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Addressing the opioid crisis: An assessment of clinicians’ training experience, practices, and attitudes within a large healthcare organization

Harshal Kirane, MD, Elina Drits, DO, Seungjun Ahn, MS, Sandeep Kapoor, MD, Jonathan Morgenstern, PhD, Joseph Conigliaro, MD, Jay Enden, MD

Abstract


Objective: To assess provider practices and attitudes toward addiction care and pain management within a large healthcare system, as well as to determine the impact of prior training and perceived effectiveness of organizational implementation strategies.

Design: A cross-sectional study.

Setting: Large healthcare organization comprising 21 hospitals.

Participants: Three hundred and thirteen healthcare providers within a large healthcare organization.

Main outcome measures: Training, practices, and attitudes toward opioid-related care.

Methods: One thousand providers including physicians (MD/DO) and physician extenders (NP/PA) were contacted via email request. The Mann-Whitney test or Fisher’s exact test, as appropriate, was used for comparisons of continuous and categorical variables, respectively.

Results: Providers lacked prior pain management (36 percent), addiction (38 percent), or buprenorphine training (92 percent). Few providers were confident in treating opioid use disorders (OUD) (19 percent) and opioid tapering (24 percent) but interested in safe prescribing practices (81 percent). While most providers preferred to refer patients for OUD (89 percent), only a small portion felt appropriate services were readily available (22 percent). Trained providers appear significantly more engaged in checking Prescription Drug Monitoring Program database [median = 1 (Q1 = 1, Q3 = 2) vs 2(1, 3); p < 0.001], comfortable obtaining urine drug screens [2(2, 3) vs 3(2, 4); p < 0.002], and willing to treat OUD with additional support [3(2, 4) vs 4(3, 4); p < 0.022] compared to non-trained providers. Primary care providers were more likely to view OUDs in their scope of practice [4(2, 5) vs 4(3, 5); p < 0.016] and willing to treat OUD with additional support [3(2, 3) vs 3(2, 4); p < 0.0007] compared to specialists. Buprenorphine providers appear to have more confidence in skills for OUD [2(1, 3) vs 4(3, 4); p < 0.0001] and tapering [2(1, 2) vs 4(3, 5); p < 0.0001], and diminished preference to refer [2(1, 5) vs 1(1, 2); p < 0.0009] compared to non-buprenorphine providers.

Conclusions: Providers within a large healthcare system lack training and confidence in management of opioid-related care. Buprenorphine training positively modified key attitudes toward addiction care, yet engagement in medication-assisted treatment remains limited. Providers are concerned about opioid risks, and view guideline implementation and direct input from addiction specialists as effective organizational strategies. Further research is needed to clarify the efficacy of such approaches.


Keywords


healthcare systems, primary care providers, physician education, opioids, addiction, pain management, buprenorphine, implementation

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References


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DOI: http://dx.doi.org/10.5055/jom.2019.0503

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