Johnson Emily, Ghosh Monty, Daniels Vijay John, Wild T Cameron, Campbell-Scherer Denise, Mellinger Jessica, Winder Gerald S, Fernandez Anne C, Kirkwood Jessica, Tandon Puneeta
Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Can Liver J. 2023 Oct 30;6(3):295-304. doi: 10.3138/canlivj-2022-0036. eCollection 2023 Oct.
Alcohol use disorder (AUD) is a leading cause of cirrhosis. Insufficient clinician knowledge and comfort managing AUD impacts access to treatment. Using Kern's Framework for Curriculum Development, we aimed to (i) develop and evaluate the effect of an "AUD in cirrhosis" educational intervention on clinicians' knowledge, attitudes, comfort, preparedness, and intention (practice habits) to integrate AUD management into their practice, and (ii) assess clinicians' motivation using Self Determination Theory.
Kern's approach was used for curriculum development. Pilot session feedback informed a three-part flipped-classroom series conducted by interdisciplinary clinicians in hepatology, psychiatry, primary care, and addiction psychology. Participants watched a video followed by a live session focused on (a) withdrawal, (b) screening and brief intervention, and (c) prescribing pharmacotherapy. Questionnaires assessing knowledge and practice habits were adapted from the literature. Attitudes were evaluated using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Self Determination Theory informed motivation questions.
Paired sample t-tests on pre-post questionnaires ( = 229 clinicians; 95 completed questionnaires) revealed significant improvements in preparedness and comfort screening, providing a brief intervention, prescribing pharmacotherapy, and SAAPPQ domains. No significant changes were observed in the intention to prescribe pharmacotherapy. Effect size analysis showed medium to large effects across most topic areas.
The developed sessions improved knowledge, attitudes, and practice habits of clinicians caring for this patient population. Given the rise in AUD and significant consequences in cirrhosis, this data offers promise that interactive education may improve practice habits of clinicians interfacing with this patient population.
酒精使用障碍（AUD）是肝硬化的主要病因。临床医生在管理AUD方面知识不足且缺乏信心，这影响了患者获得治疗的机会。我们运用克恩课程开发框架，旨在：（i）开发并评估“肝硬化中的AUD”教育干预对临床医生在将AUD管理纳入其临床实践方面的知识、态度、信心、准备情况和意愿（实践习惯）的影响；（ii）运用自我决定理论评估临床医生的动机。
采用克恩方法进行课程开发。根据试点课程的反馈，由肝病学、精神病学、初级保健和成瘾心理学领域的跨学科临床医生开展了一个分为三个部分的翻转课堂系列。参与者先观看视频，然后参加现场课程，内容聚焦于：（a）戒断；（b）筛查和简短干预；（c）药物治疗处方。评估知识和实践习惯的问卷是根据文献改编的。使用简短酒精及酒精问题认知问卷（SAAPPQ）评估态度。自我决定理论为动机问题提供了依据。
对前后问卷进行配对样本t检验（n = 229名临床医生；95份问卷完成）显示，在准备情况和筛查信心、提供简短干预、开具药物治疗处方以及SAAPPQ各领域均有显著改善。在开具药物治疗处方的意愿方面未观察到显著变化。效应量分析表明，在大多数主题领域都有中等到较大的效应。
所开发的课程改善了照顾该患者群体的临床医生的知识、态度和实践习惯。鉴于AUD的增加及其在肝硬化中造成的严重后果，这些数据表明互动式教育有望改善与该患者群体接触的临床医生的实践习惯。
