Lars Henrik Ryther Myklebust

• Myklebust, Lars Henrik; Eide, Desiree; Wüsthoff, Linda Elise Couessurel; Melis, Francesca; Oldervoll, Ann & Pirro, Silvana De [Vis alle 7 forfattere av denne artikkelen] (2025). Changes in self-reported mental health, anxiety and depression among patients in heroin-assisted treatment: Findings from a Norwegian trial project. European Addiction Research. ISSN 1022-6877. 31, s. 286–296. doi: 10.1159/000547375. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Norway’s heroin-assisted treatment (HAT) project started in 2022, aimed at targeting individuals with severe opioid use disorder (OUD) who did not benefit from first-line, conventional opioid agonist treatment. The use of pharmaceutical diacetylmorphine in HAT may particularly benefit patients with comorbid psychiatric disorders due to its structured nature, which includes daily contact with outpatient clinics. However, previous findings on mental health outcomes in HAT have been inconclusive. The main aim of this study was to explore changes in patients’ self-rated mental health and anxiety and depression over the first 12 months of HAT in Norway. Methods: We used data from 2 questions about patients’ self-rated mental health and anxiety and depression collected from 79 patients at the start of treatment (baseline) and at 3, 6, and 12 months into treatment. Ordinal logistic regression models were used to examine the changes in the responses over the observational period and to explore the potential effects of predictors such as gender and age, self-reported substance use, and clinic site. Results: We found a gradual improvement in self-rated mental health from baseline over the observational period, with a statistically significant shift in response distribution at the 12-month mark (p = 0.017). The distribution of responses indicating “good” mental health increased with a 35% improvement at 12 months, with a corresponding decline of 48% in “bad” mental health. For self-rated anxiety and depression, we found no change in severity of self-rated symptoms. A decline of 48% in the proportion of responses reporting severe symptoms at 12 months was aligned with a simultaneous increase of 17% reporting moderate symptoms. Age and previous suicide attempts were significant predictors of both outcomes; gender influenced anxiety and depression only, whereas clinic site influenced only mental health ratings. Conclusion: HAT appears to gradually improve patients’ self-rated mental health over time, possibly by enhancing overall psychological well-being. Self-rated symptoms of anxiety and depression may not be affected by this treatment, indicating that psychiatric conditions can persist in HAT for those struggling with them. This highlights the importance of specific psychiatric assessments and targeted interventions for at least a subset of patients, underscoring the need for integrated treatment approaches within HAT programs that address both substance use and co-occurring psychiatric disorders.

• Wynn, Rolf; Ellingsen, Gunnar Adelsten; Fernandez, Lorena Garcia; Myklebust, Lars Henrik Ryther; Bystad, Martin Kragnes & Gabarron, Elia (2025). Facing the Future: The Case of the Response Centre of Tromsø Municipality. Studies in Health Technology and Informatics. ISSN 0926-9630. 323, s. 327–331. doi: 10.3233/SHTI250105. Fulltekst i vitenarkiv Vis sammendrag

  Introduction - The increased demands put on the health and care services coupled with technological developments have formed an impetus for the implementation of assistive (or, welfare) technologies in the Norwegian health and care sector. <p> <p>Methods - We discuss the organization and functionality of a unit that monitors and coordinates the use of these technologies, named a ‘Response Centre’ in a Norwegian municipality. <p> <p>Results - We briefly present some of the assistive technology devices in current use, and discuss some ethical dilemmas that arise with their implementation in the care of the elderly and disabled. <p> <p>Conclusion - Assistive technolgies are likely to become increasingly important in the health and welfare sector as the proportion of eldery persons increases.

• Melis, Francesca; Clausen, Thomas; Castel, Charlotte Jocelyne Yvonne; Dadras, Omid; Pirro, Silvana De & Myklebust, Lars Henrik Ryther [Vis alle 9 forfattere av denne artikkelen] (2024). Patient Characteristics From Norway’s First Heroin-Assisted Treatment Clinics. Substance use & addiction journal. 46(1), s. 13–24. doi: 10.1177/29767342241271991. Fulltekst i vitenarkiv Vis sammendrag

  Background: Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country’s OUD treatment system. This study describes and compares patients’ baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT. Methods: This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation (n = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using t-tests, Mann–Whitney U tests, Chi-square, and Fisher’s exact test. Results: The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, P < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment. Conclusion: This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors.

