Michelle Geier - Academia.edu (original) (raw)
Papers by Michelle Geier
Journal of Pharmacy Practice
Background: The San Francisco Department of Public Health initiated naloxone prescribing at 6 saf... more Background: The San Francisco Department of Public Health initiated naloxone prescribing at 6 safety net clinics. We evaluated this intervention, demonstrating that naloxone prescribing from primary care clinics is feasible and acceptable. Objective: To evaluate acceptability of naloxone dispensing to patients prescribed opioids among pharmacists serving clinics participating in a naloxone intervention. Methods: We surveyed 58 pharmacists from November 2013 through January 2015 at pharmacies that serviced San Francisco safety net clinics. Surveys collected information on demographics, experiences in dispensing naloxone, and interest in prescriptive authority. We conducted descriptive analyses and assessed bivariate relationships. Results: Most respondents were staff (56.9%) or supervising pharmacists (34.5%). Most (92.9%) were aware their pharmacy stocked naloxone and 86.8% felt it should be prescribed to some or all patients on long-term opioids. Most (82.1%) dispensed naloxone at ...
The primary care companion for CNS disorders, Jan 31, 2018
To describe the effect of a multimodal intervention targeting chronic benzodiazepine and sedative... more To describe the effect of a multimodal intervention targeting chronic benzodiazepine and sedative-hypnotic prescriptions in a large behavioral health system. This retrospective study analyzed chronic sedative-hypnotic prescription rates in patients seeking mental health services in a large behavioral health system. The multimodal intervention consisted of provider education, coordination of care with all providers involved in patient care, and guideline development and implementation for safe prescribing of sedative-hypnotics. Three time periods were analyzed: preintervention (October 2013-December 2013), 12-month assessment (October 2014-December 2014), and 24-month assessment (October 2015-December 2015). The primary outcome of the study was the change in frequency of chronic (≥ 60 days) sedative-hypnotic prescriptions received before and after the multimodal intervention. The secondary outcome included the change in prescription rates in a priori-defined cohorts: patients on meth...
Journal of substance abuse treatment, 2018
Extended-release naltrexone (XRNTX) is an effective treatment for alcohol use disorder (AUD). We ... more Extended-release naltrexone (XRNTX) is an effective treatment for alcohol use disorder (AUD). We sought to evaluate the feasibility, acceptability, and preliminary effectiveness and cost-effectiveness of XRNTX delivered as a stand-alone service to persons with severe AUD who are high utilizers of multiple urgent and emergency medical services (HUMS). Of 15 HUMS persons with severe AUD selected based on chart review, 11 agreed to participate. Participants received a mean of 4.5 injections (range 2-7). Modest benefits from XRNTX were observed in terms of patients' Urge-to-Drink Score and the costs of emergency medical services utilized. Though limited by a small sample size, costs including client utilization and study related expenses during the post-enrollment period were less than client utilization costs in the pre-enrollment period. We also observed non-significant improvements in the number of drinking days, but no change in quality of life as measured by the EQ-5D. Eighty-e...
Mental Health Clinician
Introduction: Sublingual buprenorphine is indicated for opioid dependence. It comes in 2 formulat... more Introduction: Sublingual buprenorphine is indicated for opioid dependence. It comes in 2 formulations: a mono buprenorphine product (BUP) and a combination product containing naloxone (BUP-NAL), which functions as an abuse deterrent. Sublingual naloxone does not reach clinically significant levels except in cases of hepatic impairment, where its metabolism can be impaired. Substantial naloxone accumulation could block the therapeutic effects of buprenorphine. The risk of hepatic impairment is elevated in the opioid dependence population, and our case highlights the need for careful evaluation of hepatic function and consideration of BUP. Case/Results: We report a patient with end-stage liver disease who began BUP-NAL induction with modest improvement on treatment day 1 followed by sustained withdrawal after receiving an observed dose on day 2. He returned to the clinic 2 days after his second successive day of BUP-NAL, vomiting and complaining of persistent withdrawal. To avoid pote...
Mental Health Clinician, 2012
Mental Health Clinician, 2015
CNS Spectrums, 2014
The purpose of this investigation was to assess detection and treatment rates for perinatal depre... more The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period. Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well. A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting. Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.
