Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors

Klimas, Jan; Small, Will; Ahamad, Keith; Cullen, William R.; Mead, Annabel; Rieb, Launette; Wood, Evan; McNeil, Ryan

doi:10.1186/s13722-017-0086-9

Cited by 15 publications

(30 citation statements)

References 59 publications

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“…Our study also builds on literature describing widespread negative provider attitudes toward people with substance use, 32 and supports that ECHO-especially peer faculty-can shift that. Finally, this study builds on growing literature about training healthcare providers-and especially physicians [33][34][35] -in addictions care. It is novel in that it targets interprofessional hospital providers, uses case-based learning with cases identified in real time by providers newly engaging in the treatment of SUDs, and focuses on continuing education for practicing professionals.…”

Section: Discussionmentioning

confidence: 99%

Spreading Addictions Care Across Oregon’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program

et al. 2020

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BACKGROUND: Despite evidence of effectiveness, most US hospitals do not deliver hospital-based addictions care. ECHO (Extension for Community Healthcare Outcomes) is a telementoring model for providers across diverse geographic areas. We developed and implemented a substance use disorder (SUD) in hospital care ECHO to support statewide dissemination of best practices in hospital-based addictions care. OBJECTIVES: Assess the feasibility, acceptability, and effects of ECHO and explore lessons learned and implications for the spread of hospital-based addictions care. DESIGN: Mixed-methods study with a pre-/post-intervention design. PARTICIPANTS: Interprofessional hospital providers and administrators across Oregon. INTERVENTION: A 10-12-week ECHO that included participant case presentations and brief didactics delivered by an interprofessional faculty, including peers with lived experience in recovery. APPROACH: To assess feasibility and acceptability, we collected enrollment, attendance, and participant feedback data. To evaluate ECHO effects, we used pre-/post-ECHO assessments and performed a thematic analysis of open-ended survey responses and participant focus groups. KEY RESULTS: We recruited 143 registrants to three cohorts between January and September 2019, drawing from 32 of Oregon's 62 hospitals and one southwest Washington hospital. Ninety-six (67.1%) attended at least half of ECHO sessions. Participants were highly satisfied with ECHO. After ECHO, participants were more prepared to treat SUD; however, prescribing did not change. Participants identified substantial gains in knowledge and skills, particularly regarding the use of medications for opioid use disorder; patient-centered communication with people who use drugs; and understanding harm reduction as a valid treatment approach. ECHO built a community of practice and reduced provider isolation. Participants recognized the need for supportive hospital leadership, policies, and SUD resources to fully implement and adopt hospital-based SUD care. CONCLUSIONS: A statewide, interprofessional SUD hospital care ECHO was feasible and acceptable. Findings may be useful to health systems, states, and regions looking to expand hospital-based addictions care.

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Section: Discussionmentioning

confidence: 99%

Spreading Addictions Care Across Oregon’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program

et al. 2020

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“…This discomfort has been noted in prior studies. [40][41] Since 13 of 15 of our participants had received MAT training, this observation suggests that MAT training alone is inadequate to address the discomfort.…”

Section: Discussionmentioning

confidence: 99%

Preceptors’ Preparedness to Teach About Substance and Opioid Use Disorder: A Qualitative Study

Lowe

Kogan

Feldman

et al. 2022

Preprint

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Study Aim: Little is known about preceptors’ comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors’ views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies.Methods: Particiants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach.Results: Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include role modeling positive behaviors, negative patient bias as a barrier and need for longitudinal curriculum), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors’ own training, and need for clinical students to be trained). Conclusions: Data analysis enabled the construction of a conceptual framework reflecting a continuum of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles, in order to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.

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“…There are suggestions that medical students who frequently use drugs or drink to excess during medical school, which includes after-exam partying, are at risk for developing a pattern of habitual use [18]. An emerging medical field, addiction medicine, can overlap the gap of the prevention and treatment of risky substance use and addiction has prevented [19,20].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of psychoactive substances consumption among students of first and fifth year of Faculty of Medicine of Sarajevo University

Catovic¹,

Gudelj²

2021

GSC Adv. Res. Rev.

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A psychoactive or psychotropic substance is a chemical substance that acts primarily upon the central nervous system, altering mental processes, e.g., cognition or affect. Their use can lead to addiction, so in common language ‘substance abuse’ implicate dependence-producing effect. In general, initiation to substance use happen during adolescence and early adulthood. The aim of this study was determining the pattern of psychoactive substance consumption among students at Faculty of Medicine of Sarajevo University. A cross-sectional study was conducted during May 2019 at Faculty of Medicine of Sarajevo University. The survey covered 102 students, who attended first and fifth year of study. The research instrument was a self-administered anonymous questionnaire. Results were expressed as percentages and means ± standard deviation. During statistical analysis we performed Chi-squared and the bivariate testes. A sample included 102 students, of which 66 (64.7%) were female and 36 (35.3%) were male, while 52 (51.0%) attended first year and 50 (49.0%) attended fifth year. The majority of students (91.2%) had consumed caffeine. Consumption of cigarettes reported 63.7% of students, and consumption of alcohol reported 60.8% of students. Statistically significant differences in consumption of alcohol (P<0.0005), THC (P<0.0005), cocaine (P=0.001), and amphetamine (P=0.017) were found between gender. Statistically significant differences in consumption of cigarettes (P=0.034), caffeine (P=0.017), alcohol (P=0.007), THC (P<0.0005), and sedatives (P=0.003) were found between two study group. The use of psychotropic substances in youth represents a serious public health problem. Students should implement their knowledge, not only in their practice environment, but in everyday life.

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Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors

Cited by 15 publications

References 59 publications

Spreading Addictions Care Across Oregon’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program

Spreading Addictions Care Across Oregon’s Rural and Community Hospitals: Mixed-Methods Evaluation of an Interprofessional Telementoring ECHO Program

Preceptors’ Preparedness to Teach About Substance and Opioid Use Disorder: A Qualitative Study

Characteristics of psychoactive substances consumption among students of first and fifth year of Faculty of Medicine of Sarajevo University

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