85 Physician-perceived Barriers to Treating Opiate Use Disorder in the Emergency Department

Logan, Gideon; Craen, Alexandra; Drone, Emily; Houck, Jessica; Alvarez, Felicia; Patel, Pankaj B.; Lebowitz, David; Dub, Larissa; Elahi, Nubaha; Ganti, Latha

doi:10.1016/j.annemergmed.2020.09.095

Cited by 1 publication

(8 citation statements)

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“…Our search yielded 9308 studies published between January 1, 1960, and October 5, 2021, with 1280 remaining after removal of duplicates and 552 assessed for eligibility (eFigure 1 in Supplement 1). Of 283 studies…”

Section: Resultsmentioning

confidence: 99%

“…The number of studies increased over time. For example, 4 studieswere published in 2000 and 21 in 2021, with a high of 31 in 2020 (eTable 2, eTable 3, eTable 4, eTable 5, and eFigure 2 in Supplement 1). Together, the included studies describe the views of 66 732 physicians who largely practiced general practice, internal medicine, or family medicine primarily in an office setting in the US.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies addressed more than 1 intervention. Alcohol (86 studies), nicotine (30 studies), and opioids (104 studies) were most often studied alone. Among studies reporting on multiple drugs (44 studies), alcohol was included most often (38 studies…”

Section: Resultsmentioning

confidence: 99%

“…Most studies did not gather or report data on all reasons. When queried, institutional environment (173 of 213 articles [81.2%]) was the most common reason, followed by lack of skill (170 of 230 articles [73.9%]…”

Section: Resultsmentioning

confidence: 99%

“…The number of studies increased over time. For example, 4 studies 89,156,184,236 were published in 2000 and 21 33,48,49,66,68,75,77,79,93,107,108,113,139,142,148,240,251,255,302,306,313 in 2021, with a high of 31 8,27,47,50,52,54,69,74,92,100,114,121,146,147,161,165,174,182,191,193,199,204,206,209,221,247,263,270,275,287,…”

Section: Study Characteristicsmentioning

confidence: 99%

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Physician Reluctance to Intervene in Addiction

Campopiano von Klimo,

Nolan,

Corbin

et al. 2024

JAMA Netw Open

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ImportanceThe overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.ObjectiveTo describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.Data SourcesA literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.Study SelectionPublications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.Data Extraction and SynthesisTwo reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.Main Outcomes and MeasuresThe primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.ResultsA total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.Conclusions and RelevanceIn this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%