• Lassemo, Eva & Myklebust, Lars Henrik Ryther (2021). Changes in patterns of coercion during a nine-year period in a Norwegian psychiatric service area. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. 30(4). doi: 10.1002/mpr.1889. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objective: There is debate regarding the use of coercion in the psychiatric services and how to minimize its use. We examine changes in the use of coercion in one Norwegian psychiatric service area during a nine-year period.Methods: All patients receiving psychiatric services during the periods 2003–2006 and 2008–2012 in the study area were identified, subsequently also only those who had been involuntarily admitted or subjected to involuntary outpatient treatment. Yearwise rates of patients admitted to coercion and coercive treatment-episodes throughout the study period were calculated.Results: The overall number and the rate of coerced patients decreased to the total patient population. Most of the reduction were initially of the observational period.However, the number of coercive episodes per coerced patient increased. The pattern of outpatient versus inpatient modes of coercion both reflected this main trend. Conclusion: The use of coercion seem to be reduced overall, although the increase in treatment-episodes per patient may indicate a complex pattern in use and registration of coercion. The results may be related to legislative changes,restructuring of psychiatric services, or/and modified attitudes of health-personnel to coercion following a range of efforts to reduce it.

• Lassemo, Eva; Myklebust, Lars Henrik Ryther; Salazzari, Damiano & Kalseth, Jorid (2021). Psychiatric readmission rates in a multi-level mental health care system – a descriptive population cohort study. BMC Health Services Research. 21(1), s. 1–15. doi: 10.1186/s12913-021-06391-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Readmission rates are frequently used as a quality indicator for health care, yet their validity for evaluating quality is unclear. Published research on variables affecting readmission to psychiatric hospitals have been inconsistent. The Norwegian specialist mental health care system is characterized by a multi-level structure; hospitals providing specialized -largely unplanned care and district psychiatric centers (DPCs) providing generalized -more often planned care. In certain service systems, readmission may be an integral part of individual patients’ treatment plan. The aim of the present study was to describe and examine the task division in a multi-level health care system. This we did through describing differences in patient population (age, sex, diagnosis, substance abuse comorbidity and length of stay) and admissions types (unplanned vs. planned) treated at different levels (hospital, DPC or both), and by examining whether readmission risk differ according to type and place of treatment of index-admission and travel-time to nearest hospital and DPC. Methods In this population-based cohort study using administrative data we included all individuals aged 18 and older who were discharged from psychiatric inpatient care with an ICD-10 diagnosis F2-F6 (“functional mental disorders”) in 2012. Selecting each individual’s first discharge during 2012 as index gave N = 16,185 for analyses following exclusions. Analysis of readmission risk were done using Kaplan-Maier failure curves. Results Overall, 15.1 and 47.7% of patients were readmitted within 30 and 365 days, respectively. Unplanned admission patients were more likely to be readmitted within 30 days than planned patients. Those transferred between hospital and DPC during index admission were more likely to be readmitted within 365 days, and to experience planned readmission. Patients with short travel time were more likely to have unplanned readmission, while patients with long travel time were more likely to have planned readmission. Conclusions DPCs and hospitals fill different purposes in the Norwegian health care system, which is reflected in different patient populations. Differences in short term readmission rates between hospitals and DPCs disappeared when type of admission (unplanned/planned) was considered. The results stress the importance of addressing differences in organisation and task distribution when comparing readmission rates between mental health systems. Keywords: Readmission, Psychiatry, Multi-level mental health care system, Survival analysis Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

• Myklebust, Lars Henrik Ryther & Lassemo, Eva (2020). The role of local inpatient psychiatric units and general practitioner on continuity of care in Northern Norway: A case-register study. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. 30(2). doi: 10.1002/mpr.1866. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: The general practitioners' (GP) role in the care of mental health patients has received increased attention. The literature underlines the need for integration of primary and specialist services, but cross-boundary continuity for patients with severe conditions may be particularly poor. The aim of this study was to analyze the collaboration between primary care and different models of specialized psychiatric services for patients with severe conditions. Methods: We compared a local and a centralized model of mental health care. Service utilization over a 5-year period was studied. Results: Findings suggest that a local institution-based model of services positively affects the use of both GP and specialist outpatient care, with most inpatients utilizing both GP and specialist outpatient consultations. In the centralized model, a substantial proportion of inpatients only used GP outpatient care. Furthermore, inpatients that used both GP and specialist outpatient services received more of both services compared to those who did not enter specialist outpatient care at all. Conclusion: Local inpatient units may positively affect continuity of care and collaboration between general practitioners and specialist psychiatric services compared to more traditional hospital units, probably because better functional integration of services, better facilitation of clinical alliances/relationships, or a more network-oriented treatment philosophy. Keywords: continuity of care; general practitioners; mental health; psychiatry.

