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McAfee NW, Schumacher JA, Madson MB, Villarosa-Hurlocker MC, Williams DC. The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1236-1246. [PMID: 35320126 DOI: 10.1097/acm.0000000000004674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. METHOD The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. RESULTS Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. CONCLUSIONS SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.
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Affiliation(s)
- Nicholas W McAfee
- N.W. McAfee is assistant professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi; ORCID: 0000-0002-7992-9124
| | - Julie A Schumacher
- J.A. Schumacher is professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael B Madson
- M.B. Madson is professor, School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi; ORCID: 0000-0002-2025-8856
| | - Margo C Villarosa-Hurlocker
- M.C. Villarosa-Hurlocker is assistant professor, Department of Psychology, University of New Mexico, Albuquerque, New Mexico; ORCID: 0000-0002-9744-8551
| | - Daniel C Williams
- D.C. Williams is associate professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Damewood A, Davis SK, Beebe LH. Integrated Education Reduces Negative Attitudes Toward Persons with Substance Use Disorders: A Pilot Study. Issues Ment Health Nurs 2022; 43:528-531. [PMID: 34731064 DOI: 10.1080/01612840.2021.1993387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Educational practices to reduce negative attitudes toward persons with substance use disorders (SUD) are urgently needed for undergraduate nursing students, but few studies have examined their long term effectiveness. In this pilot, consenting students completed the Drug and Drug Problems Perception Questionnaire (DDPPQ) anonymously online, before and 1 year after integrated curricular content about SUD. Pretest scores were significantly higher than posttest, indicating higher negative attitudes toward persons with SUD before the integrated content. Time main effect was statistically significant. To our knowledge, this is the first report examining long-term effects of an educational intervention with reinforcement in multiple courses over time upon the attitudes of undergraduate nursing students toward persons with SUD.
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Affiliation(s)
- Andi Damewood
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Sharon Keck Davis
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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Squibb A, Bussey A, Chauvin B. A prospective cohort study evaluating enhanced addiction medicine curriculum graduate medical education on bias, clinical readiness and future practice. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19107.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Studies demonstrate gaps in graduate medical education (GME) in treatment of opioid-use disorders (OUD). There is lack of consensus on best practices to address gaps between clinical readiness and community need despite action to improve education. Through enhanced OUD curriculum, we evaluated the impact in bias, clinical readiness, and intent for future practice OUD compared to usual training in a multi-specialty community-based GME Institution between 2018 and 2020. Objective Evaluate impact of enhanced OUD training during residency to usual training in GME. Methods Residents and faculty members were voluntarily surveyed at baseline and after 2 years in years 2018 and 2020. Interventions included SAHMSA buprenorphine-waiver training, treatment of OUD with medication-assisted treatment (MAT) in the primary care office, and two required addiction medicine rotations. The survey included questions related to bias, self- perceived clinical readiness, faculty teaching self- perceived readiness, and intent for future practice. Results Participation in the survey was 29%, 45%, and 48% for the baseline, control group and intervention group, respectively. The enhanced training group demonstrated statistically significant improvements in four out of seven bias questions, six out of eight clinical-readiness questions and intention to utilize MAT in future practice. Additional findings include a decrease in intent to prescribe MAT from the baseline group to the control group over the two-year period. Conclusions Data from this single-institution survey demonstrate that intentional enhanced OUD education can impact resident physician bias, self-perceived clinical readiness, and intent to treat patients with OUD in future practice.
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Spinella SA, Samberg D, McNeil M, Rothenberger SD, Roy PJ, Carter AE. A Video- and Case-Based Curriculum on the Management of Alcohol Use Disorder for Internal Medicine Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11236. [PMID: 35434301 PMCID: PMC8967922 DOI: 10.15766/mep_2374-8265.11236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is commonly undertreated. Physicians cite discomfort with AUD medication as a barrier to treatment. While several curricula teach and assess screening and brief interventions, few teach and assess learner knowledge of treatment options. METHODS We created a video- and case-based curriculum for internal medicine residents delivered by 16 internal medicine faculty in three 30-minute sessions at four clinic sites. Learner knowledge, attitudes, and confidence were assessed before and after the curriculum. We used qualitative methods to evaluate learner reflections. We also assessed faculty satisfaction with the curriculum. RESULTS Of 153 residents receiving the curriculum, 35 (23%) completed both pre- and postsurveys. Median percent correct on knowledge questions improved from 67% pre- to 80% postcurriculum (p < .001). Confidence increased for all three items assessing it, with a notable increase in confidence with pharmacotherapy (2.9 pre- vs. 4.5 postcurriculum on a 7-point Likert scale with high scores indicating greater confidence, p < .001). Positive attitudes toward people with AUD increased from 3.4 pre- to 3.9 postcurriculum (p < .001) on a 7-point Likert scale. Learners continued to express concerns about prescribing logistics, the role of primary care, and management of ongoing use. Thirteen of 16 faculty (83%) completed the postcurricular survey; all said they would be happy to facilitate again. DISCUSSION Implementation of this curriculum for the management of AUD improved resident knowledge, attitudes, and confidence in AUD treatment. The curriculum was acceptable to faculty and is ideal for programs looking to expand teaching about AUD.
