Hospital-based clinicians lack knowledge and comfort in initiating medications for opioid use disorder: opportunities for training innovation

Abstract

Background Hospital-based clinicians infrequently initiate medications for opioid use disorder (MOUD) for hospitalized patients. Our objective was to understand hospital-based clinicians’ knowledge, comfort, attitudes, and motivations regarding MOUD initiation to target quality improvement initiatives. Methods General medicine attending physicians and physician assistants at an academic medical center completed questionnaires eliciting barriers to MOUD initiation, including knowledge, comfort, attitudes and motivations regarding MOUD. We explored whether clinicians who had initiated MOUD in the prior 12 months differed in knowledge, comfort, attitudes, and motivations from those who had not. Results One-hundred forty-three clinicians completed the survey with 55% reporting having initiated MOUD for a hospitalized patient during the prior 12 months. Common barriers to MOUD initiation were: (1) Not enough experience (86%); (2) Not enough training (82%); (3) Need for more addiction specialist support (76%). Overall, knowledge of and comfort with MOUD was low, but motivation to address OUD was high. Compared to MOUD non-initiators, a greater proportion of MOUD initiators answered knowledge questions correctly, agreed or strongly agreed that they wanted to treat OUD (86% vs. 68%, p = 0.009), and agreed or strongly agreed that treatment of OUD with medication was more effective than without medication (90% vs. 75%, p = 0.022). Conclusions Hospital-based clinicians had favorable attitudes toward MOUD and are motivated to initiate MOUD, but they lacked knowledge of and comfort with MOUD initiation. To increase MOUD initiation for hospitalized patients, clinicians will need additional training and specialist support.

Barriers to initiate buprenorphine and methadone for opioid use disorder treatment with postdischarge treatment linkage

“…Participants reported that processes to screen for, and to diagnose OUD, to initiate medications for OUD, and to ensure OUD treatment linkage following hospital discharge could be improved with protocols or pathways. Thus, we will develop an electronic health record (EHR)-based pathway that incorporates nursing prompts to complete screening questions for unhealthy substance use at hospital admission, an embedded COWS 35 38 To address this barrier, we will offer quarterly in-person or video conferencing seminars with educational content including how to initiate medications for OUD, for example, traditional versus low dose buprenorphine initiation, the legality around the use of medications for OUD in the hospital and outpatient setting, and clear goals and expectations for nurses, clinicians, and social workers to incorporate these OUD treatment pathways into their hospital workflow. We will provide positive feedback to clinicians with updates on success stories of patients who remain engaged in treatment following in-hospital OUD treatment initiation to motivate and enhance practice change.…”

Point/counterpoint: Should full agonist opioid medications be offered to hospitalized patients for management of opioid withdrawal?

“…Use of these specific medications is associated with increased days of antibiotic therapy, 21 decreased risk of recurrent infection, 22 and reduced overdose mortality 23 among hospitalized patients with infections and OUD, however, hospital clinicians are reluctant to initiate these medications due to a lack of experience and training. 24 In one study of Veterans Affairs hospitals, fewer than 15% of hospitalized patients with OUD were ever treated with these medications. 12 Proposing the use of oxycodone or hydromorphone STERN ET AL.…”

Perspectives and Recommendations from Hospitalized Patients with Substance Use Disorders: A Qualitative Study

“…7,8 Second, largely due to a lack of knowledge and teaching, many hospital providers are uncomfortable treating SUDs – including opioid use disorder (OUD) and alcohol use disorder (AUD), for which evidence-based treatments are widely available. 4,10,11 Together, these factors likely contribute to an established under-treatment of these SUDs in hospital settings, in addition to lower provider engagement, patient-provider collaboration, and treatment adherence. 11–18…”

“…4,10,11 Together, these factors likely contribute to an established under-treatment of these SUDs in hospital settings, in addition to lower provider engagement, patient-provider collaboration, and treatment adherence. 11–18…”

“…Efforts to address these patients’ concerns and consider novel interventions can increase satisfaction, engagement, trust in the therapeutic alliance, and overall care quality. 5,11,13–18,20,21,23 Furthermore, coordinating patient engagement in the evaluation, design and delivery of health services can lead to enhanced care delivery and education development. 24…”