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Zoorob R, In Kim-Vences S, Hirth JM, Schaper K, Grigoryan L, Gonzalez S, Kowalchuk A. Asynchronous online training increased knowledge, confidence, and intent to screen and treat substance use disorders among primary care clinicians practicing in Texas. Prev Med 2024; 185:108038. [PMID: 38857769 DOI: 10.1016/j.ypmed.2024.108038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Despite increasing prevalence of substance use disorders (SUD), few patients are diagnosed and treated in primary care settings. This study evaluated changes in knowledge, confidence, and intention to implement screening and brief intervention (SBI) and SUD treatment after clinicians participated in an asynchronous online education course. METHODS A self-selected sample of primary care clinicians in Texas participated in online SBI and SUD education March 2021-July 2023. Baseline and post-training surveys evaluated changes in knowledge, confidence, and intent to implement SBI and SUD treatment. Changes were compared using paired t-tests. Multivariable linear regression examined factors potentially associated with confidence and intention to implement changes. Clinician feedback regarding the course was included. RESULTS Of 613 respondents, 50.9% were practicing family medicine clinicians. Knowledge of adolescent screening tools increased from 21.9% to 75.7% (p < 0.001). Knowledge about the number of drinks that define excessive drinking among non-pregnant women increased from 24.5% at baseline to 64.9% (p < 0.001). Clinicians reported lowest confidence in providing opioid use disorder pharmacotherapy, which improved after program participation. Intent to implement SBI and medication for alcohol, nicotine and opioid use disorders increased (p < 0.001) after training. No factors were associated with change in confidence or intention to implement in multivariable models (p > 0.05). Satisfaction was high and nearly 60% reported intention to change their clinical practice because of the program. CONCLUSION Knowledge, confidence, and intent to implement SBI and SUD treatment increased after completing the online course. Clinician satisfaction was high and demonstrated improved intention to implement SBI and SUD treatment.
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Affiliation(s)
- Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Sung In Kim-Vences
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jacqueline M Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kylie Schaper
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sandra Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alicia Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Kowalchuk A, Ostovar-Kermani TG, Schaper K, Grigoryan L, Hirth JM, Mejia MC, Spooner KK, Zoorob RJ. Factors associated with intention to implement SBI and SUD treatment: a survey of primary care clinicians in Texas enrolled in an online course. BMC PRIMARY CARE 2024; 25:192. [PMID: 38807054 PMCID: PMC11134618 DOI: 10.1186/s12875-024-02427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice. METHODS This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory of Planned Behavior and included measures of knowledge, subjective norms, and perceived behavioral controls related to SBI and SUD treatment. Intention to engage in SBI and SUD treatment was assessed as the outcome. RESULTS Of 645 participants included in this study, 59.5% were physicians. Knowledge was low, with less than half correctly reporting what was considered a standard drink (39.6%) and only 20% knew the correct number of alcoholic beverages considered risky drinking in 21-year-old non-pregnant women. Subjective norms, such as having colleagues within their practice support addressing SUDs, and perceived behavioral control such as having SUD screening routinized within clinic workflows, were positively associated with intention to implement SBI and SUD treatment in primary care settings. CONCLUSIONS Modifying knowledge gaps, subjective norms, and perceived behavioral control requires a multipronged interventional approach that blends accessible clinician training with systemic workplace enhancements and a collective shift in professional norms.
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Affiliation(s)
- Alicia Kowalchuk
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA.
| | - Tiffany G Ostovar-Kermani
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Kylie Schaper
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Jacqueline M Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Maria Carmenza Mejia
- Department of Population Health and Social Medicine, Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, USA
| | - Kiara K Spooner
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, suite 600, Houston, TX, 77098, USA
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Inpatient care provider perspectives on the development and implementation of an addiction medicine consultation service in a small urban setting. Subst Abuse Treat Prev Policy 2022; 17:70. [PMID: 36303182 PMCID: PMC9612624 DOI: 10.1186/s13011-022-00497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate provider perspectives on the development and implementation of an inpatient Addiction Medicine Consult Service, including their awareness of the service, its perceived role in the continuum of care, and changes over time in their perceptions of care quality for inpatients with substance use disorders. METHODS Repeated cross-sectional survey of hospital-based physicians, nurses and social workers performed at service launch (April-June, 2017) and 4 years later (March-June, 2021). RESULTS Providers had generally positive perceptions of the service and its impact on care quality, but encountered significant barriers at both time points in meeting patient needs (related to high patient complexity and difficulty connecting patients with community services post-discharge). Relative to physicians and social workers, nurses were less likely to be familiar with the service or see it as beneficial. CONCLUSIONS Findings indicate that the service fills a gap that existed previously in the local system of care; however, numerous opportunities exist to further strengthen the system beyond the hospital setting to promote longer-term health among people who use substances. For nurses in particular, outreach, education, and other resources (e.g., dedicated nursing role support, nurse liaison) are warranted to ensure that nurses feel supported and confident caring for this patient population.
