Category: Pilot study

Hospital based opioid agonist treatment

Researchers recently found that many people with co-occurring mental health and substance use disorders are admitted to inpatient psychiatric units. According to a 2019 report from the Boston’s Institute for Healthcare Improvement and The Grayken Center, “hospitals have the opportunity to make a major impact in reducing morbidity and mortality related to opioid use.” The present study, therefore, looked at patients admitted to an acute care hospital in Vancouver, British Columbia. It sought to improve our understanding of this population and the care provided so that we can improve patients’ outcomes and care experiences.

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Excellent scale assesses needs across four countries

ruler

What is the smartest scale for asking clinicians about their training needs?

In a new article published by the Journal of Substance Abuse Treatment, we report findings from a study that looked at a new scale, the training needs assessment. Read more or watch podcast below:

We wanted to find out whether a new tool – Training Need Assessment – does what it’s set to do, measure training needs.

QUICK FACT:  Addiction Medicine (AM) rarely uses Training Need Assessments (TNA).

How we did the study?

We did a cross-sectional study in four countries (Indonesia, Ireland, Lithuania and the Netherlands). 483 health professionals working in addiction care completed AM-TNA. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach’s Alpha, ANOVA determined the discriminative validity.

What has the scale found?

  • Tailored training of health professionals is one of the elements to narrow the “scientific knowledge-addiction treatment” gap. Addiction Medicine (AM) rarely uses Training Need Assessments (TNA). The AM-TNA scale is a reliable, valid instrument to measure addiction medicine training needs. The AM-TNA helps to determine the profile of future addiction specialist.

The Training Need Assessment is a reliable, valid instrument to measure addiction medicine training needs.

Why is the scale important?

The AM-TNA proved reliable and valid. Additionally, the AM training needs in the non-clinical domain appeared positively related to the overall level of AM proficiency. Furthermore, researchers should study whether the AM-TNA can also measure changes in AM competencies over time and compare different health professionals. Finally, the AM-TNA assists tailoring training to national, individual and group addiction priorities.

Reference: Pinxten, W.J.L. et al. (2019) Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries.  Journal of Substance Abuse Treatment , Volume 99 , 61 – 66

For more info read the full article in the Journal of Substance Abuse Treatment 99 (2019) 61–66 https://doi.org/10.1016/j.jsat.2019.01.009

Read more about this topic in a post from 2017: What are the core skills of an addiction expert?

What are the core skills of an addiction expert?

You can also read a related post from 2015: International Society of Addiction Medicine | Congress #isam2015

International Society of Addiction Medicine | Congress #isam2015

Closing gap between workforce needs and training provision in addiction medicine

Substance use disorders represent a significant social and economic burden globally. While effective interventions exist, the overall treatment coverage remains limited, with lack of an adequately trained workforce as one of the prominent reasons.

World over, recent initiatives have been taken to improve the training in addiction medicine; however, further efforts are required in building curricula that are internationally applicable. Here, we present a recent paper published in the British Journal of Psychiatry – International, https://www.cambridge.org/core/journals/bjpsych-international

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Clinician-Scientist Training in Addiction Medicine

clinician-scientist
In a new article from the Academic Medicine, we argue that clinician-scientist training is one of the most important bridges to cross the growing divide between recent advances in addiction science and care.
Often, unskilled lay personnel deliver inadequate care, reports state.
Medical education has long been the missing piece in the response to the global addiction problem. Instead of treating addiction as a disease, governments have focused on drug prohibition and control. This approach has failed by many measures, and, as a result, millions of people have suffered. Addiction science has identified a range of more and more evidence-based approaches to treat substance-use disorders.  Especially through early identification and treatment. However, most interventions are not used to their full potential. Better physician education can improve the accurate use of evidence-based treatments.
 
To this end, the British Columbia Centre on Substance Use (BCCSU) and St. Paul’s hospital, have recently opened a large Addiction Medicine Fellowship. The fellowship is 12 months long and trains doctors from general practice, internal medicine and psychiatry. The Addiction Medicine Foundation (AMF) accredited the fellowship and the alumni can write AMF exams. Also, they get research training through intensive mentorship and quality opportunities to write and publish research manuscripts, through academic half-days, journal clubs and conferences. They also get media training, learn to influence public policy, advocate for patients, and lead academic research projects.
 

Why clinician-scientist matters

Most health systems don’t specifically train generalist doctors in addiction medicine; when they do, this is often for a handful of psychiatry programmes that train a definite number of addiction psychiatrists. Our fellowship trains family physicians, internists and other disciplines. This expands the specialist treatment workforce to professionals seeing many people with substance use disorders and well positioned to bridge the implementation gap. Access to effective treatments grows.

Source: Klimas, J., McNeil, R., Small, W., Cullen, W. Clinician-Scientist Training in Addiction Medicine: A Novel Programme in a Canadian Setting.  Academic Medicine 92(10):1367, October 2017. 

Using Doctors Notes to See How They Treat people with Mental Health Disorders: New study out now

April 9th: Prevention and treatment of mental disorders challenge primary care doctors worldwide. Most of them use electronic medical records (EMRs) to keep track of their patients. A team of students and scientists from University of Limerick was led by Dr Cullen and wanted to see how doctors record mental health disorders in their records. They wanted to find out whether these notes can be used for research.


The researchers randomly sampled 690 patients from seven general practices in Ireland (age from18–95, 52% male, 52% low-income).

A mental disorder (most commonly anxiety/stress, depression and problem alcohol use) was recorded in the clinical records of 139 (20%) during the 2-year study period. While most patients with the common disorders had been prescribed medication (i.e. antidepressants or benzodiazepines), a minority had been referred to other agencies or received psychological interventions. ‘Free text’ consultation notes and ‘prescriptions’ were how most patients with disorders were identified. Diagnostic coding alone would have failed to identify 92% of patients with a disorder.
Although mental disorders are common in general practice, this study suggests their formal diagnosis, disease coding and access to psychological treatments are priorities for future research efforts.
Citation for the original study:  M. Gleeson, A. Hannigan, R. Jamali, K. Su Lin, J. Klimas, M. Mannix, Y. Nathan, R. O’Connor, C. O’Gorman, C. Dunne, D. Meagher and W. Cullen. Using electronic medical records to determine prevalence and treatment of mental disorders in primary care: a database study. Irish Journal of Psychological Medicine, available on CJO2015. doi:10.1017/ipm.2015.10. 
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9641472&fulltextType=RA&fileId=S0790966715000105