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Duval M, Aquizerate A, Jaulin E, Rousselet M, Kuhn E, Guilleminot A, Nicolleau I, Pele S, Herault T, Artarit P, Soulidou-Jacques E, Laforgue EJ, Victorri-Vigneau C. Physicians, pharmacists and take-home naloxone: What practices? The SINFONI study. Therapie 2024:S0040-5957(24)00074-X. [PMID: 39174452 DOI: 10.1016/j.therap.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/27/2024] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE For several years, both the French Addictovigilance Network and French health authorities have consistently emphasized the need to provide opioid users with take-home naloxone (THN), the specific antidote for opioid overdoses. In March 2022, the French Health Authority recommended systematically assessing the appropriateness of prescribing THN to all opioid users, regardless of the context, and identified 8 high-risk situations. However, at present, THN distribution remains limited, particularly among primary care healthcare professionals. This study, conducted by the Pays de la Loire Centre for Evaluation and Information on Drug Dependence-Addictovigilance and supported by the Regional Health Agency, aims to explore healthcare professionals' practices and perceptions of these high-risk situations. METHODS An ad-hoc questionnaire was distributed via mail by the project's regional institutional partners to the target healthcare professionals: pharmacists, general practitioners (GPs), physicians practicing in specialities other than general medicine (SPs: algologists, psychiatrists and addictologists). It was completed online from 20/10/2022 to 30/12/2022. RESULTS Out of the 355 participants (158 pharmacists, 167 GPs and 30 SPs), nearly all were managing patients on opioids. In total, 47.7% of physicians and 27.8% of pharmacists reported experiencing difficulties in dealing with the risk of overdose when prescribing or dispensing opioids to their patients. In the 12months preceding the study, only 8 pharmacists and 34 physicians had prescribed/dispensed THN, primarily due to a lack of awareness of its existence (52% of pharmacists and 72% of physicians) and challenges in addressing the eight overdose risk situations listed by the HAS (ranging from 54% to 83% for all professionals). The best-trained healthcare professionals were those who prescribed the most THN (P<0.001). CONCLUSION The identification of barriers related to THN distribution in the regional SINFONI study, conducted among primary care healthcare professionals managing patients on opioids, highlights the need to develop a training tool specifically tailored for these professionals.
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Affiliation(s)
- Mélanie Duval
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France
| | - Aurélie Aquizerate
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France
| | - Emmanuelle Jaulin
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France
| | - Morgane Rousselet
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France; Nantes Université, Université Tours, CHU Nantes, CHU Tours, Inserm, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44000 Nantes, France
| | - Emmanuelle Kuhn
- Nantes Université, CHU de Nantes, UIC22, Service Douleur Soins Palliatifs et Soins de Support, 44093 Nantes, France; Réseau Douleur de l'Ouest (REDO), 44000 Nantes, France
| | - Alain Guilleminot
- Union Régionale des Professionnels de Santé Libéraux (URPS) Pharmaciens Pays de la Loire, 44200 Nantes, France
| | - Isabelle Nicolleau
- Conseil Régional de l'Ordre des Pharmaciens (CROP) Pays de la Loire, 44004 Nantes, France
| | - Solen Pele
- Structure Régionale d'Appui et d'Expertise (SRAE) en Addictologie des Pays de la Loire, 44200 Nantes, France
| | - Thomas Herault
- Union Régionale des Médecins Libéraux (URML) Pays de la Loire, 44230 Saint-Sébastien-sur-Loire, France
| | - Pascal Artarit
- Direction régionale du Service médical (DRSM) des Pays de la Loire, 44000 Nantes, France
| | - Eleni Soulidou-Jacques
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France; Nantes Université, Université Tours, CHU Nantes, CHU Tours, Inserm, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44000 Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU de Nantes, Centre d'Évaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, 44000 Nantes, France; Nantes Université, Université Tours, CHU Nantes, CHU Tours, Inserm, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, 44000 Nantes, France.
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Smith KR, Shah NK, Adamczyk AL, Weinstein LC, Kelly EL. Harm reduction in undergraduate and graduate medical education: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:986. [PMID: 38129846 PMCID: PMC10734177 DOI: 10.1186/s12909-023-04931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients' ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.
