Berland Noah, Fox Aaron, Tofighi Babak, Hanley Kathleen
a New York University School of Medicine , New York , New York , USA.
b Department of Medicine , Division of General Internal Medicine , Albert Einstein College of Medicine , Bronx , New York , USA.
Subst Abus. 2017 Apr-Jun;38(2):123-128. doi: 10.1080/08897077.2016.1275925. Epub 2016 Dec 27.
Opioid overdose deaths have reached epidemic proportions in the United States. This problem stems from both licit and illicit opioid use. Prescribing opioids, recognizing risky use, and initiating prevention, including opioid overdose prevention training (OOPT), are key roles physicians play. The American Heart Association (AHA) modified their basic life support (BLS) algorithms to consider naloxone in high-risk populations and when a pulse is appreciated; however, the AHA did not provide OOPT. The authors' intervention filled this training deficiency by teaching medical students opioid overdose resuscitation with a Train-the-Trainer model as part of mandatory BLS training.
The authors introduced OOPT, following a Train-the-Trainer model, into the required basic life support (BLS) training for first-year medical students at a single medical school in a large urban area. The authors administered pre- and post-evaluations to assess the effects of the training on opioid overdose knowledge, self-reported preparedness to respond to opioid overdoses, and attitudes towards patients with substance use disorders (SUDs).
In the fall 2014, 120 first-year medical students received OOPT. Seventy-three students completed both pre- and posttraining evaluations. Improvements in knowledge about and preparedness to respond to opioid overdoses were statistically significant (P < .01) and large (Cohen's D = 2.70 and Cohen's D = 2.10, respectively). There was no statistically significant change in attitudes toward patients with SUDs.
The authors demonstrated the effectiveness of OOPT as an adjunct to BLS in increasing knowledge about and preparedness to respond to opioid overdoses; improving attitudes toward patients with SUDs likely requires additional intervention. The authors will characterize knowledge and preparedness durability, program sustainability, and long-term changes in attitudes in future evaluations. These results support dissemination of OOPT as a part of BLS training for all medical students, and potentially all BLS providers.
阿片类药物过量致死在美国已达到流行程度。这个问题源于合法和非法阿片类药物的使用。开具阿片类药物处方、识别危险使用情况以及开展预防工作，包括阿片类药物过量预防培训（OOPT），是医生的关键职责。美国心脏协会（AHA）修改了其基础生命支持（BLS）算法，以便在高危人群中以及触及脉搏时考虑使用纳洛酮；然而，AHA并未提供OOPT。作者的干预措施通过以培训培训师模式教授医学生阿片类药物过量复苏技能，作为强制性BLS培训的一部分，填补了这一培训空白。
作者在一个大城市的一所医学院，将遵循培训培训师模式的OOPT引入到一年级医学生的必修基础生命支持（BLS）培训中。作者进行了培训前和培训后的评估，以评估培训对阿片类药物过量知识、自我报告的应对阿片类药物过量的准备情况以及对物质使用障碍（SUD）患者态度的影响。
2014年秋季，120名一年级医学生接受了OOPT。73名学生完成了培训前和培训后的评估。在阿片类药物过量知识和应对准备方面的改善具有统计学意义（P < .01）且幅度较大（科恩d值分别为2.70和2.10）。对SUD患者的态度没有统计学上的显著变化。
作者证明了OOPT作为BLS辅助手段在增加阿片类药物过量知识和应对准备方面的有效性；改善对SUD患者的态度可能需要额外的干预。作者将在未来的评估中描述知识和准备的持续性、项目的可持续性以及态度的长期变化。这些结果支持将OOPT作为所有医学生BLS培训的一部分进行推广，甚至可能推广到所有BLS提供者。
