bias in many demographic groups, but has yet to experimentally investigate whether science faculty exhibit a bias against female students that could contribute to the gender disparity in academic science. In a randomized double-blind study (n = 127), science faculty from research-intensive universities rated the application materials of a student—who was randomly assigned either a male or female name—for a laboratory manager position. Faculty participants rated the male applicant as significantly more competent and hireable than the (identical) female applicant. These participants also selected a higher starting salary and offered more career mentoring to the male applicant. The gender of the faculty participants did not affect responses, such that female and male faculty were equally likely to exhibit bias against the female student. Mediation analyses indicated that the female student was less likely to be hired because she was viewed as less competent. We also assessed faculty participants’ preexisting subtle bias against women using a standard instrument and found that preexisting subtle bias against women played a moderating role, such that subtle bias against women was associated with less support for the female student, but was unrelated to reactions to the male student. These results suggest that interventions addressing faculty gender bias might advance the goal of increasing the participation of women in science.

/pdf/science-faculty-s-subtle-gender-biases-favor-male-students-1999g000ej.pdf

Science faculty’s subtle gender biases favor male students

The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.

/pdf/drug-dependence-a-chronic-medical-illness-implications-for-2ql87388e1.pdf

Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system per- formance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

/pdf/from-triple-to-quadruple-aim-care-of-the-patient-requires-3fmv5oblqa.pdf

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

The goals of this report are to describe the development of an inpatient-based alcohol and drug abuse consultation service in a university hospital. At the University of Wisconsin Hospital, we collected data on baseline diagnosis, health services, and costs for inpatients who received such a consultation in 1992-1993 (n = 1,098, 3.5% of all admissions). Follow-up interviews were conducted on a sample of 175 subjects. At the initial assessment, 65% were nicotine dependent, and 50% met criteria for alcohol dependence, 19% for alcohol abuse, 13% for alcohol and drug abuse/dependence. The average cost to patients for a consultation was $220. At the 6-month follow-up interview (n = 175), 42% of the subjects reported complete abstinence, 70% reported reductions in use, and 56% participated in an alcohol and drug treatment program. An inpatient-based alcohol and drug abuse consultation service provides a critical benefit that has not previously been offered in most academic medical centers.

Hospital-based alcohol and drug specialty consultation service: does it work?

In June 1998, there were 1.8 million inmates in correctional facilities for adults; 1.2 million in state and federal prisons and 600,000 in municipal/county jails (668 persons per 100,000 U.S. population). Rates of TB, AIDS, mental illness, and substance abuse are 2–13 times higher in persons living in jails and prisons. This study was designed to assess the level of training offered to residents in seven medical specialties in the care of addicted incarcerated persons. The study design involved two stages. The first entailed a mailed survey to 1,831 residency directors in family medicine, internal medicine, osteopathic medicine, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. The second stage was a telephone interview, about substance use disorders, of faculty listed by the residency directors as teaching residents. The mailed survey was completed by 1,205 residency directors (66%). The 769 faculty from those identified programs, who participated in the telephone interview, rep...

Medical Education About the Care of Addicted Incarcerated Persons: A National Survey of Residency Programs.

A significant portion of research project costs is incurred before the receipt of grant funds This poses a problem for the initiation of primary care research, especially in community practice settings Potential investigators need financial support for staff time, training, pilot work, and grant proposal writing if primary care researchers are to compete successfully for grant funds To find this support, we need to understand and eventually quantify the actual costs of research with attention to those that are incurred before the receipt of grant funds We outline 10 phases of the research process and provide a model for understanding where costs are incurred and by whom Costs include those associated with maintaining practice interest in research, supporting practice participation, and disseminating research findings They may be incurred by either an academic center or a research network, by the practices and physicians themselves, or by an extramural funding source The needed investment for initiating primary care research can be itemized and, with further research, quantified This will enhance the arguments for capital investments in the primary care research enterprise

The cost of primary care research.

Background Knee and hip osteoarthritis (KHOA) are common, chronic conditions affecting function, morbidity and mortality. Although the societal burden is high and guidelines are available to guide management, many patients do not receive recommended care. We investigated patient and physician perspectives on barriers and facilitators to KHOA guideline-based treatment and patient experiences in living with KHOA and navigating care. Methods Thirty-minute face-to-face interviews were conducted with primary care physicians and up to 4 patients of each physician at a US academic medical center. Physicians were recruited from 1 general internal medicine clinic and 1 family medicine clinic. All of their patients diagnosed with knee or hip osteoarthritis from 2008 to 2011 and under their care during the study period (2008-2015) were mailed study recruitment materials. Interviews were audio-recorded and transcribed. Content analysis was performed using QSR NVivo. Results Six of 19 physicians (31.6%) responded to the recruitment email and completed the interview. Seventy-three patients were sent recruitment letters; 18 (24.7%) expressed interest and 11 were scheduled for and completed the interview. Many patients reported a poor understanding of osteoarthritis and available treatment options and obtained most of their information from sources other than their medical team. They expressed fear of joint pain and often modified activities to avoid all pain. Many developed complex, time intensive treatment regimens that were not always evidence-based. Physicians expressed difficulties in managing osteoarthritis given time constraints and competing agenda items at appointments. Many felt that asking patients to make lifestyle changes for weight loss and exercise was daunting and unachievable. Both physicians and patients expressed interest in obtaining osteoarthritis education. Conclusions Although evidence-based treatments for KHOA exist, our study highlights patient and physician barriers to receipt of this care. Better educational resources and new models of care to address these barriers may contribute to improved osteoarthritis management.

Linda Baier Manwell

Papers

Hospital-based alcohol and drug specialty consultation service: does it work?

Medical Education About the Care of Addicted Incarcerated Persons: A National Survey of Residency Programs.

The cost of primary care research.

Patient and physician perceptions of knee and hip osteoarthritis care: A qualitative study.

The Effect of Workplace Health Care Worker Stress and Burnout on Patient Outcomes