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Affiliation(s)
- Kelsey R Smith
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA.
| | - Nina K Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, #100, Philadelphia, PA, 19107, USA
| | - Abby L Adamczyk
- Scott Memorial Library, Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA, 19107, USA
| | - Lara C Weinstein
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
- Center for Social Medicine and Humanities, University of California Los Angeles, B7-435, Semel Institute, Los Angeles, CA, 90095-1759, USA
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Bharne P, Kelly E, Rajkumar S, Iglesias A, Ponnapalli S, Haslund-Gourley B, Gadegbeku A. Temporal Reinforcement of Naloxone Training Results in Significant Retention of Anti-bias and Overdose-Response Knowledge. Cureus 2023; 15:e45415. [PMID: 37854753 PMCID: PMC10581504 DOI: 10.7759/cureus.45415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The opioid epidemic is an increasingly severe problem affecting public health and leading to significant economic burdens on healthcare systems. Overdose reversal training and de-stigmatization efforts are common strategies used to combat this epidemic. Nevertheless, healthcare professionals report a lack of confidence in administering naloxone and high stigmatization levels toward people with opioid use disorder (OUD). While one-time educational training reduces stigma and improves naloxone administration confidence, we previously demonstrated that knowledge retention at a three-month follow-up is reduced among a cohort of medical students. This study aimed to improve the effectiveness of opioid overdose awareness and reversal training (OOART) with a three-month follow-up abbreviated OOART (aOOART) booster video. METHODS Voluntary OOART was offered to first-year medical students (M1) at the Drexel University College of Medicine in 2022. At this training, 82 students completed a pre-training survey to establish a baseline knowledge and attitude toward people with OUD and their familiarity with the steps to reverse an opioid overdose. Following the hour-long training, 64 of 82 (79%) participants completed the post-training survey to measure the immediate retention of training information. After 2.5 months, students were randomly selected to receive a 6.5-minute aOOART booster video or serve as an unboosted control. Students in the booster and non-booster cohorts then completed a three-month follow-up survey. RESULTS Students who received the aOOART booster had significantly increased opioid reversal knowledge scores compared to non-boosted control students at the three-month follow-up. The aOOART booster resulted in a retention of the lowered stigma, and participants expressed a higher willingness to respond to an opioid overdose compared to participants who did not receive the booster video at the three-month follow-up. CONCLUSIONS This study shows that an aOOART booster method improves knowledge retention following initial OOART. Further, the aOOART booster video served to maintain participants' reduced stigma toward people with OUD and maintained participants' willingness to respond to an opioid overdose. These results support the incorporation of an abbreviated, periodic OOART reinforcement video into opioid overdose response training nationwide. We believe this "booster video" approach is a novel and effective method to improve healthcare professionals' and medical student preparedness to render appropriate care to people with OUD.
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Affiliation(s)
| | - Erin Kelly
- College of Medicine, Drexel University, Philadelphia, USA
| | - Sujay Rajkumar
- College of Medicine, Drexel University, Philadelphia, USA
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Sandhu RK, Heller MV, Buckanavage J, Haslund-Gourley B, Leckron J, Kupersmith B, Goss NC, Samson K, Gadegbeku AB. A longitudinal study of naloxone opioid overdose awareness and reversal training for first-year medical students: specific elements require reinforcement. Harm Reduct J 2022; 19:70. [PMID: 35780103 PMCID: PMC9250225 DOI: 10.1186/s12954-022-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background The opioid epidemic is a progressively worsening public health crisis that continues to impact healthcare system strategies such as overdose reversal and destigmatization. Even among healthcare professionals, there remains a lack of confidence in naloxone administration and a prevalence of stigma. While training can play a major impact in reducing these shortcomings, the long-term effectiveness has yet to be characterized in training healthcare professionals. This study examined the long-term retention of opioid overdose awareness and reversal training (OOART) by evaluating performance at two-time intervals, immediately post-training and at a 3-month follow-up. Methods Voluntary training was offered to first-year (M1) medical students at the Drexel University College of Medicine in 2021. At this training, 118 students completed training, 95 completed the post-training survey, and 42 completed the 3-month follow-up. Results Opioid reversal knowledge questions assessed significantly increased scores post-training and at the 3-month follow-up. In three of the attitude questions, scores were improved at both follow-up timepoints. In addition, three attitude questions indicating a participant’s confidence to respond to an opioid overdose situation increased directly after the training, but regressed at the 3-month follow-up. The remaining questions did not show any statistical difference across the survey intervals. Conclusions This study establishes that while OOART provides participants with the knowledge of how to respond to an opioid overdose, the retention of this knowledge at a 3-month interval is reduced. The results were mixed for longitudinal assessment of participant’s attitudes toward people with opioid use disorder. Some positive increases in attitudes were retained at the 3-month interval, while others trended back toward pre-training levels. These results support the effectiveness of the training but also provide evidence that OOART must be reinforced often. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00656-y.
