scholarly journals A Resident-Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder

2021 ◽  
Vol 16 (6) ◽  
Author(s):  
Ashish P Thakrar ◽  
David Furfaro ◽  
Sara Keller ◽  
Ryan Graddy ◽  
Megan Buresh ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Methadone Maintenance ◽  
Internal Medicine Resident ◽  
Opioid Use Disorder ◽  
Hospitalized Patients ◽  
Opioid Use ◽  
Medicine Resident ◽  
Clinician Education ◽  
Engagement In Treatment

BACKGROUND: Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions. OBJECTIVE: To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance. DESIGN, SETTING, PARTICIPANTS: Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services. INTERVENTION: We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up. MEASUREMENTS: The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine. RESULTS: The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine. CONCLUSION: Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.

scholarly journals Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jarratt D. Pytell ◽  
Megan E. Buresh ◽  
Ryan Graddy
Keyword(s):  
Retrospective Chart Review ◽  
Internal Medicine Resident ◽  
Patient Characteristics ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Continuity Clinic ◽  
Opioid Treatment ◽  
Attitudes And Practices ◽  
Medicine Resident ◽  
Resident Continuity Clinic

Abstract Background The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Previous research shows improvements in knowledge, attitudes, and practices after exposure to OUD care. Few studies report outcomes for patients with OUD in resident physician continuity practices. Methods A novel internal office-based opioid treatment (OBOT) program was initiated in a resident continuity clinic. Surveys of resident and staff knowledge and attitudes of OBOT were administered at baseline and 4 months. A retrospective chart review of the 15-month OBOT clinic obtained patient characteristics and outcomes. Results Twelve patients with OUD were seen in the OBOT clinic. Seven patients (58%) were retained in care at the end of the study period for a range of 9–15 months. Eight patients demonstrated a good clinical response. Surveys of residents and staff at 4 months were unchanged from baseline showing persistent lack of comfort in caring for patients with OUD. Conclusions OBOT can be successfully integrated into resident continuity practices with positive patient outcomes. Improvement in resident and staff attitudes toward OBOT were not observed and likely require direct and frequent exposure to OUD care to increase acceptance.

scholarly journals Using a Resident Discharge Clinic for Resident Education and Patient Care: A Feasibility Study

2014 ◽  
Vol 6 (3) ◽  
pp. 536-540 ◽  
Author(s):  
Katrina A. Booth ◽  
Lisa M. Vinci ◽  
Julie L. Oyler ◽  
Amber T. Pincavage
Keyword(s):  
Internal Medicine ◽  
Care Transitions ◽  
Internal Medicine Resident ◽  
Readmission Rates ◽  
Resident Perceptions ◽  
Medicine Resident ◽  
Baseline Group ◽  
Before And After ◽  
Resident Learning

Abstract Background Many patients in internal medicine resident continuity clinics experience difficulty accessing care, making posthospitalization ambulatory follow-up challenging. Experiential learning in care transitions is also lacking for residents. Objective We sought to assess the feasibility and impact of a weekly Resident Discharge Clinic (RDC) in increasing access to early posthospitalization follow-up and providing learning opportunities for residents. Methods We staffed the RDC with an ambulatory block resident, an internal medicine preceptor, and a clinical pharmacist. We assessed time to posthospitalization follow-up, readmission rates, and resident perceptions of postdischarge care for resident-clinic patients, comparing data before and after RDC implementation. Results There were 636 discharges in the baseline group, 662 during the intervention period, and 56 in the RDC group. Six months after RDC implementation, the percentage of discharged resident-clinic patients with follow-up within 7 days improved from 6.6% at baseline to 9.7% (P  =  .04). The mean interval to the posthospitalization follow-up appointment in the RDC group was 7.4 days compared with 33.9 days in the baseline group (P < .001). The percentage of surveyed residents (n  =  72) who agreed that early follow-up was easy to arrange increased from 21% to 77% (P < .001). There was no significant decrease in the 30-day readmission rate for patients in the RDC group (18.1% versus 12.5%, P  =  .29). Conclusions The RDC was easily implemented, increased access to timely posthospitalization follow-up, and provided a platform for resident learning about care transitions.

scholarly journals Cannabis Use Among Patients Attending A Methadone Maintenance Treatment Clinic In Nairobi, Kenya

2020 ◽  
Author(s):  
Elizabeth Wambui Ngarachu ◽  
Sarah Kanana Kiburi ◽  
Frederick R. Owiti ◽  
Rachel N. Kangethe
Keyword(s):  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Methadone Treatment ◽  
Opioid Use Disorder ◽  
Cannabis Use ◽  
Opioid Use ◽  
Loss To Follow Up ◽  
Treatment Clinic

