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Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical
Sarah E Wakeman1, Genevieve Pham Kanter, Karen Donelan
1Department of Medicine, Massachusetts General Hospital (SEW, KD); Harvard Medical School, MA (SEW, KD); Department of Health Management and Policy, Drexel University Dornsife School of Public Health (GPK); Leonard Davis Institute of Health Economics, University of Pennsylvania, PA (GPK); and Mongan Institute Health Policy Center, Massachusetts General Hospital, MA (KD).
Objective:
To assess the impact of hospital substance use disorder (SUD) initiative, which, beginning in October 2014, implemented an inpatient addiction consult team, a postdischarge addiction clinic, recovery coaches, and SUD treatment within primary care on general internists' attitudes, clinical practice, and preparedness to care for SUD.
Methods:
Pre and postintervention survey of general internal medicine physicians at Massachusetts General Hospital, in Boston, Massachusetts, in September 2014 (n = 290) and 2015 (n = 296) was conducted.
Results:
There were 149 respondents for the pre and 143 respondents for the post survey. There were no significant differences between groups. In the follow-up group, 66% of physicians had a patient receive care from the initiative. These physicians were significantly more likely to have favorable attitudes towards SUD; 44% report caring for patients with SUD is as satisfying as other clinical activities versus 9% of physicians without experience with the initiative. These physicians were significantly more likely to feel very prepared to screen for SUD (27% vs 9%), diagnose SUD (23% vs 9%), deliver a brief intervention (16% vs 5%), refer to treatment (36% vs 14%), discuss medication treatments (22% vs 5%), discuss overdose prevention and naloxone (33% vs 5%), and discuss harm reduction (22% vs 7%). They were also significantly more likely to frequently prescribe naloxone (11% vs 0%), prescribe addiction pharmacotherapy (15% vs 2%), and provide addiction treatment themselves (18% vs 5%).
Conclusion:
General internists' attitudes, preparedness, and clinical practice related to SUD significantly improved after having a patient receive care from new clinical services implemented through a hospital-wide SUD initiative.