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Affiliation(s)
- Reena K Sandhu
- Drexel University College of Medicine, Philadelphia, PA, USA.
| | | | | | | | - Joshua Leckron
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Kyle Samson
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Annette B Gadegbeku
- Department of Family, Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
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5
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Evaluation of a
pharmacist‐led
intervention on naloxone
co‐prescribing
in patients receiving chronic opioid therapy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Donohue KE, Sathe M, Wood S, Davis NL, Farber DL. A Multi-Modal Curriculum Teaching Opioid Use Disorder Management in Young Adult Populations. Cureus 2021; 13:e18499. [PMID: 34754660 PMCID: PMC8569682 DOI: 10.7759/cureus.18499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The use of both prescription and illicit opioids among adolescents and young adults (AYA) is increasing. Barriers to effective treatment of opioid use disorders among AYA range from patients leaving against medical advice to decreased knowledge and experience of providers caring for those with opioid dependence. No formal curricula for residents on AYA opioid use disorder and management have been implemented despite rapidly increasing use in this population. OBJECTIVE To develop a brief curriculum for trainees who encounter AYA that will increase knowledge and skills to treat opioid use in the AYA population. Methods: Twenty-six pediatric and family medicine interns participated in this pilot study. The multimodal curriculum included standardized patient encounters, case-based learning sessions, didactics, and high-fidelity simulations. The curriculum encompasses five individual sessions, each with a different theme: motivational interviewing, naloxone administration, opioid withdrawal medications, complex overdoses, and infectious complications of intravenous drug use. A pre-survey was administered prior to the curriculum and a post-survey was administered at the conclusion to assess its effectiveness in improving knowledge for this specific population and increasing comfort levels providing medical interventions in AYA patients with opioid use disorders. RESULTS Trainee comfort levels increased significantly in all four domains as measured by the average Likert scale, including interviewing AYA about opioid use (2.5 (standard deviation (SD) 1.2) to 4 (SD 0.9), p<0.0001)), prescribing medication for opioid use disorder (1.3 (SD 0.5) to 2.8 (SD 1.3), p<0.0001)), treating acute opioid overdose (1.5 (SD 0.8) to 3.7 (SD 0.9), p<0.0001)), and treating infectious complications of intravenous drug use (1.7 (SD 0.8) to 3 (SD 1.1), p <0.0001)). The Chi-square test showed similarly significant increases in comfort levels. CONCLUSIONS Early trainees who provide care to young adults benefit from opioid education specific to this population. Participants described increased knowledge and comfort in interviewing and treating this vulnerable patient group.
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Affiliation(s)
- Katelyn E Donohue
- Internal Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, USA
| | - Mihika Sathe
- Internal Medicine and Pediatrics, Inova Health System, Annandale, USA
| | - Samuel Wood
- Internal Medicine and Pediatrics, University of Maryland Medical Center, Baltimore, USA
| | - Natalie L Davis
- Pediatrics, University of Maryland School of Medicine, Baltimore, USA
| | - Dara L Farber
- Internal Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, USA
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Halmo RS, Sellers CM, Collin CRR, Chinamasa G, Putney JM. Changes in social work students' attitudes and knowledge following opioid overdose prevention training. Subst Abus 2021; 43:289-293. [PMID: 34214409 DOI: 10.1080/08897077.2021.1941511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Opioid use disorders are widespread, commonly occurring, and have serious impacts on individuals, families, and communities. When adequately trained, social workers play a pivotal role in treating populations impacted by opioid use through the provision of high-quality services and the shifting of negative attitudes related to opioid use. However, workforce projections indicate a growing shortage of behavioral health professionals qualified to work with such populations and, presently, social work programs are not equipped to meet these workforce needs. Emerging evidence suggests opioid overdose education is associated with improved attitudes and knowledge among health professions; however, less information exists on the outcomes of such training among social work students. Schools of social work must develop and evaluate curricular components related to opioid use prevention and management to adequately prepare students for clinical work as social work practitioners. Methods: Thirty-three advanced-year MSW students received opioid overdose training as part of a day-long seminar on substance use. Content included acute effects of opioids, withdrawal symptoms, risk factors, signs of overdose, naloxone training, and harm reduction principles. Using a single-group pretest-posttest design, students completed the Opioid Overdose Attitudes Scale (OOAS) and the Opioid Overdose Knowledge Scale (OOKS). To evaluate students' attitudes and knowledge, investigators compared overall and subscale means before and after the training via paired samples t-tests. Results: Findings indicated statistically significant improvements in the "concerns" and "competence" domains of the OOAS. Likewise, findings indicated statistically significant improvements in the "risk," "signs," "action," and "naloxone use" domains of the OOKS. Conclusion: Students reported improved opioid overdose-related knowledge and attitudes when assessed after the training as compared to before the training. Due to the nature of the study design, causality cannot be inferred from the training outcomes. Findings may help other social work programs develop curricular components related to opioid use.
