Organizational factors associated with practitioners’ support for treatment of opioid use disorder in the emergency department

Guerrero, Erick G.; Ober, Allison J.; Howard, Daniel; Khachikian, Tenie; Kong, Yinfei; Deen, Welmoed K. van; Valdez, Avelardo; Trotzky-Sirr, Rebecca; Menchine, Michael

doi:10.1016/j.addbeh.2019.106197

Cited by 13 publications

(15 citation statements)

References 23 publications

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“…As demonstrated by mean CAP-POD scale scores, PCPs reported moderately high confidence in empirically supported interventions for treating co-occurring chronic pain and OUD, and in their ability to identify patients at risk. Conversely, they had low desire to treat these patients, a finding also supported previous research ( Barry et al, 2010 ; Bishop et al, 2007 ; Guerrero et al, 2020 ). Furthermore, they perceive their patients’ access to relevant services as suboptimum, a matter that has not been well-studied, but needs to be.…”

Section: Discussionsupporting

confidence: 85%

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

Varley

Goodin

Copes

et al. 2020

Implementation Research and Practice

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Background: Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) capacity to deliver high quality, research-informed care for this population is unknown. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. Methods: Capacity to Treat Co-Occurring Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire items were developed over a 2-year process including literature review, semi-structured interviews, and expert panel review. In 2018, a national sample of 509 PCPs was recruited through email to complete a questionnaire including the initial 44-item draft CAP-POD questionnaire. CAP-POD items were analyzed for dimensionality, inter-item reliability, and construct validity. Results: Principal component analysis resulted in a 22-item questionnaire. Twelve more items were removed for parsimony, resulting in a final 10-item questionnaire with the following 4 scales: (1) Motivation to Treat patients with chronic pain and OUD (α = .87), (2) Trust in Evidence (α = .87), (3) Assessing Risk (α = .82), and (4) Patient Access to therapies (α = .79). These scales were associated with evidence-based practice attitudes, knowledge of pain management, and self-reported behavioral adherence to best practice recommendations. Conclusion: We developed a brief, 10-item questionnaire that assesses factors influencing the capacity of PCPs to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. The questionnaire demonstrated good reliability and initial evidence of validity, and may prove useful in future research as well as clinical settings. Plain language abstract Patients with co-occurring chronic pain and opioid use disorder (OUD) have unique needs that may present challenges for clinicians and health care systems. Primary care providers’ (PCPs) ability to deliver high quality, research-informed care for this population is unknown. There are no validated instruments to assess factors influencing PCP capacity to implement best practices for treating these patients. The objective of this study was to develop and test a questionnaire of factors influencing PCP capacity to treat co-occurring chronic pain and OUD. We recruited 509 PCPs to participate in an online questionnaire that included 44 potential items that assess PCP capacity. Analyses resulted in a 10-item questionnaire that assesses factors influencing capacity to implement best practice recommendations for the treatment of co-occurring chronic pain and OUD. PCPs reported moderately high confidence in the strength and quality of evidence for best practices, and in their ability to identify patients at risk. However, PCPs reported low motivation to treat co-occurring chronic pain and OUD, and perceived patients’ access to relevant services as suboptimal, highlighting two areas that should be targeted with tailored implementation strategies. The 10-item Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire can be used for two purposes: (1) to assess factors influencing PCP capacity before implementation and identify areas that may require improvement for implementation and (2) to evaluate implementation interventions aimed at increasing PCP capacity to treat this population.

