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