Jessica L Taylor1, Alison B Rapoport2, Christopher F Rowley2, Kenneth J Mukamal3, Wendy Stead2. 1. a Section of General Internal Medicine, Boston Medical Center , Boston , Massachusetts , USA. 2. b Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA. 3. c General Internal Medicine, Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA.
Abstract
BACKGROUND: Despite escalating opioid overdose death rates, addiction medicine is underrepresented in residency curricula. Providing naloxone to at-risk patients, relatives, and first responders reduces overdose deaths, but rates of naloxone prescribing remain low. The goal of this study is to examine the impact of a brief curricular intervention for internal medicine residents on naloxone prescribing rates, knowledge, and attitudes. METHODS: Internal medicine residents (N = 160) at an urban, tertiary care medical center received two 1-hour didactic sessions addressing overdose prevention, including intranasal naloxone. The number of naloxone prescriptions generated by residents was compared to faculty, who received no similar intervention, in the 3-month periods before and after the curriculum. Resident knowledge and attitudes, as assessed by pre- and post-intervention surveys, were compared. RESULTS: The resident naloxone prescribing rate increased from 420 to 1270 per 100,000 inpatient discharges (P = .01) and from 0 to 370 per 100,000 ambulatory visits (P < .001) post-intervention. Similar increases were not observed among inpatient faculty, whose prescribing rate decreased from 1150 to 880 per 100,000 discharges (P = .08), or among outpatient faculty, whose rate increased from 30 to 180 per 100,000 ambulatory visits (P < .001) but was lower than the post-intervention resident rate (P = .01). Residents demonstrated high baseline knowledge about naloxone, but just 13% agreed that they were adequately trained to prescribe pre-intervention. Post-intervention, residents were more likely to agree that they were adequately trained to prescribe (Likert mean 2.5 vs. 3.9, P < .001), to agree that treating addiction is rewarding (Likert mean 2.9 vs. 3.3, P = .03), and to attain a perfect score on the knowledge composite (57% vs. 33%, P = .05). CONCLUSIONS: A brief curricular intervention improved resident knowledge and attitudes regarding intranasal naloxone for opioid overdose reversal and significantly increased prescribing rates.
BACKGROUND: Despite escalating opioid overdose death rates, addiction medicine is underrepresented in residency curricula. Providing naloxone to at-risk patients, relatives, and first responders reduces overdose deaths, but rates of naloxone prescribing remain low. The goal of this study is to examine the impact of a brief curricular intervention for internal medicine residents on naloxone prescribing rates, knowledge, and attitudes. METHODS: Internal medicine residents (N = 160) at an urban, tertiary care medical center received two 1-hour didactic sessions addressing overdose prevention, including intranasal naloxone. The number of naloxone prescriptions generated by residents was compared to faculty, who received no similar intervention, in the 3-month periods before and after the curriculum. Resident knowledge and attitudes, as assessed by pre- and post-intervention surveys, were compared. RESULTS: The resident naloxone prescribing rate increased from 420 to 1270 per 100,000 inpatient discharges (P = .01) and from 0 to 370 per 100,000 ambulatory visits (P < .001) post-intervention. Similar increases were not observed among inpatient faculty, whose prescribing rate decreased from 1150 to 880 per 100,000 discharges (P = .08), or among outpatient faculty, whose rate increased from 30 to 180 per 100,000 ambulatory visits (P < .001) but was lower than the post-intervention resident rate (P = .01). Residents demonstrated high baseline knowledge about naloxone, but just 13% agreed that they were adequately trained to prescribe pre-intervention. Post-intervention, residents were more likely to agree that they were adequately trained to prescribe (Likert mean 2.5 vs. 3.9, P < .001), to agree that treating addiction is rewarding (Likert mean 2.9 vs. 3.3, P = .03), and to attain a perfect score on the knowledge composite (57% vs. 33%, P = .05). CONCLUSIONS: A brief curricular intervention improved resident knowledge and attitudes regarding intranasal naloxone for opioid overdose reversal and significantly increased prescribing rates.
Entities:
Keywords:
Curriculum; medical education; naloxone; opioid use disorder; overdose; substance use disorder
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Elana S Rosenthal; Adolf W Karchmer; Jesse Theisen-Toupal; Roger Araujo Castillo; Chris F Rowley Journal: Am J Med Date: 2015-11-18 Impact factor: 4.965
Authors: Reena K Sandhu; Michael V Heller; Jack Buckanavage; Benjamin Haslund-Gourley; Joshua Leckron; Brady Kupersmith; Nathaniel C Goss; Kyle Samson; Annette B Gadegbeku Journal: Harm Reduct J Date: 2022-07-02
Authors: Daniel Hargraves; Christopher C White; Marcia R Mauger; Aruna Puthota; Harini Pallerla; Patricia Wigle; Sarah L Brubaker; Jeffrey D Schlaudecker Journal: Pharm Pract (Granada) Date: 2019-09-12
Authors: Delia Motavalli; Jessica L Taylor; Ellen Childs; Pablo K Valente; Peter Salhaney; Jennifer Olson; Dea L Biancarelli; Alberto Edeza; Joel J Earlywine; Brandon D L Marshall; Mari-Lynn Drainoni; Matthew J Mimiaga; Katie B Biello; Angela R Bazzi Journal: J Gen Intern Med Date: 2020-09-11 Impact factor: 5.128
Authors: Tamara M Haegerich; Christopher M Jones; Pierre-Olivier Cote; Amber Robinson; Lindsey Ross Journal: Drug Alcohol Depend Date: 2019-09-19 Impact factor: 4.852