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Section: Discussionsupporting

confidence: 85%

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

Varley

Goodin

Copes

et al. 2020

Implementation Research and Practice

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“…The benefits of increased institutional support were addressed in six studies (40.0%) 33 , 34 , 38 , 43 , 45 , 49 . Adequate institutional support included not only appropriate staffing but also a general climate of innovation and continuing education 33 , 34 , 43 , 49 . Regulatory restrictions, both internal protocols and external policies, contributed to MOUD administration in six studies (40.0%) 8 , 33 , 34 , 40 , 55 , 56 .…”

Section: Resultsmentioning

confidence: 99%

“…System-level challenges must be addressed as well. Many system-level gaps exist within physicians’ offices and emergency departments 8 , 23 , 24 , 28 , 33 , 34 , 38 , 40 , 43 , 45 , 49 , 54 – 57 . System gaps should be remedied in organizations and local, state, and federal government levels to allow for well-equipped physicians to provide harm reduction techniques to patients.…”

Section: Discussionmentioning

confidence: 99%

Opioid Harm Reduction: A Scoping Review of Physician and System-Level Gaps in Knowledge, Education, and Practice

et al. 2022

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Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians' knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians' knowledge, education, or practice. Results: Thirtyseven studies were included. Studies examined how physicians' perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.

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“…Some of this research investigates emergency physician perceived legal barriers, logistics around prescribing, interactions with patients who lack interest, and institutional and individual attitudes around EDBUP. [20][21][22][23][24][25] However, there have been few studies focusing on EM residents' attitudes and perspectives regarding training on initiating buprenorphine for OUD in residency. To assess the educational needs and preferences of EM residents, we administered a national survey to examine the attitudes, experiences, and barriers around training to manage OUD in the ED.…”

Section: Introductionmentioning

confidence: 99%

“…There has been some research that explores the knowledge and attitudes of emergency physicians on ED‐initiated buprenorphine (EDBUP). Some of this research investigates emergency physician perceived legal barriers, logistics around prescribing, interactions with patients who lack interest, and institutional and individual attitudes around EDBUP 20–25 . However, there have been few studies focusing on EM residents' attitudes and perspectives regarding training on initiating buprenorphine for OUD in residency.…”

Section: Introductionmentioning

confidence: 99%

Resident attitudes, experiences, and preferences on initiating buprenorphine in the emergency department: A national survey

Hawk

2022

AEM Education and Training

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ObjectivesThe objective was to describe emergency medicine (EM) resident attitudes, preferences, and experiences around the knowledge and skills around the evidence‐based treatment of opioid use disorder (OUD) in the emergency department (ED).MethodsWe created an online survey that was distributed by the Emergency Medicine Residents’ Association research committee listserv to approximately 6600 resident physicians at all levels of EM residency training. Data were collected between June 2020 and October 2020. This 12‐question voluntary, anonymous survey included questions exploring EM resident preferences and experiences around the education and exposure to the evidence‐based management of patients with OUD in the ED setting. Descriptive statistics were used.ResultsA total of 288 of 6600 invited EM residents (response rate 4.4%) from 127 different EM residency programs across 38 states in the United States, District of Columbia, and Puerto Rico completed the survey. Most respondents (165/288; 57.3%) reported that it was “very important” for emergency physicians to have training to initiate buprenorphine treatment for patients with OUD. Just under half (140/288; 48.6%) reported they have or will receive X‐waiver training during residency and 46.9% (135/288) reported experience prescribing buprenorphine in the ED. The estimated proportions of EM faculty at responding residents’ primary teaching hospital with an X‐waiver was “most or all” (48/285; 16.8%), “about half” (23/285; 8.1%), “a handful” (79/285; 27.7%), “one or two” (33/285; 11.6%), “none” (19/285; 6.7%), or “not sure” (83/285; 29.1%).ConclusionSurvey results suggest that resident emergency physicians perceive the evidence‐based management of OUD to be relevant to EM residency training and are interested in receiving training on initiating medications for OUD treatment in the ED. Opportunities to improve resident education and clinical use of buprenorphine during ED residency training were identified.

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Organizational factors associated with practitioners’ support for treatment of opioid use disorder in the emergency department

Cited by 13 publications

References 23 publications

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

Development and validation of the Capacity to Treat Chronic Pain and Opioid Use Disorder (CAP-POD) questionnaire

Opioid Harm Reduction: A Scoping Review of Physician and System-Level Gaps in Knowledge, Education, and Practice

Resident attitudes, experiences, and preferences on initiating buprenorphine in the emergency department: A national survey

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