Assessment of Provider Attitudes toward #Naloxone on Twitter

Haug, Nancy A.; Bielenberg, Jennifer; Linder, Steven H; Lembke, Anna

doi:10.1080/08897077.2015.1129390

Cited by 45 publications

(42 citation statements)

References 22 publications

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“…They may be worried about stigmatizing patients or alienating them by discussing overdose prevention. 6 These concerns may be more pronounced for elderly patients or those with opioid prescriptions. Residents may also assume elderly patients use less opioids overall or use them in less risky ways than younger patients.…”

Section: Discussionmentioning

confidence: 99%

A Cross-sectional Survey Using Clinical Vignettes to Examine Overdose Risk Assessment and Willingness to Prescribe Naloxone

et al. 2018

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INTRODUCTIONThe number of opioid-related overdose deaths has increased concurrently with rising rates of opioid use nationally. 1 Clinical encounters offer an opportunity to provide high-risk patients with targeted interventions, 2 yet clinicians routinely miss the opportunity to deliver risk reduction counseling and naloxone to appropriate patients 3 due, in part, to knowledge gaps. 4,5 To better identify physician education targets, we examined how internal medicine trainees' beliefs influence willingness to prescribe naloxone, how residents assess risk of opioidrelated overdose, and concordance between risk assessment and naloxone prescription. METHODSThe study occurred at an academic medical center in Baltimore, MD, with high rates of opioid use and overdose. IRB deemed our study exempt. We surveyed internal medicine residents and collected information on beliefs and behaviors based on seven clinical vignettes. Each vignette provided patient-specific information including age, medical comorbidities, type, and quantity of opioids, and if opioids were chronically or acutely prescribed. Vignettes incorporated a range of overdose risk factors discussed in the literature: opioid dose > 50-100 morphine milligram equivalents (MME) per day confer a moderate risk, dose > 100 MME/day confer a high risk; presence of co-occurring substance use and history of previous overdose both increase risk of overdose compared to those without similar risk factors. 1 We asked residents the likelihood of overdose risk on a four-point scale (not likely, low, medium, or high) and if they would prescribe naloxone.We completed bivariate analyses looking at relationship of provider characteristics, history of having prescribed naloxone, and willingness to prescribe in the future using STATA (v.15.0, StataCorp). To analyze clinical vignettes, we collapsed risk assessment as determined by the residents into two categories of overdose likelihood: not likely/low and moderate/high. We defined discordant prescribing as occurring when residents rated patients as not likely or low risk of opioid overdose, but still prescribed naloxone and when residents rated patients as moderate to high risk but, did not prescribe naloxone. RESULTSThe survey response rate was 68% (N = 97), divided evenly among all training years. Beliefs increasing the willingness to prescribe naloxone included positive attitudes on addiction education and believing naloxone is effective in reducing overdose (Table 1). Physician demographic factors were not associated with willingness to prescribe naloxone including age (OR 0.83; 95%CI 0.65, 1.07); gender (OR 0.68; 95%CI 0.20, 2.26); race (OR 0.28; 95%CI 0.46, 3.62); or year of training (OR 0.74, 95%CI 0.38, 1.53). Having prescribed naloxone in the past did not increase the residents' likelihood of prescribing naloxone in these vignettes (OR 0.85; 95%CI − 0.16, 4.39).

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Section: Discussionmentioning

confidence: 99%

A Cross-sectional Survey Using Clinical Vignettes to Examine Overdose Risk Assessment and Willingness to Prescribe Naloxone

et al. 2018

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“…PWID often identify provider‐based stigma as a primary reason for avoiding or delaying accessing healthcare (Paquette et al, ). Stigma among healthcare providers is widely discussed in the extant literature (Haug, Bielenberg, Linder, & Lembke, ; Paquette et al, ; Tempalski, ); however, examining how healthcare providers understand their personal stigmatizing beliefs toward PWID and naloxone, and what interventions may help alter those beliefs, is not well understood. Examining stigmatization among healthcare providers may be of particular importance to the profession of nursing as a study conducted by Huag, et al, (2016) found that compared with other healthcare providers, nurses were responsible for the highest number of stigmatizing posts on social media about naloxone (2016).…”

Section: Discussionmentioning

confidence: 99%

Integrating naloxone education into an undergraduate nursing course: Developing partnerships with a local department of health

Carter

Caudill²

2020

Public Health Nursing

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Background: Substance misuse continues to be a significant concern in the United States, with over 700,000 lives lost from a drug overdose between 1999 and 2017.However, nursing curricula have failed to keep pace with the epidemic. Methods:The current study used a pre-post study design and involved a convenience sample of undergraduate nursing students (n = 37) enrolled in a community health nursing course. Students completed an 11-item online survey examining naloxone stigma, naloxone self-efficacy, and naloxone knowledge. A paired sample t test was conducted to evaluate the impact of the in-person training and education event. Results: There was a statistically significant increase in post-intervention naloxone knowledge scores from the pre-survey (M = 3.57, SD = 0.959) to the post-survey (M = 4.70, SD = 0.520). Stigma toward naloxone demonstrated a statistically significant increase in the post-intervention stigma survey (M = 9.00, SD = 1.312) compared with the pre-intervention stigma survey (M = 7.78, SD = 2.228). Naloxone self-efficacy also demonstrated a statistically significant increase in the post-intervention naloxone efficacy survey (M = 10.08, SD = 1.064) compared with the pre-intervention naloxone efficacy scores (M = 7.38, SD = 2.22). Conclusions:The students' scores demonstrated a significant increase in naloxone knowledge, self-efficacy, and stigma. Future research is needed to explore the impact of integrating naloxone education in the undergraduate nursing curriculum. K E Y W O R D Sharm reduction, naloxone, nursing education, overdose prevention How to cite this article: Carter G, Caudill P. Integrating naloxone education into an undergraduate nursing course:Developing partnerships with a local department of health.

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“…Thirdly, a linear mixed model was built to examine the adjusted association between the stigma score and other selected variables, in which the province and clinic unit were treated as random-effects factors. We selected the independent variables of the model based on our prior knowledge about potential factors associated with service providers' stigma towards PWUD (Haug et al, 2016;Li et al, 2015;Lin et al, 2018;Ronzani et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…For service providers, their negative attitudes to PWUD may decrease their interaction with patients and reduce adherence to treatment protocols (Li, Wu, Cao, & Zhang, 2012;Lin, Lan, Li, & Rou, 2018). Meanwhile, the occupational burnout and fatigue of service providers may be increased as a result of working with stigmatized groups (Haug, Bielenberg, Linder, & Lembke, 2016;Morgan, Lee, & Sebar, 2015).…”

Section: Introductionmentioning

confidence: 99%

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

Luo

Lin

Feng

et al. 2019

International Journal of Drug Policy

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Background: Drug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors. Methods: The cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers. Results: The Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value < 0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=−1.79; 95% CI: −3.13, −0.45; p-value = 0.009). Conclusion: The findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.

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Assessment of Provider Attitudes toward #Naloxone on Twitter

Abstract: Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers.

Cited by 45 publications

References 22 publications

A Cross-sectional Survey Using Clinical Vignettes to Examine Overdose Risk Assessment and Willingness to Prescribe Naloxone

A Cross-sectional Survey Using Clinical Vignettes to Examine Overdose Risk Assessment and Willingness to Prescribe Naloxone

Integrating naloxone education into an undergraduate nursing course: Developing partnerships with a local department of health

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

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