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Affiliation(s)
- Rebekah S Halmo
- School of Social Work, Simmons University, Boston, Massachusetts, USA
| | - Christina M Sellers
- School of Social Work, Simmons University, Boston, Massachusetts, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Gordon Chinamasa
- School of Social Work, Simmons University, Boston, Massachusetts, USA
| | - Jennifer M Putney
- School of Social Work, Simmons University, Boston, Massachusetts, USA
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Motavalli D, Taylor JL, Childs E, Valente PK, Salhaney P, Olson J, Biancarelli DL, Edeza A, Earlywine JJ, Marshall BDL, Drainoni ML, Mimiaga MJ, Biello KB, Bazzi AR. "Health Is on the Back Burner:" Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs. J Gen Intern Med 2021; 36:129-137. [PMID: 32918199 PMCID: PMC7858998 DOI: 10.1007/s11606-020-06201-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The estimated 2.2 million people who inject drugs (PWID) in the USA experience significant gaps in preventive healthcare and a high burden of infectious, psychiatric, and other chronic diseases. Many PWID rely on emergency medical services, which are costly and not designed to deliver preventive services, manage chronic conditions, or address social needs. OBJECTIVE The objective of this study was to explore barriers and facilitators to primary care utilization from the perspectives of PWID in New England, a region highly affected by the overdose crisis. DESIGN Participants completed semi-structured qualitative interviews exploring substance use and healthcare utilization patterns. PARTICIPANTS We recruited 78 PWID through community-based organizations (e.g., syringe service programs) in 16 urban and non-urban communities throughout Massachusetts and Rhode Island. APPROACH Thematic analysis identified barriers and facilitators to primary care utilization at the individual, interpersonal, and systemic levels. KEY RESULTS Among 78 PWID, 48 described recent primary care experiences; 33 had positive experiences and 15 described negative experiences involving discrimination or mistrust. Individual-level barriers to primary care utilization included perceived lack of need and competing priorities (e.g., avoiding opioid withdrawal, securing shelter beds). Interpersonal-level barriers included stigma and perceived low quality of care for PWID. Systemic-level barriers included difficulty navigating healthcare systems, inadequate transportation, long wait times, and frequent provider turnover. Participants with positive primary care experiences explained how appointment reminders, flexible hours, addiction medicine-trained providers, case management services, and transportation support facilitated primary care utilization and satisfaction. CONCLUSIONS Findings regarding the multilevel barriers and facilitators to accessing primary care among PWID identify potential targets for programmatic interventions to improve primary care utilization in this population. Based on these findings, we make recommendations for improving the engagement of PWID in primary care as a means to advance individual and public health outcomes.
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Affiliation(s)
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Ellen Childs
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Peter Salhaney
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Jennifer Olson
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Dea L Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
| | - Joel J Earlywine
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, 02118, USA.
