"Hospital-Based Clinicians Lack Knowledge and Comfort in Initiating Medications for Opioid Use Disorder: Opportunities for Training Innovation"
Article Authors: Andrea Jakubowski, Sumeet Singh-Tan, Kristine Torres-Lockhart, Shadi Nahvi, Melissa Stein, Aaron Fox, and Tiffany Lu
Article Link: https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-023-00386-x
Write-up by IRIS team members: Victoria Barreira
This article explores factors that may contribute to hospital medical staff underutilizing medications for opioid use disorder (MOUD) for their patients. By examining staff’s knowledge, attitudes, and motivations towards patients with OUD based on whether they had or had not initiated MOUD for patients in the last year, authors aimed to identify quality improvement initiatives to improve patient care.
Survey responses using a measure developed by the study authors were collected from a sample of 143 hospital staff. Participants came from specialties such as internal medicine and family medicine, and roles including attending physicians, physician assistants, and nurse practitioners.
Results showed that 55% had initiated patient MOUD within the last year (recent initiators), with 36% reporting initiation of buprenorphine and 35% initiating methadone. Only 17% of the entire sample were comfortable or very comfortable initiating buprenorphine. Staff who were recent MOUD initiators reported higher levels of comfort in initiating methadone. A greater proportion of recent physician initiators stated that buprenorphine can be used to treat withdrawal.
Recent MOUD initiation was significantly related to factors including staff’s knowledge, comfort, and attitudes towards patients with OUD. For example, there were positive statistical associations found between recent initiation and 1) staff’s belief that treating OUD is more effective with MOUD than without, and 2) staff’s working to increase their knowledge of OUD.
Though researchers found that motivation to initiate MOUD was high, staff identified these top barriers: experience with this practice, lack of training, and the need for more addiction specialist support. To address these obstacles, researchers suggested staff and systems level interventions. These included development of protocols for MOUD initiation as well as use of peer recovery coaches and patient navigation programs. Specialized training and consultation, specifically interactive small group workshops with one-on-one coaching, were also recommended. Prior research supports these steps as effective ways to develop staff motivation, confidence, skill, and ultimately their practice in initiating this life saving and evidence-based practice.
The Mosaic Group’s Reverse the Cycle (RTC) program is one resource to support greater use of MOUD. Results from IRIS funded research indicated that exposure to the RTC model improved emergency department staff attitudes towards patients with OUD can be found here.
Jakubowski, A., Singh-Tan, S., Torres-Lockhart, K., Nahvi, S., Stein, M., Fox, A. D., Lu, T. (2023). Hospital-based clinicians lack knowledge and comfort in initiating medications for opioid use disorder: opportunities for training innovation. Addiction Science & Clinical Practice, 18(1), 31. https://doi.org/10.1186/s13722-023-00386-x