Robles Maria, Mortazavi Leila, Vannerson Julie, Matthias Marianne S
Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA.
VA HSRD Center for Health Information and Communication, Roudebush VAMC, Roudebush, Indiana, USA.
Teach Learn Med. 2022 Oct-Dec;34(5):514-521. doi: 10.1080/10401334.2021.1897597. Epub 2021 May 11.
The number of people with an Opioid Use Disorder (OUD) continues to outpace access to associated medication. Ninety-six percent of states report higher rates of OUD than access to medications, and, despite being the standard of care, only 3% of physicians currently prescribe medication for opioid use disorder (MOUD). Prior studies have shown that decreasing barriers, such as a lack of knowledge about MOUD, increased physicians' willingness to prescribe. However, most internal medicine residency programs do not have a required addiction curriculum. As a result, we created a curriculum and conducted qualitative interviews with residents to better understand experiences with the curriculum.
In an effort to overcome physician-centered barriers associated with prescribing MOUD, we developed and implemented a week-long curriculum, Addiction Week, for second and third year Internal Medicine Residents at Indiana University School of Medicine in a safety-net clinic. The curriculum included the following: didactics on substance use disorder (SUD), including OUD and alcohol use disorder, and MOUD (mostly buprenorphine), and mostly web-based, peer-reviewed and guideline based readings about addiction, direct observation of addiction counselors, direct discussion with people receiving MOUD, observation of a group therapy session, informal discussion with providers who prescribe MOUD, and, for some residents, observation of a physician prescribing MOUD. After completing the curriculum, the residents participated in an hour long audio-recorded interview to better understand their experiences with the curriculum.
This study was completed at a residency program where residents were not previously exposed to outpatient MOUD prescribing. Due to limited availability of faculty treating patients with MOUD, residents spent the majority of their time shadowing a social worker.
Residents described gaining a deeper understanding of OUD by having the opportunity to interact with patients in a stable outpatient setting, which for many led to increased confidence and willingness to prescribe MOUD for people with OUD.
The greater understanding of addiction and willingness to prescribe MOUD described by residents in this study indicate that this type of curriculum may be a promising way to increase MOUD prescribing. Further studies are needed to evaluate whether this intervention can change prescribing behaviors.
Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1897597.
患有阿片类药物使用障碍（OUD）的人数持续超过相关药物的可及性。96%的州报告称，OUD发病率高于药物可及率，而且，尽管药物辅助治疗（MOUD）是标准治疗方法，但目前只有3%的医生开具治疗阿片类药物使用障碍的药物。先前的研究表明，减少诸如对MOUD缺乏了解等障碍，会提高医生开具此类药物的意愿。然而，大多数内科住院医师培训项目并没有必修的成瘾课程。因此，我们创建了一门课程，并对住院医师进行了定性访谈，以更好地了解他们对该课程的体验。
为克服与开具MOUD相关的以医生为中心的障碍，我们为印第安纳大学医学院安全网诊所的二年级和三年级内科住院医师开发并实施了为期一周的课程“成瘾周”。该课程包括以下内容：关于物质使用障碍（SUD）的教学内容，包括OUD和酒精使用障碍，以及MOUD（主要是丁丙诺啡），还有大多基于网络、经过同行评审且基于指南的关于成瘾的阅读材料，直接观察成瘾咨询师，与接受MOUD治疗的患者直接讨论，请观察一次团体治疗课程，与开具MOUD药物的医疗服务提供者进行非正式讨论，并且，对于一些住院医师，观察一名医生开具MOUD药物的过程。完成课程后，住院医师参加了一次为时一小时的录音访谈，以更好地了解他们对该课程的体验。
本研究是在一个住院医师培训项目中完成的——该项目的住院医师此前未曾接触过门诊MOUD处方。由于治疗MOUD患者的教员数量有限，住院医师大部分时间都在跟随一名社会工作者见习。
住院医师表示通过有机会在稳定的门诊环境中与患者互动，对OUD有了更深入的了解，这对许多人来说增强了信心，并提高了为OUD患者开具MOUD药物的意愿。
本研究中住院医师所描述的对成瘾有了更深入的理解以及开具MOUD药物的意愿表明，这类课程可能是增加MOUD处方的一种很有前景的方式。需要进一步研究来评估这种干预措施是否能改变处方行为。
本文补充数据可在网上获取，网址为https://doi.org/10.1080/10401334.2021.1897597。