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Franklin Edwards G, Mierisch C, Mutcheson B, Horn K, Henrickson Parker S. A review of performance assessment tools for rescuer response in opioid overdose simulations and training programs. Prev Med Rep 2020; 20:101232. [PMID: 33163333 PMCID: PMC7610043 DOI: 10.1016/j.pmedr.2020.101232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022] Open
Abstract
Since the 1990s, more than 600 overdose response training and education programs have been implemented to train participants to respond to an opioid overdose in the United States. Given this substantial investment in overdose response training, valid assessment of a potential rescuers' proficiency in responding to an opioid overdose is important. The aim of this article is to review the current state of the literature on outcome measures utilized in opioid overdose response training. Thirty-one articles published between 2014 and 2020 met inclusion criteria. The reviewed articles targeted laypersons, healthcare providers, and first responders. The assessment tools included five validated questionnaires, fifteen non-validated questionnaires, and nine non-validated simulation-based checklists (e.g., completion of critical tasks and time to completion). Validated multiple choice knowledge assessment tools were commonly used to assess the outcomes of training programs. It is unknown how scores on these assessment tools may correlate with actual rescuer performance responding to an overdose. Seven studies reported ceiling effects most likely attributed to participants' background medical knowledge or experience. The inclusion of simulation-based outcome measures of performance, including the commission of critical errors and the time to naloxone administration, provides better insight into rescuer skill proficiency.
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Affiliation(s)
- G. Franklin Edwards
- Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, USA
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Carilion Clinic Center for Simulation, Research and Patient Safety, Roanoke, VA, USA
| | - Cassandra Mierisch
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Carilion Clinic, Department of Orthopedics and Opioid Task Force, Roanoke, VA, USA
| | | | - Kimberly Horn
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Virginia-Maryland College of Veterinary Medicine, Department of Population Health Sciences Virginia Tech, Blacksburg, VA, USA
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Carilion Clinic Center for Simulation, Research and Patient Safety, Roanoke, VA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Abrams MP, Klapheke M. Objective Structured Clinical Examination Skill Station Is Effective for Assessing Acute Opioid Overdose Resuscitation. Cureus 2020; 12:e11511. [PMID: 33354455 PMCID: PMC7744215 DOI: 10.7759/cureus.11511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction In recent decades, deaths related to heroin, illicit fentanyl, and prescription opioids have risen in the United States. Utilizing new clinical guidelines and non-prescription naloxone, we aimed to develop a competency-based assessment for clinical skills in opioid overdose resuscitation outside of the hospital setting. Methods An assessment of opioid resuscitation skills, consisting of an Objective Structured Clinical Examination (OSCE) skill station-utilizing a simulation mannequin and a standardized patient portraying the patient’s relative-followed by a facilitated individual debrief, was added to the fourth year Psychiatry Boot Camp for students entering a psychiatry residency. A survey was given to students to assess the OSCE’s believability, value, and impact on confidence in managing out-of-hospital overdose. Results Following the OSCE, 2017-2019 graduating students entering a psychiatry residency (N=10) all agreed or strongly agreed that the OSCE “was realistic and believable” and “was valuable as an educational tool. Most either agreed (N=7) or strongly agreed (N=1) they felt confident of their skill in managing out-of-hospital opioid overdose. A small number (n=2) were neutral in the confidence of their skill in managing out-of-hospital opioid overdose. Discussion Based on early medical student feedback (n=10), this OSCE skill station provides a promising competency-based assessment for opioid overdose resuscitation outside of the hospital setting. Its use could be expanded to other medical disciplines in undergraduate and graduate education.
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Frush BW, Malone JR. Suffering and the moral orientation of presence: lessons from Nazi medicine for the contemporary medical trainee. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106061. [PMID: 32332152 DOI: 10.1136/medethics-2020-106061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Medical trainees should learn from the actions of Nazi physicians to inform a more just contemporary practice by examining the subtle assumptions, or moral orientations, that led to such heinous actions. One important moral orientation that still informs contemporary medical practice is the moral orientation of elimination in response to suffering patients. We propose that the moral orientation of presence, described by theologian Stanley Hauerwas, provides a more fitting response to suffering patients, in spite of the significant barriers to enacting such a moral orientation for contemporary trainees.
