Category: Primary care

Addiction training provision must meet training needs

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Closing the gap between training needs and training provision in addiction medicine

 

Substance use disorders pose a significant global social and economic burden. Although effective interventions exist, treatment coverage remains limited.

 

The lack of an adequately trained workforce is one of the prominent reasons.

Recent initiatives improved training nationally, but further efforts are required to build curricula that are internationally applicable. We therefore believe that the training needs of professionals in the area have not yet been explored in sufficient detail.

Addiction training provision must meet training needs

We propose that a peer-led survey to assess those needs, using a standardised structured tool, would help to overcome this deficiency.

The findings from such a survey could be used to develop a core set of competencies which is sufficiently flexible in its implementation to address the specific needs of the wide range of professionals working in addiction medicine worldwide.

Source: Arya, S., Delic, M., Ruiz, B., Klimas, J., Papanti, D., Stepanov, A., . . . Krupchanka, D. (2019). Closing the gap between training needs and training provision in addiction medicine. BJPsych International, 1-3. doi:10.1192/bji.2019.27

If you enjoyed reading about this research, you might enjoy reading about a similar needs assessment here:

Scoping the needs of early career addiction specialists, Protocol

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Boost for Oral Opioid Agonist Therapy

Although opioid agonist treatment is effective in treating opioid use disorders, retention in such treatment is suboptimal in part due to quality of care issues. A new initiative sought to boost treatment of opioid use disorders so that people stay there longer. This article describes how teams did in a structured quality improvement initiative in Vancouver, Canada. (more…)

Place matters, teachers and learners #CCME18

mountain climber

We learn best in places that support our learning and our bio psycho socio spiritual development – from toddlers to elders, reports Jan Klimas from the Canadian Medical Education conference #CCME18.

Starting in Toronto, Justin Hsu and colleagues from University of Toronto described how they improved spaces for communities in teaching ambulatory care, or the so called Medical Education Teaching Clinics (METC). They plan to evaluate METC clinics via audit of referrals to the teaching clinic and the learner satisfaction survey.
Presentation title: Creating unique spaces to support community-based ambulatory care education: the E3 experience.
Presentation authors: Jerry Maniate, Elizabeth Wooster, Douglas Wooster, Justin Hsu

British Columbia quality matters

Jan Klimas’ team from University of British Columbia evaluated hospital as a place of learning about substance use disorders. Who learns most about addictions in hospitals? Using mixed-methods approach, this team showed that medical students get more out of a rotation in hospital than residents or senior learners. Especially in the areas of safe prescribing, screening and withdrawal management. Why is that? Do residents know more or are they more resistant to new learning? For many medical students, hospital could be the first place where they see someone with addiction and that could be why they learn more in this setting.
Presentation title: Who learns most about addiction in the hospitals? A mixed methods study.
Presentation authors: Jan Klimas, Evan Wood, Walter Cullen, Will Small, Seonaid Nolan, Annabel Mead, Mark McLean, Christophe Fairgrieve, Keith Ahamad, Huiru Dong, Breanne Reel, Lauren Gorfinkel, Nadia Fairbairn

Derek Wilson and colleagues from the same university focused on the quality of health education learning environment (HELES study). HELES survey tool looked at relationship, personal development and program culture as the key parts of the learning environment at the faculty of medicine. For example, the evaluation asked whether the learners have developed a strong sense of community.
Presentation title: Evaluating the Quality of Health Professions Learning Environments: Validation of the Health Education Learning Environment Survey (HELES).
Presentation authors: Derek Wilson, Shayna Rusticus, Derek Wilson, Oscar Casiro, Kevin Eva, Lisa Hazlett, Chris Lovato

Calgary explores and experiences

Maureen Topps and collaborators from University of Calgary, Cumming School of Medicine, asked whether in addition to focusing on the deficiencies and gaps in education, whether we could research the successful activities related to professionalism. The postgraduate education is a key stage in training the next generation of competent and professional clinicians. Professionalism is hard to define and to define it may “limit it,” as Dr Barnhoorn writes in the Academic Medicine journal (2006, Vol. 91, No. 9). But how does the place of learning make for more professional doctors? Slowing down and taking time to plan interactions appears to foster professionalism among other factors such as communication training.
Presentation title: Contexts and Experiences of Postgraduate Residents that support successfully meeting professionalism challenges.
Presentation authors: Janet de Groot, Maureen Topps, Aliya Kassam, Maureen Topps