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Le test de concordance de script : un outil pédagogique multimodal. Rev Med Interne 2018; 39:566-573. [DOI: 10.1016/j.revmed.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/17/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022]
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Chander G, Monroe AK, Crane HM, Hutton HE, Saag MS, Cropsey K, Eron JJ, Quinlivan EB, Geng E, Mathews WC, Boswell S, Rodriquez B, Ellison M, Kitahata MM, Moore RD, McCaul ME. HIV primary care providers--Screening, knowledge, attitudes and behaviors related to alcohol interventions. Drug Alcohol Depend 2016; 161:59-66. [PMID: 26857898 PMCID: PMC4841449 DOI: 10.1016/j.drugalcdep.2016.01.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown. METHODS We conducted a cross-sectional survey of HIV providers from 8 HIV clinical sites across the United States. Surveys queried knowledge and use of alcohol screening, brief advice, counseling and pharmacotherapy, confidence and willingness to prescribe pharmacotherapy and barriers to their use of alcohol pharmacotherapy. We used multivariable logistic regression to examine provider factors associated with confidence and willingness to prescribe pharmacotherapy. RESULTS Providers (N=158) were predominantly female (58%) and Caucasian (73%); almost half were infectious disease physicians and 31% had been in practice 10-20 years. Most providers (95%) reported always or usually screening for alcohol use, although only 10% reported using a formal screening tool. Over two-thirds never or rarely treated alcohol-dependent patients with pharmacotherapy themselves. Most (71%) referred alcohol-dependent patients for treatment. Knowledge regarding alcohol pharmacotherapy was low. The major barrier to prescribing pharmacotherapy was insufficient training on use of pharmacotherapy. Provider confidence ratings were positively correlated with their practice patterns. CONCLUSIONS HIV providers reported high rates of screening for alcohol use, though few used a formal screening tool. Most providers referred alcohol dependent patients to outside resources for treatment. Few reported prescribing alcohol pharmacotherapy. Increased training on alcohol pharmacotherapy may increase confidence in prescribing and use of these medications in HIV care settings.
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Affiliation(s)
- Geetanjali Chander
- Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States.
| | - Anne K Monroe
- Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States.
| | - Heidi M Crane
- Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States.
| | - Heidi E Hutton
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States.
| | - Michael S Saag
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL. 1720 7th Ave S., Birmingham, AL 35294-0017, United States.
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 7th Ave S., Birmingham, AL 35294-0017, United States.
| | - Joseph J Eron
- Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States.
| | - E Byrd Quinlivan
- Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States.
| | - Elvin Geng
- Department of Medicine, University of California at San Francisco, 1001 Potrero Ave, SFGH 80, San Francisco, CA 94110, United States.
| | - William Christopher Mathews
- Department of Medicine, University of California San Diego, 200 W Arbor Dr # 140, San Diego, CA 92103, United States.
| | - Stephen Boswell
- Department of Medicine, Harvard University School of Medicine, Mass Fenway Community Health Ctr, 1340 Boylston St, Boston, MA 02215, United States.
| | - Benigno Rodriquez
- Department of Medicine-Infectious Diseases, Case Western Reserve University, 111000 Euclid Ave, Cleveland, OH 44106, United States
| | - Megan Ellison
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States.
| | - Mari M Kitahata
- Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States.
| | - Richard D Moore
- Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States.
| | - Mary E McCaul
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States.
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Harris JM, Sun H. A randomized trial of two e-learning strategies for teaching substance abuse management skills to physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1357-1362. [PMID: 23887001 PMCID: PMC3769087 DOI: 10.1097/acm.0b013e31829e7ec6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To compare the educational effectiveness of two virtual patient (VP)-based e-learning strategies, versus no training, in improving physicians' substance abuse management knowledge, attitudes, self-reported behaviors, and decision making. METHOD The 2011-2012 study was a posttest-only, three-arm, randomized controlled trial in 90 resident and 30 faculty physicians from five adult medicine primary care training programs. The intervention was one of two 2-hour VP-based e-learning programs, designed by national experts to teach structured screening, brief interventions, referral, and treatment skills. One used traditional problem solving with feedback (unworked example), and the other incorporated an expert demonstration first, followed by problem solving with feedback (worked example). The main outcome measure was performance on the Physicians' Competence in Substance Abuse Test (P-CSAT, maximum score = 315), a self-administered, previously validated measure of physicians' competence in managing substance abuse. The survey was completed at the outset of the study and two months later. RESULTS Overall P-CSAT scores were virtually identical (202-211, P > .05) between both intervention groups and the no-training control group at both times. Average faculty P-CSAT scores (221.9, 224.6) were significantly higher (P < .01) than resident scores (203.7, 202.5) at both times. CONCLUSIONS This study did not provide evidence that a brief, worked example, VP-based e-learning program or a traditional, unworked, VP-based e-learning program was superior to no training in improving physicians' substance abuse management skills. The study did provide additional evidence that the P-CSAT distinguishes between physicians who should possess different levels of substance abuse management skills.
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Affiliation(s)
- John M Harris
- University of Arizona College of Medicine, Tucson, AZ 85724-5121, USA.
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