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Affiliation(s)
- Benjamin Wade Frush
- Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jay R Malone
- Department of Pediatrics and Critical Care Medicine, Washington University in St Louis, St Louis, Missouri, USA
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Jawa R, Luu T, Bachman M, Demers L. Rapid Naloxone Administration Workshop for Health Care Providers at an Academic Medical Center. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10892. [PMID: 32175476 PMCID: PMC7062540 DOI: 10.15766/mep_2374-8265.10892] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Opioid overdose is a growing problem in the US. Often, residents are first responders to community and in-hospital opioid overdoses, and so, hands-on naloxone administration education is necessary. While residents get a brief algorithm on suspected opioid overdose during their mandatory American Heart Association basic life support training, there is a lack of hands-on standardized curricula on how to administer this lifesaving medication. METHODS To fill this gap, we developed a hands-on workshop for medical trainees on how to respond to an opioid overdose. Trainees who completed our workshop left with a first-responder naloxone kit using the Massachusetts statewide open prescription. All attendees were asked to take a voluntary pre- and posttraining survey. RESULTS A total of 80 trainees from a variety of specialties and training levels participated in this workshop. We were able to successfully link the pre- and postdata of 29 participants. Trainees were assessed on comfort in administering naloxone as a first responder and in teaching patients how to administer naloxone (via a 5-point Likert scale) and on percentage of time they prescribed naloxone to high-risk patient populations. We saw statistically significant increases in comfort in using naloxone and comfort in teaching patients to administer naloxone. DISCUSSION This innovative curriculum provides an adaptable, short, and effective workshop with hands-on practice for medical trainees at a variety of training levels. The workshop can efficiently train future health care professionals how to approach an opioid overdose.
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Affiliation(s)
- Raagini Jawa
- Infectious Disease/Addiction Medicine Fellow, Department of Medicine, Boston Medical Center
| | - Thuy Luu
- Clinical Pharmacy Specialist—Internal Medicine, Boston Medical Center
| | - Melissa Bachman
- Clinical Pharmacy Specialist Lead—Internal Medicine, Boston Medical Center
| | - Lindsay Demers
- Assistant Professor, Department of Medicine, Boston University School of Medicine
- Director, Education Evaluation Core, Boston University School of Medicine
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Haegerich TM, Jones CM, Cote PO, Robinson A, Ross L. Evidence for state, community and systems-level prevention strategies to address the opioid crisis. Drug Alcohol Depend 2019; 204:107563. [PMID: 31585357 DOI: 10.1016/j.drugalcdep.2019.10756311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Practitioners and policy makers need evidence to facilitate the selection of effective prevention interventions that can address the ongoing opioid overdose epidemic in the United States. METHODS We conducted a systematic review of publications reporting on rigorous evaluations of systems-level interventions to address provider and patient/public behavior and prevent prescription and illicit opioid overdose. A total of 251 studies were reviewed. Interventions studied included 1) state legislation and regulation, 2) prescription drug monitoring programs (PDMPs), 3) insurance strategies, 4) clinical guideline implementation, 5) provider education, 6) health system interventions, 7) naloxone education and distribution, 8) safe storage and disposal, 9) public education, 10) community coalitions, and 11) interventions employing public safety and public health collaborations. RESULTS The quality of evidence supporting selected interventions was low to moderate. Interventions with the strongest evidence include PDMP and pain clinic legislation, insurance strategies, motivational interviewing in clinical settings, feedback to providers on opioid prescribing behavior, intensive school and family-based programs, and patient education in the clinical setting. CONCLUSIONS Although evidence is growing, further high-quality research is needed. Investigators should aim to identify strategies that can prevent overdose, as well as influence public, patient, and provider behavior. Identifying which strategies are most effective at addressing prescription compared to illicit opioid misuse and overdose could be fruitful, as well as investigating synergistic effects and unintended consequences.
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Affiliation(s)
- Tamara M Haegerich
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Pierre-Olivier Cote
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Amber Robinson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
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Muzyk A, Smothers ZPW, Akrobetu D, Ruiz Veve J, MacEachern M, Tetrault JM, Gruppen L. Substance Use Disorder Education in Medical Schools: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1825-1834. [PMID: 31663960 DOI: 10.1097/acm.0000000000002883] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE As medical schools adapt their curricula to prepare future physicians for the opioid crisis and for treating patients with substance use disorders (SUDs), educators should refer to courses described in the literature. This scoping review aimed to (1) provide a comprehensive evaluation and summation of peer-reviewed literature reporting on SUD education in medical schools globally and (2) appraise the research quality and educational outcomes reported in SUD education studies in medical schools. METHOD The authors searched 6 databases (3 Ovid MEDLINE databases, Embase, ERIC, and Web of Science) from inception through May 25, 2018. Original English-language research studies focusing on medical students and describing SUD education in medical schools were included. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess included studies. RESULTS Of 3,178 articles identified, 43 met inclusion criteria. Studies were conducted in 9 countries. Most reported on educational interventions for tobacco (n = 20; 47%); others reported on interventions for SUDs broadly (n = 15; 35%), alcohol (n = 8; 19%), and opioids (n = 1; 2%). The mean MERSQI score was 12.27 (standard deviation 2.30). Four studies (9%) reported on educational outcomes at the level of behaviors or patient or health care outcomes. The majority (n = 39; 91%) reported significant benefits. CONCLUSIONS Educational interventions relating to SUDs were effective in improving medical students' knowledge, skills, and attitudes. Educators should develop courses that achieve higher-level educational outcomes, increase education on opioid use disorders, and focus on the greatest public health concerns.