• Myklebust, Lars Henrik Ryther; Sørgaard, Knut W. & Wynn, Rolf (2017). How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions. SAGE Open Medicine. 5. doi: 10.1177/2050312117724311. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Studies on the dynamics between service organization and acute admissions to psychiatric specialized care have given ambiguous results. We studied the effect of several variables, including service organization, coercion, and patient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study in Norway, we compared a “deinstitutionalized” and a “locally institutionalized” model of mental health services. One had only community outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the local District Psychiatric Centre. Methods: From the case registries, we identified a total of 5338 admissions, which represented all the admissions to the psychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order to control for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regression model. Results: The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377, 95% confidence interval = 4.131–13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582– 4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds available at small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions. Conclusion: While it is likely that the seriousness of the patients’ condition is the most important factor in doctors’ decisions to refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization of mental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds at local District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems with local community outpatient services and beds at Central Mental Hospitals.

• Myklebust, Lars Henrik Ryther; Sørgaard, Knut W. & Wynn, Rolf (2015). Local inpatient units may increase patients' utilization of outpatient services: A comparative cohort-study in Nordland County, Norway. Psychology Research and Behavior Management. 8, s. 251–257. doi: 10.2147/PRBM.S94857. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: In the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care. <p>Methods: Two different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays. <p>Results: The majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients’ use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays. <p>Conclusion: Psychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.

• Myklebust, Lars Henrik Ryther; Sørgaard, Knut & Wynn, Rolf (2014). Local psychiatric beds appear to decrease the use of involuntary admission: A case-registry study. BMC Health Services Research. 14. doi: 10.1186/1472-6963-14-64. Fulltekst i vitenarkiv Vis sammendrag

  Background: Studies on the effect of organizational factors on the involuntary admission of psychiatric patients have been few and yielded inconclusive results. The objective was to examine the importance of type of service-system, level of care, length of inpatient stay, gender, age, and diagnosis on rates of involuntary admission, by comparing one deinstitutionalized and one locally institutionalized service-system, in a naturalistic experiment. Methods: 5538 admissions to two specialist psychiatric service-areas in North Norway were studied, covering a four-year period (2003-2006). The importance of various predictors on involuntary admission were analyzed in a logistic regression model. Results: Involuntary admission to the services was associated with the diagnosis of psychosis, male sex, being referred to inpatient treatment, as well as type of service-system. Patients from the deinstitutionalized system were more likely to be involuntarily admitted. Conclusions: Several factors predicted involuntary status, including male sex, the diagnosis of psychosis, and type of service-system. The results suggests that having psychiatric beds available locally may be more favourable than a traditional deinstitutionalized service system with local outpatient clinics and central mental hospitals, with respect to the use of involuntary admission.

• Skre, Ingunn; Friborg, Oddgeir; Elgarøy, Sigmund; Evans, Chris; Myklebust, Lars Henrik Ryther & Lillevoll, Kjersti [Vis alle 8 forfattere av denne artikkelen] (2013). The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples. BMC Psychiatry. 13. doi: 10.1186/1471-244X-13-99. Fulltekst i vitenarkiv Vis sammendrag

  Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations. Conclusions The CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders. Keywords: Outcome measure; CORE-OM; Translation; Reliability; Confirmatory factor analysis

• Myklebust, Lars Henrik Ryther; Olstad, Reidun E.; Bjorbekkmo, Svein; Eisemann, Martin; Wynn, Rolf & Sørgaard, Knut (2012). Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway. International Journal of Integrated Care (IJIC). 11. doi: 10.5334/ijic.674. Fulltekst i vitenarkiv Vis sammendrag

  The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. To study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Inpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals.