Nicole Delaloye and colleagues from the same university presented results from her Masters research of the MSc/MD program. Clinicians should be both polite and respective, but not overly submissive. Why do we follow orders? Resuscitation requires wise action, not passive deference. What happens when learners hold back too much and how does the place of learning impact submissiveness? Mechanisms that underly submission in the moment of revival include learner’s mental state, what was going on inside and outside the room, team and motivation.
Presentation title: An Exploration of Deference Behaviours Exhibited within the Paediatric Resuscitation Environment and the Educational Implications.
Presentation authors: Nicole Delaloye, Elaine Gilfoyle, Rachel Ellaway, Aliya Kassam, Elizabeth Oddone Paolucci

In summary, the best learning places not only support our learning, but also challenge us to learn knew knowledge, adopt the discipline’s values, overcome deference and become successful professionals in our own right.

The opinions and views in this article present the views of the author and not the named persons or the #CCME18 conference organisers.

Does alcohol use change after shift to Methadose?

alcohol drink, methadose
Do people drink more when they switch to Methadose? It is 10 times more concentrated than methadone –  proven treatment of opioid use disorder. We did not find more drinking after the switch. But others found changes in opioid use patterns coinciding with the change.

switch
We talked to 787 people receiving methadone for opioid use disorder in Vancouver, Canada.  Our new study followed them as they switched from methadone (1mg/mL) to Methadose (10mg/mL). We asked whether their drinking has changed after the switch – between 2013 and 2015. 16% said they drank too much at least once in the last six months. Those who drank too much were not more likely to do so after the shift to Methadose. The Substance Use& Misuse journal has published the study this week. 
Persons on methadone for opioid use disorder may report going through opioid withdrawal and increasing their illicit opioid use when switched to Methadose. We need to understand impacts of these changes on other forms of drug use. Careful and planned information about upcoming changes may help people cope with the potential risks better.

Conclusion

In sum, change is the law of life. Those who do not change do not survive in nature. For complex systems, such as health care, change management is the key to success. Healthy, happy and satisfied patients are healthcare’s success best proof. If they self-report negative experiences following methadone changes, their opinions should inform change management in order to build a better, patient-centered care. Their opinions, together with our findings, could help future formulary decisions in addiction treatment. Various methadone formulations may have little short-term impact on heavy alcohol use. Let’s evaluate the long-term impact.

Naloxone and Irish Primary Care Practitioners

We wanted to know what General Practitioners’ (GP) views and experiences of opioid addiction, overdose care and naloxone provision are. Naloxone is an antidote to opioid overdose, also known as Narcan.

How was the study done?
We sent 448 GPs an anonymous postal survey.
They all had students on placements from University College Dublin in Ireland.
Over 75% of GPs had patients who used illicit opiates, and 25% prescribed methadone to treat opioid use disorders.



What did the study find?
We found that two thirds of GPs were in favour of a project to increase naloxone availability in the community; almost one third would take part in such a scheme. Intranasal naloxone was much preferred to single, or multiple dose, intramuscular naloxone.  Few GPs objected to wider naloxone availability.
Irish primary care doctors are keen to distribute Naloxone in the community.
Why is the study important?
Every year, more people die in Ireland due to opioid overdoses than in car accidents.
Over 200 overdose deaths occur annually in Ireland.  Overdose prevention and management, including naloxone provision, should be a priority for healthcare services.   Naloxone is an effective treatment and is now being considered for wider lay use. This study showed that general practitioners commonly provide healthcare for patients with opiate use disorder and want more naloxone in this setting.

Reference:
Barry, T., Klimas, J., Tobin, H., Egan, M., Bury, G. (2017) Opiate Addiction and Overdose: Experiences, Attitudes and Appetite for Community Naloxone Provision. British Journal of General Practice. In press  http://bjgp.org/content/early/2017/02/27/bjgp17X689857/tab-article-info