Journal of Pharmacy Practice
Background: The San Francisco Department of Public Health initiated naloxone prescribing at 6 saf... more Background: The San Francisco Department of Public Health initiated naloxone prescribing at 6 safety net clinics. We evaluated this intervention, demonstrating that naloxone prescribing from primary care clinics is feasible and acceptable. Objective: To evaluate acceptability of naloxone dispensing to patients prescribed opioids among pharmacists serving clinics participating in a naloxone intervention. Methods: We surveyed 58 pharmacists from November 2013 through January 2015 at pharmacies that serviced San Francisco safety net clinics. Surveys collected information on demographics, experiences in dispensing naloxone, and interest in prescriptive authority. We conducted descriptive analyses and assessed bivariate relationships. Results: Most respondents were staff (56.9%) or supervising pharmacists (34.5%). Most (92.9%) were aware their pharmacy stocked naloxone and 86.8% felt it should be prescribed to some or all patients on long-term opioids. Most (82.1%) dispensed naloxone at ...
The primary care companion for CNS disorders, Jan 31, 2018
To describe the effect of a multimodal intervention targeting chronic benzodiazepine and sedative... more To describe the effect of a multimodal intervention targeting chronic benzodiazepine and sedative-hypnotic prescriptions in a large behavioral health system. This retrospective study analyzed chronic sedative-hypnotic prescription rates in patients seeking mental health services in a large behavioral health system. The multimodal intervention consisted of provider education, coordination of care with all providers involved in patient care, and guideline development and implementation for safe prescribing of sedative-hypnotics. Three time periods were analyzed: preintervention (October 2013-December 2013), 12-month assessment (October 2014-December 2014), and 24-month assessment (October 2015-December 2015). The primary outcome of the study was the change in frequency of chronic (≥ 60 days) sedative-hypnotic prescriptions received before and after the multimodal intervention. The secondary outcome included the change in prescription rates in a priori-defined cohorts: patients on meth...
Journal of substance abuse treatment, 2018
Extended-release naltrexone (XRNTX) is an effective treatment for alcohol use disorder (AUD). We ... more Extended-release naltrexone (XRNTX) is an effective treatment for alcohol use disorder (AUD). We sought to evaluate the feasibility, acceptability, and preliminary effectiveness and cost-effectiveness of XRNTX delivered as a stand-alone service to persons with severe AUD who are high utilizers of multiple urgent and emergency medical services (HUMS). Of 15 HUMS persons with severe AUD selected based on chart review, 11 agreed to participate. Participants received a mean of 4.5 injections (range 2-7). Modest benefits from XRNTX were observed in terms of patients' Urge-to-Drink Score and the costs of emergency medical services utilized. Though limited by a small sample size, costs including client utilization and study related expenses during the post-enrollment period were less than client utilization costs in the pre-enrollment period. We also observed non-significant improvements in the number of drinking days, but no change in quality of life as measured by the EQ-5D. Eighty-e...
Mental Health Clinician
Introduction: Sublingual buprenorphine is indicated for opioid dependence. It comes in 2 formulat... more Introduction: Sublingual buprenorphine is indicated for opioid dependence. It comes in 2 formulations: a mono buprenorphine product (BUP) and a combination product containing naloxone (BUP-NAL), which functions as an abuse deterrent. Sublingual naloxone does not reach clinically significant levels except in cases of hepatic impairment, where its metabolism can be impaired. Substantial naloxone accumulation could block the therapeutic effects of buprenorphine. The risk of hepatic impairment is elevated in the opioid dependence population, and our case highlights the need for careful evaluation of hepatic function and consideration of BUP. Case/Results: We report a patient with end-stage liver disease who began BUP-NAL induction with modest improvement on treatment day 1 followed by sustained withdrawal after receiving an observed dose on day 2. He returned to the clinic 2 days after his second successive day of BUP-NAL, vomiting and complaining of persistent withdrawal. To avoid pote...
Mental Health Clinician, 2012
Mental Health Clinician, 2015
CNS Spectrums, 2014
The purpose of this investigation was to assess detection and treatment rates for perinatal depre... more The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period. Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well. A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting. Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.