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Affiliation(s)
- Sara A. Spinella
- Clinical Assistant Professor of Medicine, Department of Medicine, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System
| | - Diana Samberg
- Assistant Professor of Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Melissa McNeil
- Professor of Medicine and Associate Chief of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System
| | - Scott D. Rothenberger
- Assistant Professor of Medicine and Statistician, Center for Research on Health Care Data Center, Department of Medicine, University of Pittsburgh School of Medicine
| | - Payel Jhoom Roy
- Assistant Professor of Medicine and Clinical Director of Addiction Medicine Consult Service, Department of Medicine, University of Pittsburgh School of Medicine
| | - Andrea E. Carter
- Assistant Professor of Medicine and Associate Program Director of Internal Medicine Residency Program, Department of Medicine, University of Pittsburgh School of Medicine
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Acquavita SP, Richardson GB, Smith R, Van Loon RA, Brehm B, Kim K, Diers T. Outcomes of an interprofessional SBIRT training program: Knowledge attainment and perceived competence for practice. Subst Abus 2021; 42:935-943. [PMID: 33797345 DOI: 10.1080/08897077.2021.1900982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND One way to address substance misuse is to train health professional students in Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention strategy. This study evaluated a semester-long, 50-hour elective SBIRT training that blended online coursework with interprofessional experiences. Medicine, nursing, pharmacy, and social work students completed an interprofessional standardized patient experience and completed a minimum of two interprofessional SBIRT experiences at community agencies. Methods: We analyzed longitudinal data from 197 students using structural equation modeling to examine gains in knowledge and perceived competence, as well as to test if background variables predicted 30-day application of SBIRT knowledge and skills, 30-day satisfaction' 12-month frequencies of care for performing SBIRT; and number of SBIRT clients/patients served directly. Results: Overall, student SBIRT knowledge and perceived competence both increased by more than a standard deviation during the course. Students who experienced larger gains in perceived competence rated the course significantly higher in terms of relevance and usefulness and, in turn, served significantly more SBIRT clients/patients during the following year. We did not find evidence that intra-individual growth in knowledge impacted the degree to which students ultimately applied SBIRT components. Finally, students who had more previous training and experience related to substance abuse ultimately reported greater application of SBIRT knowledge and skills. Interprofessional differences included: At baseline, medicine students had significantly lower substance abuse education knowledge as compared to the other disciplines. Pharmacy and social work students were more likely to have had previous experience with motivational interviewing. Baseline perceived competence in applying SBIRT was higher in social work and nursing. Upon completion, pharmacy and medicine students had lower satisfaction with the course. Conclusions: These findings suggest that SBIRT courses can increase knowledge and perceived competence; moreover, student background characteristics, work settings, and experiences may have important effects on learning SBIRT.
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Affiliation(s)
- Shauna P Acquavita
- College of Allied Health Sciences School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA.,Center for Addiction Research, University of Cincinnati, Cincinnati, Ohio, USA
| | - George B Richardson
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rachel Smith
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ruth Anne Van Loon
- College of Allied Health Sciences School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
| | - Bonnie Brehm
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA
| | - Karissa Kim
- College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tiffiny Diers
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Richardson GB, Smith R, Lowe L, Acquavita SP. Structure and longitudinal invariance of the Short Alcohol and Alcohol Problems Perception Questionnaire. J Subst Abuse Treat 2020; 115:108041. [PMID: 32600628 DOI: 10.1016/j.jsat.2020.108041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
Many studies have employed the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) to measure professionals' attitudes toward working with people experiencing alcohol problems. However, research has not confirmed the internal structure of the SAAPPQ, leaving open the possibility that scale scores are not valid empirical proxies for underlying attitudes. It is also unclear if measurement invariance holds over time or across groups. This is an important gap in light of evidence that (a) experiences can change the structure of scales and (b) structures of some popular scales differ dramatically between groups. Thus, measurement bias may confound comparisons of composite SAAPPQ scores between measurement occasions or groups. To address these gaps in the literature, we conducted a longitudinal examination of the psychometrics of the SAAPPQ using data from 241 human services professionals-in-training. We found a four-factor structure, rather than the previously reported five factors. Configural, metric, and a strong degree of scalar invariance held longitudinally. Few factor intercorrelations were significant at time one and they strengthened over time, suggesting that the SAAPPQ should not be aggregated at higher-order levels (i.e., global scores should not be used). Findings suggest four SAAPPQ subscale scores may be used as valid proxies for attitudes toward alcohol users; however, additional confirmatory studies are needed to ensure that measurement bias does not compromise inferences based on SAAPPQ scores.
