"The Stars Haven't Aligned": A Mixed-methods Study of Medical Students' Experience With Buprenorphine Training and Subsequent Prescribing During Internship.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Jocelyn R James, Allana Hall, James Darnton, Judith I Tsui, Jared W Klein
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引用次数: 0

Abstract

Objectives: We explored sustainability of confidence in key skills related to opioid use disorder (OUD) care and barriers and facilitators of prescribing buprenorphine among residents who had completed buprenorphine training during medical school.

Methods: Medical students who took an elective buprenorphine training course before graduation were surveyed immediately following the training ("baseline") and again 1 year later. Baseline surveys included demographics and confidence with key skills in OUD care. Follow-up surveys re-assessed confidence with key skills and additionally included waiver status, history of prescribing buprenorphine, and residency climate toward buprenorphine. Focus group interviews explored barriers and facilitators of prescribing buprenorphine.

Results: Sixty-one students participated in the training and completed the baseline survey. Seventy-two percent of trainees completed the follow-up survey; of these, 36% had obtained a waiver and just over half of those had used it to prescribe buprenorphine. In unadjusted analyses comparing 1-year follow-up results to the baseline survey, smaller percentages of learners reported strong confidence in screening for and diagnosing OUD (23% vs 46%, P=0.004), counseling patients with OUD regarding treatment options (11% vs 44%, P<0.001), and prescribing buprenorphine to treat a patient with OUD (11% vs 33%, P<0.001). Qualitative results suggested that learners experienced both bureaucratic and environmental barriers to prescribing buprenorphine.

Conclusions: Removal of the waiver requirement addresses only some barriers to buprenorphine prescribing among medical trainees. Residency climate and clinical systems conducive to prescribing buprenorphine will be necessary to sustain confidence managing OUD and increase buprenorphine prescribing during residency.

“星星还没有对齐”:医学生实习期间丁丙诺啡训练和后续处方的混合方法研究
目的:探讨在医学院接受过丁丙诺啡培训的住院医师对阿片类药物使用障碍(OUD)护理相关关键技能的信心的可持续性,以及开具丁丙诺啡处方的障碍和促进因素。方法:毕业前参加丁丙诺啡选修课的医学生在训练结束后立即接受调查(“基线”),1年后再次接受调查。基线调查包括人口统计数据和对OUD护理关键技能的信心。后续调查重新评估了对关键技能的信心,另外还包括放弃状态、丁丙诺啡处方史和丁丙诺啡的居住环境。焦点小组访谈探讨了丁丙诺啡处方的障碍和促进因素。结果:61名学生参加了培训并完成了基线调查。72%的学员完成了后续调查;其中,36%的人获得了豁免,超过一半的人用它来开丁丙诺啡。在将1年随访结果与基线调查进行比较的未经调整的分析中,较小比例的学习者表示对筛查和诊断OUD有很强的信心(23%对46%,P=0.004),并就治疗方案向OUD患者提供咨询(11%对44%)。结论:取消豁免要求只解决了医学培训生开具丁丙诺啡处方的一些障碍。住院医师气候和有利于丁丙诺啡处方的临床系统对于维持信心管理OUD和增加丁丙诺啡在住院医师期间的处方是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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