In-Hospital Training in Addiction Medicine: A Mixed-Methods Study of Health Care Provider Benefits and Differences

Gorfinkel, Lauren; Klimas, Jan; Reel, Breanne; Dong, Huiru; Ahamad, Keith; Fairgrieve, Christopher; McLean, Mark; Mead, Annabel; Nolan, Seonaid; Small, Will; Cullen, William R.; Wood, Evan; Fairbairn, Nadia

doi:10.1080/08897077.2018.1561596

Cited by 18 publications

(25 citation statements)

References 24 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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“…[63][64][65][66] For example, the addiction medicine consult team (AMCT) at St. Paul's Hospital in Vancouver offers a structured clinical rotation that involves a fourweek rotating addiction educational curriculum consisting of didactic lectures, journal clubs, mortality and morbidity rounds, and grand rounds presentations. 64,67,68 Trainees are supervised in learning to conduct addiction medicine consults, including inpatient withdrawal management, MI, coordination of addiction treatment for medical comorbidities, screening, brief intervention and referral to treatment (SBIRT) and pharmacological management of substance use disorders. 64,67,68 The AMCT then conducts all follow-up treatment recommendations and coordination.…”

Section: Impact Of Multidisciplinary Addiction Training Programs On Enhancing Competenciesmentioning

confidence: 99%

“…64,67,68 Trainees are supervised in learning to conduct addiction medicine consults, including inpatient withdrawal management, MI, coordination of addiction treatment for medical comorbidities, screening, brief intervention and referral to treatment (SBIRT) and pharmacological management of substance use disorders. 64,67,68 The AMCT then conducts all follow-up treatment recommendations and coordination.…”

Section: Impact Of Multidisciplinary Addiction Training Programs On Enhancing Competenciesmentioning

confidence: 99%

“…66 Residents and fellows who participated in the St. Paul's Hospital AMCT training program improved their competencies in multiple categories, including substance use screening, history taking, treating withdrawal, relapse prevention, the management of nicotine and opioid use disorder, safe prescribing for opioid use disorder, and the neurobiology of addiction. 64 In summary, integrated clinical rotations and fellowship programs are efficient in enhancing multiple addiction psychiatry competencies simultaneously. 63,66 General psychiatry residents from Michigan state who completed a 50-item test on general knowledge about substance use disorders showed improved retest scores upon completing their rotations.…”

Section: Impact Of Multidisciplinary Addiction Training Programs On Enhancing Competenciesmentioning

confidence: 99%

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Towards competency-based medical education in addictions psychiatry: a systematic review

et al. 2021

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Background: Current curriculum guidelines for addiction training in psychiatry need to be adapted to the competency by design framework to integrate clinical skills in addiction. Objective: We conducted a systematic review to identify curricular and educational interventions to build competency among psychiatry residents and fellows in addiction psychiatry. Methods: We followed the PRISMA guidelines, searching five databases from inception to August 2020 for relevant evaluation-type studies exploring addiction psychiatry competency among psychiatry residents and fellows. We appraised study quality using the Joanna Briggs Institute's risk of bias tool for observational designs. Results: From 1600 records, 17 studies met inclusion criteria. Addiction psychiatry competencies spanned themes involving core knowledge development; attitudinal, communication and leadership skills; screening, assessment, diagnosis; management; and special populations. Examples of effective educational interventions to enhance addiction competency include specific modules for substance use disorders and integrated clinical rotations that simultaneously combine multiple types of skills. Lived experience improved trainee attitudes towards addiction psychiatry. Conclusions: While there is current evidence supporting strategies for developing competency in addiction psychiatry, the lack of studies measuring sustained competence over a longer-term follow-up period and the absence of randomized controlled trials limit the overall strength of evidence in this review. Current psychiatry entrustable professional activities (EPAs) involving addiction only partly overlap with curriculum training guidelines and studies identified in this review. These EPAs need to be better identified for training programs, competence in those EPAs better delineated for residents and preceptors, and evaluations should be done to ensure that adequate competence in addictions is attained and sustained.

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“…Finally, by treating addiction and modeling patient-centered addictions care, hospitalists can legitimize and destigmatize the disease of addiction, 8 and have the potential to mentor and train students, residents, nurses, and other staff. 27…”

Section: Individual Hospitalistsmentioning

confidence: 99%

A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder

Englander

Priest

Snyder

et al. 2019

Journal of Hospital Medicine

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In-Hospital Training in Addiction Medicine: A Mixed-Methods Study of Health Care Provider Benefits and Differences

Cited by 18 publications

References 24 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

Towards competency-based medical education in addictions psychiatry: a systematic review

A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder

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