• Myklebust, Lars Henrik Ryther; Sørgaard, Knut; Røtvold, Ketil & Wynn, Rolf (2012). Factors of importance to involuntary admission. Nordic Journal of Psychiatry. ISSN 0803-9488. 66(3), s. 178–182. doi: 10.3109/08039488.2011.611252. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther; Sørgaard, Knut; Bjorbekkmo, Svein; Eisemann, Martin & Olstad, Reidun E. (2010). Time-trends in the utilization of decentralized mental health in Norway - a natural experiment: The VELO-project. International Journal of Mental Health Systems. 4(5). doi: 10.1186/1752-4458-4-5. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther; SØrgaard, knut; Bjorbekkmo, S; Nymann, Asle; Molvik, S & Olstad, Reidun E. (2009). Bed utilization in two differently organized community mental health services in Northern Norway: the VELO-project. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 44(7), s. 550–557. doi: 10.1007/s00127-008-0470-6. Fulltekst i vitenarkiv
• Bjorbekkmo, Svein; Myklebust, Lars Henrik Ryther; Olstad, Reidun E.; Molvik, Stian; Nymann, Asle & Sørgaard, Knut (2009). Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice: the VELO study. International Journal of Mental Health Systems. 3 (May)(9). doi: 10.1186/1752-4458-3-9. Fulltekst i vitenarkiv
• Wynn, Rolf; Myklebust, Lars Henrik Ryther & Bratlid, Trond (2007). Psychologists and coercion: Decisions regarding involuntary psychiatric admission and treatment in a group of Norwegian psychologists. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039480701773139. Fulltekst i vitenarkiv
• Wynn, Rolf & Myklebust, Lars Henrik Ryther (2006). Patients' Satisfaction and Self-Rated Improvement Following Coercive Interventions. Psychiatry, Psychology and Law. ISSN 1321-8719. doi: 10.1375/pplt.13.2.199. Fulltekst i vitenarkiv
• Wynn, Rolf; Myklebust, Lars Henrik Ryther & Bratlid, Trond (2006). Attitudes to coercion among health-care workers and the general public in Norway. Journal of Psychiatric Intensive Care. ISSN 1742-6464. doi: 10.1017/S1742646406000252. Fulltekst i vitenarkiv
• Wynn, Rolf; Myklebust, Lars Henrik Ryther & Stensland, Geir Øyvind (2005). Attitudes to the use of diagnostic instruments among clinicians in northern Norway. Australian and New Zealand journal of psychiatry (Print). ISSN 0004-8674. doi: 10.1080/j.1440-1614.2005.01569.x. Fulltekst i vitenarkiv

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• Myklebust, Lars Henrik Ryther; Eide, Desiree; Arnevik, Espen Ajo; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune [Vis alle 14 forfattere av denne artikkelen] (2024). Evaluation of heroin-assisted treatment in Norway: protocol for a mixed methods study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10767-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Opioid agonist treatment (OAT) for patients with opioid use disorder (OUD) has a convincing evidence base, although variable retention rates suggest that it may not be beneficial for all. One of the options to include more patients is the introduction of heroin-assisted treatment (HAT), which involves the prescribing of pharmaceutical heroin in a clinical supervised setting. Clinical trials suggest that HAT positively affects illicit drug use, criminal behavior, quality of life, and health. The results are less clear for longer-term outcomes such as mortality, level of function and social integration. This protocol describes a longitudinal evaluation of the introduction of HAT into the OAT services in Norway over a 5-year period. The main aim of the project is to study the individual, organizational and societal effects of implementing HAT in the specialized healthcare services for OUD. Methods The project adopts a multidisciplinary approach, where the primary cohort for analysis will consist of approximately 250 patients in Norway, observed during the period of 2022–2026. Cohorts for comparative analysis will include all HAT-patients in Denmark from 2010 to 2022 (N = 500) and all Norwegian patients in conventional OAT (N = 8300). Data comes from individual in-depth and semi-structured interviews, self-report questionnaires, clinical records, and national registries, collected at several time points throughout patients’ courses of treatment. Qualitative analyses will use a flexible inductive thematic approach. Quantitative analyses will employ a wide array of methods including bi-variate parametric and non-parametric tests, and various forms of multivariate modeling. Discussion The project’s primary strength lies in its comprehensive and longitudinal approach. It has the potential to reveal new insights on whether pharmaceutical heroin should be an integral part of integrated conventional OAT services to individually tailor treatments for patients with OUD. This could affect considerations about drug treatment even beyond HAT-specific topics, where an expanded understanding of why some do not succeed with conventional OAT will strengthen the knowledge base for drug treatment in general. Results will be disseminated to the scientific community, clinicians, and policy makers. Trial registration The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), ref.nr.:195733.

