Specific disciplines addressing substance use: AMERSA in the 21st century

Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies

Background

The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion.

Objectives

The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients.

Results

Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum.

Conclusion

To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé.

Substance use-related continuing education course objectives: Alignment with professional competencies

Background: Novel educational efforts are needed to prepare the current and future interprofessional health care workforce to address the range of substance use-related health problems. A 6-module massive open online course (MOOC) was developed to provide education to health professionals of various disciplines on the fundamentals of substance use-related treatment. The purpose of this project was to match course objectives to substance use-related competencies for 5 disciplines: nurses, pharmacists, physicians, physician assistants (PA), and social workers. Methods: Content expert raters within each discipline determined what Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) core competencies were matched to each objective for the 6 modules of the MOOC. The number of objectives across the 6 modules was summated. Results: All nursing and social work competencies were mapped to the course objectives. For physicians, PAs, and pharmacists, the proportions of knowledge-based competencies that mapped to the course objective were 58%, 76%, and 80%, respectively, and proportions of skill-based competencies that mapped to the course objective were 88%, 83%, and 75%, respectively. For those 3 groups, 100% of attitude-based competencies mapped to the course objective. Conclusions: The competency-based mapping with the MOOC objectives supports the interprofessional design of the course and discipline-specific competencies needed to promote the best outcomes for patients.

Does the Length of Time to Complete an Online Program Matter?

Health care providers are challenged to meet the simultaneous demands of delivering clinical care and acquiring new information, especially in the context of the coronavirus disease 2019 pandemic, the opioid epidemic, and concurrent escalation in alcohol and other drug use. To address the gap in knowledge related to substance use, screening, brief intervention, and referral to treatment (SBIRT), a self-paced online educational program, was developed and delivered to 169 learners. Posttest knowledge scores increased for all learners and did not differ based on their pace of completion. Results indicated that this module provides a means for busy clinicians to increase their ability to manage substance use, even if their learning occurs in multiple sessions interrupted by other pressing demands. Future iterations of this course could further enhance clinical competency by addition of an online clinical simulation component. [J Contin Educ Nurs. 2021;52(11):505-510.].

Physical therapists should play a greater role in managing patients with opioid use and opioid misuse

The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists' knowledge and skills related to managing patients taking prescription opioid medications for pain.