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Affiliation(s)
- Andrew Muzyk
- A. Muzyk is associate professor, Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, and associate professor of the practice of medical education, Duke University School of Medicine, Durham, North Carolina; ORCID: http://orcid.org/0000-0002-6904-2466. Z.P.W. Smothers is a second-year student, Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina. D. Akrobetu is a second-year student, Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina. J. Ruiz Veve is a third-year student, Doctor of Pharmacy Program, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina. M. MacEachern is informationist, Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-8872-1181. J.M. Tetrault is associate professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. L. Gruppen is professor, Department of Learning Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0002-2107-0126
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Hargraves D, White CC, Mauger MR, Puthota A, Pallerla H, Wigle P, Brubaker SL, Schlaudecker JD. Evaluation of an interprofessional naloxone didactic and skills session with medical residents and physician assistant learners. Pharm Pract (Granada) 2019; 17:1591. [PMID: 31592036 PMCID: PMC6763304 DOI: 10.18549/pharmpract.2019.3.1591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/01/2019] [Indexed: 11/14/2022] Open
Abstract
Background The CDC has reported 399,230 opioid-related deaths from 1999-2017. In 2018, the US surgeon general issued a public health advisory, advising all Americans to carry naloxone. Studies show that enhanced naloxone access directly reduces death from opioid overdose. Despite this, health care professional learners report low knowledge and confidence surrounding naloxone. Therefore, it becomes critical that medical education programs incorporate didactic and experiential sessions improving knowledge, skills and attitudes regarding harm reduction through naloxone. Objectives 1. Describe the components and evaluation of a replicable and adaptable naloxone didactic and skills session model for medical providers; 2. Report the results of the evaluation from a pilot session with family medicine residents and physician assistant students; and 3. Share the session toolkit, including evaluation surveys and list of materials used. Methods In July 2017, a literature search was completed for naloxone skill training examining best practices on instruction and evaluation. A training session for family medicine residents and physician assistant learners was designed and led by University of Cincinnati College of Medicine and College of Pharmacy faculty. The same faculty designed a pre and post session evaluation form through internal review on elements targeting naloxone knowledge, attitude, and self-efficacy. Results The training session included one hour for a didactic and one hour for small group live skills demonstration in four methods of naloxone administration (syringe and ampule, nasal atomizer, branded nasal spray and auto injector). Forty-eight participants showed statistically significant (p<0.05) improvement in knowledge (67.5% to 95.9%), attitudes (71.2% to 91.2%), and self-efficacy (62.1% to 97.8%) from pre to post assessment. Forty-four of 48 participants agreed that the pace of the training was appropriate and that the information will be of use in their respective primary care practices. Supply costs for the session were USD 1,200, with the majority being reusable on subsequent trainings. Conclusions Our study of a naloxone didactic and skills session for primary care trainees demonstrated significant improvements in knowledge, self-efficacy, and attitudes. It provides an adaptable and efficient model for delivery of knowledge and skills in naloxone administration training. The pilot data suggest that the training was efficacious.
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Affiliation(s)
- Daniel Hargraves
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Christopher C White
- Associate Professor of Family & Community Medicine. College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Marcia R Mauger
- College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Aruna Puthota
- The Christ Hospital; & Family Medicine Residency Program, University of Cincinnati. Cincinnati, OH (United States).
| | - Harini Pallerla
- Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Patricia Wigle
- James L. Winkle College of Pharmacy, University of Cincinnati. Cincinnati, OH (United States).
| | - Sarah L Brubaker
- Program Coordinator, Department of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
| | - Jeffrey D Schlaudecker
- Associate Professor of Family & Community Medicine, College of Medicine, University of Cincinnati. Cincinnati, OH (United States).
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