Amanda Giesler - Academia.edu (original) (raw)

Papers by Amanda Giesler

BMJ Open, Sep 1, 2022

Introduction The emergence of COVID-19 introduced a dual public health emergency in British Colum... more Introduction The emergence of COVID-19 introduced a dual public health emergency in British Columbia, which was already in the fourth year of its opioid-related overdose crisis. The public health response to COVID-19 must explicitly consider the unique needs of, and impacts on, communities experiencing marginalisation including people with opioid use disorder (PWOUD). The broad move to virtual forms of primary care, for example, may result in changes to healthcare access, delivery of opioid agonist therapies or fluctuations in co-occurring health problems that are prevalent in this population. The goal of this mixed-methods study is to characterise changes to primary care access and patient outcomes following the rapid introduction of virtual care for PWOUD. Methods and analysis We will use a fully integrated mixed-methods design comprised of three components: (a) qualitative interviews with family physicians and PWOUD to document experiences with delivering and accessing virtual visits, respectively; (b) quantitative analysis of linked, population-based administrative data to describe the uptake of virtual care, its impact on access to services and downstream outcomes for PWOUD; and (c) facilitated deliberative dialogues to co-create educational resources for family physicians, PWOUD and policymakers that promote equitable access to high-quality virtual primary care for this population. Ethics and dissemination Approval for this study has been granted by Research Ethics British Columbia. We will convene PWOUD and family physicians for deliberative dialogues to co-create educational materials and policy recommendations based on our findings. We will also disseminate findings via traditional academic outputs such as conferences and peer-reviewed publications.

Annals of Internal Medicine, 2013

Background: Opioid overdose is a leading cause of accidental death in the United States. Objectiv... more Background: Opioid overdose is a leading cause of accidental death in the United States. Objective: To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses. Design: Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society. Data Sources: Published literature calibrated to epidemiologic data.

CJEM, Jan 23, 2018

CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdos... more CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdose accept emergency department (ED)-based take-home naloxone (THN). What did this study ask? Why do at-risk ED patients refuse or accept THN? What did this study find? Those refusing THN felt: 1) not at risk of overdose; or 2) their ED visit was not the right time or place for THN. Those accepting THN wanted to save the lives of others. Why does this study matter to clinicians? Those refusing ED THN may accept THN elsewhere if referred to appropriate community services for overdose risk education and THN distribution.

Annals of emergency medicine, Jan 10, 2016

Although the World Health Organization recommends take-home naloxone to address the increasing gl... more Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance. At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance. Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as "Indigenous." Of...

JMIR Medical Education, 2019

United Nations publication, Sales No. E.16.XI.7 This publication may be reproduced in whole or in... more United Nations publication, Sales No. E.16.XI.7 This publication may be reproduced in whole or in part and in any form for educational or non-profit purposes without special permission from the copyright holder, provided acknowledgement of the source is made. The United Nations Office on Drugs and Crime (UNODC) would appreciate receiving a copy of any publication that uses this publication as a source.

BMJ Open, Sep 1, 2022

Introduction The emergence of COVID-19 introduced a dual public health emergency in British Colum... more Introduction The emergence of COVID-19 introduced a dual public health emergency in British Columbia, which was already in the fourth year of its opioid-related overdose crisis. The public health response to COVID-19 must explicitly consider the unique needs of, and impacts on, communities experiencing marginalisation including people with opioid use disorder (PWOUD). The broad move to virtual forms of primary care, for example, may result in changes to healthcare access, delivery of opioid agonist therapies or fluctuations in co-occurring health problems that are prevalent in this population. The goal of this mixed-methods study is to characterise changes to primary care access and patient outcomes following the rapid introduction of virtual care for PWOUD. Methods and analysis We will use a fully integrated mixed-methods design comprised of three components: (a) qualitative interviews with family physicians and PWOUD to document experiences with delivering and accessing virtual visits, respectively; (b) quantitative analysis of linked, population-based administrative data to describe the uptake of virtual care, its impact on access to services and downstream outcomes for PWOUD; and (c) facilitated deliberative dialogues to co-create educational resources for family physicians, PWOUD and policymakers that promote equitable access to high-quality virtual primary care for this population. Ethics and dissemination Approval for this study has been granted by Research Ethics British Columbia. We will convene PWOUD and family physicians for deliberative dialogues to co-create educational materials and policy recommendations based on our findings. We will also disseminate findings via traditional academic outputs such as conferences and peer-reviewed publications.

Annals of Internal Medicine, 2013

Background: Opioid overdose is a leading cause of accidental death in the United States. Objectiv... more Background: Opioid overdose is a leading cause of accidental death in the United States. Objective: To estimate the cost-effectiveness of distributing naloxone, an opioid antagonist, to heroin users for use at witnessed overdoses. Design: Integrated Markov and decision analytic model using deterministic and probabilistic analyses and incorporating recurrent overdoses and a secondary analysis assuming heroin users are a net cost to society. Data Sources: Published literature calibrated to epidemiologic data.

CJEM, Jan 23, 2018

CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdos... more CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdose accept emergency department (ED)-based take-home naloxone (THN). What did this study ask? Why do at-risk ED patients refuse or accept THN? What did this study find? Those refusing THN felt: 1) not at risk of overdose; or 2) their ED visit was not the right time or place for THN. Those accepting THN wanted to save the lives of others. Why does this study matter to clinicians? Those refusing ED THN may accept THN elsewhere if referred to appropriate community services for overdose risk education and THN distribution.

Annals of emergency medicine, Jan 10, 2016

Although the World Health Organization recommends take-home naloxone to address the increasing gl... more Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance. At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance. Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as "Indigenous." Of...

JMIR Medical Education, 2019

United Nations publication, Sales No. E.16.XI.7 This publication may be reproduced in whole or in... more United Nations publication, Sales No. E.16.XI.7 This publication may be reproduced in whole or in part and in any form for educational or non-profit purposes without special permission from the copyright holder, provided acknowledgement of the source is made. The United Nations Office on Drugs and Crime (UNODC) would appreciate receiving a copy of any publication that uses this publication as a source.