• Eide, Desiree; Pirro, Silvana De; Myklebust, Lars Henrik Ryther; Melis, Francesca; Oldervoll, Ann & Clausen, Thomas (2024). Norway's first heroin-assisted treatment clinics: initial impact of the intervention. Fulltekst i vitenarkiv
• Wynn, Rolf & Myklebust, Lars Henrik Ryther (2021). Adapting the traditional case report to a biopsychosocial format. European psychiatry. ISSN 0924-9338. 64, s. S745–S745. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther & Wynn, Rolf (2017). The mortality gap. Patients with serious mental conditions. Mortality, morbidity and use of health services. European psychiatry. ISSN 0924-9338. doi: 10.1016/j.eurpsy.2017.01.565. Fulltekst i vitenarkiv
• Wynn, Rolf & Myklebust, Lars Henrik Ryther (2017). Health professionals’ reactions to patients’ social media posts about treatment. International Journal of Integrated Care (IJIC). doi: 10.5334/ijic.3262. Fulltekst i vitenarkiv
• Wynn, Rolf & Myklebust, Lars Henrik Ryther (2017). The decentralization and integration of Norwegian psychiatric services and possible implications for coercive practices. International Journal of Integrated Care (IJIC). doi: 10.5334/ijic.3273. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther & Wynn, Rolf (2016). Inpatients´ utilization of GP and psychiatric outpatient care. A comparison of a central-institution versus a local-institution based system of psychiatry. A case-register study. International Journal of Integrated Care (IJIC). doi: 10.5334/ijic.2860. Fulltekst i vitenarkiv
• Wynn, Rolf & Myklebust, Lars Henrik Ryther (2016). The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway. International Journal of Integrated Care (IJIC). doi: 10.5334/ijic.2796. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther; Sourouri, Saher & Olssøn, Ingrid (2011). The applicability of ‘Outcome Rating-Scale' and ‘Session Rating-Scale' in an outpatient hospital setting. Psychiatrische Praxis. ISSN 0303-4259. doi: 10.1055/s-0031-1277848. Fulltekst i vitenarkiv
• Lassemo, Eva Irene; Myklebust, Lars Henrik Ryther & Sørgaard, Knut W. (2011). Patient cost and treatment unit cost comparison in the VELO-Study. Psychiatrische Praxis. ISSN 0303-4259. 38. doi: 10.1055/s-0031-1277824. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther & Wynn, Rolf (2009). Predictors of involuntary admission to a major Norwegian psychiatric hospital. Fulltekst i vitenarkiv
• Myklebust, Lars Henrik Ryther; Bjorbekkmo, Svein & Sørgaard, Knut (2009). Continuity of Care, Systems Integration and Patient Transitions: Central or Local Psychiatric Beds? The VELO-Project. European psychiatry. ISSN 0924-9338. doi: 10.1016/S0924-9338(09)71107-1. Fulltekst i vitenarkiv
• Eide, Desiree; Bjørnestad, Ronny; Brummer, Julie Elizabeth; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune [Vis alle 17 forfattere av denne artikkelen] (2024). Midtveisrapport om heroinassistert behandling fra 2022-2023 (SERAF rapport 4/2024). Senter for rus- og avhengighetsforskning. Fulltekst i vitenarkiv Vis sammendrag

  Denne midtveisrapporten tar for seg de to første årene av Norges første heroinassisterte behandlingsprogram (HAB) som er planlagt å vare ut 2026 som et tidsavgrenset klinisk forsøksprosjekt. Forsøksprosjektet HAB ble etablert som del av legemiddelassistert rehabilitering (LAR) i Oslo og Bergen. Fra 1. januar 2022 til 31. desember 2023 ble 92 av totalt 97 pasienter inkludert i forskningsprosjektet som skal evaluere de to nyetablerte HABklinikkene. Denne rapporten beskriver etableringen av klinikkene, pasienterfaringer og pasientrapporterte resultater mens de var i heroinassistert behandling. Denne rapporten gir en midtveisevaluering av forsøksprosjektet. En endelig og utvidet evalueringsrapport vil bli levert i løpet av første halvdel av 2026.

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