Category: Primary care

Two birds with one stone: physicians training in research

Combined training in addiction medicine and research is feasible and acceptable for physicians – a new study shows; however, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required.

Addiction care is usually provided by unskilled lay-persons in most countries. The resulting care is inadequate, effective treatments are overlooked and millions of people suffer despite recent discovery of new treatments for substance use disorders. In rare instances when addiction care is provided by medical professionals, they are not adequately trained in caring for people with substance use disorders and, therefore, feel unprepared to provide such care.  Physician scientists are the bridge between science and practice. Despite large evidence-base upon which to base clinical practice, most health systems have not combined training of healthcare providers in addiction medicine and research. 
In recent years, new programmes have emerged to train the comprehensive addiction medicine professionals internationally.

We undertook a qualitative study to assess the experiences of 26 physicians who completed such a training programme in Vancouver, Canada. They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software. We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training.  Competing priorities, to include clinical and family responsibilities, hindered training.

Read more here: http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0862-y
Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W. (2017) Two birds with one stone: Experiences of Combining Clinical and Research Training in Addiction Medicine. BMC Medical Education, 17:22

General practice is a key route for distribution of naloxone in the community

Naloxone
Naloxone is an antidote to opioid overdose also known as Narcan.

Irish family doctors in training want Narcan to be more available and want to distribute it.    

We poled 136 Irish family doctors attending a training conference. They were in their third and final years of residency.

photocredit: oxywatchdog.com

We found that trainees have real experience of the problem at an early phase of their careers, and
trainees are conscious of the needs of people with opioid use disorders and the potential of family medicine to meet these needs, but trainees receive little structured preparation for this role.

Irish family doctors in training are keen to distribute Naloxone in the community.

More people die in Ireland due to opioid overdoses than in car accidents.
Naloxone can save lives. Ireland has approximately 640 doctors in specialist training for family medicine at any time. Although 60% of them have administered Naloxone to a person in overdose, only 13% of their training clinics prescribe methadone to people with opioid use disorders.

Reference:
Klimas, J., Tobin, H., Egan, M., Barry, T., Bury, G. (2016) General Practice – a key route for distribution of naloxone in the community. Experience, interest and training needs in Ireland. J Int Drug Policy, 38:1-3

What do persons on methadone in primary care think about alcohol screening?

Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care

New Paper Out Now

Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.

photocredit: emerald

Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.

Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.

Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat

See also my previous posts about the PINTA study:

New paper out now: Psychosocial Interventions for Alcohol use among problem drug users

2014

Beg, steel or borrow: getting physicians to recruit patients in clinical trials

Addiction Medicine Education for Healthcare Improvement Initiatives: New Paper out Now

2013

Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland

Fidelity questions

Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project

Hepatitis C unchanged, but drinking soared

NEW PAPER OUT NOW 

What is the study about?

           We wanted to find out how many people receiving treatment for opioid addiction (methadone) have Hepatitis C and other blood borne viruses
           And whether anything changed between the years 2006 and 2013

QUICK FACT:

Over a third of people who receive methadone in primary care and who drink excessively test positive for Hepatitis C
 

asam.org

How was the study done?

           In 2013, we have done a secondary analysis of data collected during a feasibility study of an alcohol brief intervention for people attending primary care for methadone treatment
           We looked at two studies done in 2006 and 2013 and compared them

What did the study find?

           We found the proportion of patients with problem alcohol use was much higher (46% v 35%) in 2013.
           37% of people who had Hepatitis C also drank excessively
In 2013, number of people who had Hepatitis C was not different from 2006, but more people drank excessively.

Why is the study important?

           Many people who receive treatment for opioid addiction have Hepatitis C
           Treatment of Hepatitis C is expensive
           Because heavy drinking can make the treatment even more expensive, we should help people drink less
Reference: Improvements in HCV-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention. Journal of Addiction Medicine: September/October 2016 – Volume 10 – Issue 5 – p 363–364
(http://journals.lww.com/journaladdictionmedicine/Citation/2016/10000/Commentary_on_Zeremski_et_al___2016___.11.aspx)