Reducing Opioid Bias is Necessary (ROBIN): An Educational Program to Reduce Addiction Stigma

Enhancing Knowledge and Attitudes Regarding Opioid Use Disorder Among Private Primary Care Clinics: A Quality Improvement Project

ABSTRACT

Opioid use disorder (OUD) continues to impact communities worldwide. British Columbia specifically declared a public health emergency in April 2016. It is known that patients with OUD often experience barriers in access to care, including limited knowledge and training among providers, as well as persisting stigma in the medical community. The Doctor of Nursing Practice quality improvement project sought to provide barrier-targeted OUD education while using multiple effective teaching methods, such as test-enhanced learning, to family nurse practitioners (FNPs) working among private primary care clinics to assess the impact on knowledge and attitudes. In review of an experience survey, zero participants had received prior education on OUD (N = 7). The Drug and Drug Problems Perceptions Questionnaire was used to assess attitudes. In review of the data, attitudes before receiving education (Mdn = 74) improved after receiving barrier-targeted education (Mdn = 66), W = 0, p < .05. Knowledge was tested at three time points. After a review of unique identifiers, four participant tests were successfully linked. It was found that knowledge after receiving education (M = 7.75, Mdn = 7.5) improved in comparison with baseline knowledge (M = 6, Mdn = 6) and further improved after a 1-month time frame (M = 8.5, Mdn = 8.5). Although the project was limited by sample size, providing education to FNPs who have not received prior education on OUD, and using modalities such as test-enhanced learning, showed a favorable impact on knowledge and attitudes. In light of the opioid epidemic, nursing leaders must continue to actively engage practicing FNPs and students with OUD education. FNPs are well positioned to be champions in this area and may mobilize teams to overcome barriers among private primary care clinics and increase access to care.

Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce

INTRODUCTION

Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants.

METHODS

We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control.

RESULTS

Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points.

CONCLUSIONS

NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.

Correlation of rs35753505 polymorphism in Neuregulin 1 gene with psychopathology and intelligence of people with schizophrenia

BACKGROUND AND AIM

Schizophrenia is one of the most severe psychiatric disorders. About 0.5 to 1% of the world's population suffers from this non-Mendelian disorder. Environmental and genetic factors seem to be involved in this disorder. In this article, we investigate the alleles and genotypic correlation of mononucleotide rs35753505 polymorphism of Neuregulin 1 (NRG1), one of the selected genes of schizophrenia, with psychopathology and intelligence.

MATERIALS AND METHODS

102 independent and 98 healthy patients participated in this study. DNA was extracted by the salting out method and the polymorphism (rs35753505) were amplified by polymerase chain reaction (PCR). Sanger sequencing was performed on PCR products. Allele frequency analysis was performed using COCAPHASE software, and genotype analysis was performed using Clump22 software.

RESULTS

According to our study's statistical findings, all case samples from the three categories of men, women, and overall participants significantly differed from the control group in terms of the prevalence of allele C and the CC risk genotype. The rs35753505 polymorphism significantly raised Positive and Negative Syndrome Scale (PANSS) test results, according to a correlation analysis between the two variables. However, this polymorphism led to a significant decrease in overall intelligence in case samples compared to control samples.

CONCLUSION

In this study, it seems that the rs35753505 polymorphism of NRG1 gene has a significant role in the sample of patients with schizophrenia in Iran and also in psychopathology and intelligence disorders.