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Affiliation(s)
- George B Richardson
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America.
| | - Rachel Smith
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
| | - Linnea Lowe
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
| | - Shauna P Acquavita
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
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Pringle JL, Cochran J, Aruru M. Role of pharmacists in the Opioid Use Disorder (OUD) crisis. Res Social Adm Pharm 2019; 15:228-229. [DOI: 10.1016/j.sapharm.2018.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update. Curr Opin Psychiatry 2018; 31:324-332. [PMID: 29846264 DOI: 10.1097/yco.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Alcohol is a leading risk factor for ill health and premature death. Regardless of poor levels of implementation achieved after more than 30 years of research and policy advice, alcohol screening and brief advice (SBA) remains one of the best policy options. This study updates the evidence by considering recent publications on SBA for heavy drinking and alcohol use disorder in primary healthcare at a timely moment, because researchers are, at present, debating future direction of research and policy in this field. RECENT FINDINGS Systematic literature search between 1 January 2016 and 31 December 2017 was conducted for new research on alcohol SBA in primary healthcare. In all, 63 articles were included. SUMMARY Primary healthcare-based SBA programmes are effective in reducing alcohol consumption among heavier drinkers. There is low implementation of these programmes in real practice. Academia is rethinking and debating future directions.
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Taylor JL, Rapoport AB, Rowley CF, Mukamal KJ, Stead W. An opioid overdose curriculum for medical residents: Impact on naloxone prescribing, knowledge, and attitudes. Subst Abus 2018; 39:371-376. [PMID: 29432074 DOI: 10.1080/08897077.2018.1439800] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite escalating opioid overdose death rates, addiction medicine is underrepresented in residency curricula. Providing naloxone to at-risk patients, relatives, and first responders reduces overdose deaths, but rates of naloxone prescribing remain low. The goal of this study is to examine the impact of a brief curricular intervention for internal medicine residents on naloxone prescribing rates, knowledge, and attitudes. METHODS Internal medicine residents (N = 160) at an urban, tertiary care medical center received two 1-hour didactic sessions addressing overdose prevention, including intranasal naloxone. The number of naloxone prescriptions generated by residents was compared to faculty, who received no similar intervention, in the 3-month periods before and after the curriculum. Resident knowledge and attitudes, as assessed by pre- and post-intervention surveys, were compared. RESULTS The resident naloxone prescribing rate increased from 420 to 1270 per 100,000 inpatient discharges (P = .01) and from 0 to 370 per 100,000 ambulatory visits (P < .001) post-intervention. Similar increases were not observed among inpatient faculty, whose prescribing rate decreased from 1150 to 880 per 100,000 discharges (P = .08), or among outpatient faculty, whose rate increased from 30 to 180 per 100,000 ambulatory visits (P < .001) but was lower than the post-intervention resident rate (P = .01). Residents demonstrated high baseline knowledge about naloxone, but just 13% agreed that they were adequately trained to prescribe pre-intervention. Post-intervention, residents were more likely to agree that they were adequately trained to prescribe (Likert mean 2.5 vs. 3.9, P < .001), to agree that treating addiction is rewarding (Likert mean 2.9 vs. 3.3, P = .03), and to attain a perfect score on the knowledge composite (57% vs. 33%, P = .05). CONCLUSIONS A brief curricular intervention improved resident knowledge and attitudes regarding intranasal naloxone for opioid overdose reversal and significantly increased prescribing rates.
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Affiliation(s)
- Jessica L Taylor
- a Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA
| | - Alison B Rapoport
- b Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Christopher F Rowley
- b Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Kenneth J Mukamal
- c General Internal Medicine, Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Wendy Stead
- b Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
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Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education. Clin Pharmacol Ther 2018; 103:982-989. [DOI: 10.1002/cpt.1015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/08/2017] [Accepted: 01/04/2018] [Indexed: 11/07/2022]
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