Abstract Background: Cannabis use is common among patients with opioid use disorder receiving methadone treatment. Research has shown that cannabis use during methadone treatment may impact negatively on treatment outcome. This study aimed at determining the prevalence and pattern of cannabis use and the associated socio-demographic characteristics among patients on methadone treatment. Methods: This was a retrospective study of 984 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya. Data on socio-demographic characteristics and drug use patterns based urine drug screens was collected from patients’ files. Data was analyzed using SPSS for windows version 23.0. Results: Prevalence of cannabis use was 84.8% at baseline and 62.8% during follow up. Polysubstance use pattern was observed with heroin, cannabis and benzodiazepines being the commonest drugs. Majority of cannabis users were male (88.1%), aged 28-37 years (42.2%), unemployed (74.3%), had low level of education (87.7%) and single (72.4%). Cannabis use was associated with loss to follow up (p<0.001). Females were more likely to drop out of treatment and less likely to stop using cannabis during follow up compared to males. Sociodemographic factors associated with reduced risk for cannabis use were; being in older age group 48-57 years (OR 0.51, 95%CI, 0.30-0.87, p=0.013) and university education (OR 0.15, 95%CI, 0.05-0.69, p=0.005) while being in age group 18-27 years and being married were associated with increased risk for cannabis use (OR 2.62,95%CI, 1.78-3.86,p=0.001 and OR 1.50, 95%CI, 1.7-2.10,p=0.021 respectively). Conclusion: There is a prevalence of cannabis use among patients in receiving methadone treatment in Kenya is similar. In addition, cannabis use was associated with loss to follow up and sociodemographic characteristics. Cannabis use screening and targeted interventions for management should be incorporated in methadone treatment programs to improve outcomes for patients on methadone. Key words : cannabis, opioid use disorder, methadone maintenance treatment, Kenya

scholarly journals Association Between Socio-Demographic and Health Functioning Variables Among Patients with Opioid Use Disorder Introduced by Prescription: A Prospective Cohort Study

2018 ◽  
Vol 1 (21;1) ◽  
pp. E623-E642
Author(s):  
Dr. Zainab Samaan
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Methadone Maintenance Treatment ◽  
Prospective Cohort ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use

Background: Prescription opioid misuse in Canada has become a serious public health concern and has contributed to Canada’s opioid crisis. There are thousands of Canadians who are currently receiving treatment for opioid use disorder, which is a chronic relapsing disorder with enormous impact on individuals and society. Objectives: The aim of this study was to compare the clinical and demographic differences between cohorts of patients who were introduced to opioids through a prescription and those introduced to opioids for non-medical purposes. Study Design: This was an observational, prospective cohort study. Setting: The study took place in 19 Canadian Addiction Treatment Centres across Ontario. Methods: We included a total of 976 participants who were diagnosed with Opioid Use Disorder and currently receiving methadone maintenance treatment. We excluded participants who were on any other type of prescription opioid or who were missing their 6-month follow-up urine screens. We measured the participants’ initial source of introduction to opioids along with other variables using the Maudsley Addiction Profile. We also measured illicit opioid use using urine screens at baseline and at 6-months follow-up. Results: Almost half the sample (n = 469) were initiated to opioids via prescription. Women were more likely to be initiated to opioids via a prescription (OR = 1.385, 95% CI 1.027-1.866, P = .033). Those initiated via prescription were also more likely to have post-secondary education, older age of onset of opioid use, less likely to have hepatitis C and less likely to have use cannabis. Chronic pain was significantly associated with initiation to opioids through prescription (OR = 2.720, 95% CI 1.998-3.722, P < .0001). Analyses by gender revealed that men initiated by prescription were less likely to have liver disease and less likely to use cannabis, while women initiated by prescription had a higher methadone dose. Limitations: This project was limited by its study design being observational in nature; no causal relationships can be inferred. Also, the data did not allow determination of the role that the prescribed opioids played in developing opioid use disorder. Conclusions: Our results have revealed that almost half of this methadone maintenance treatment (MMT) population has been introduced to opioids through a prescription. Given that the increasing prescribing rates of opioids has an impact on this at-risk population, alternative treatments for pain should be considered to help decrease this opioid epidemic in Canada. Key words: Opioid use disorder, chronic pain relief, methadone maintenance treatment, prescriptions, male, female

Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

2021 ◽  
Vol 12 (02) ◽  
pp. 355-361
Author(s):  
Kinjal Gadhiya ◽  
Edgar Zamora ◽  
Salim M. Saiyed ◽  
David Friedlander ◽  
David C. Kaelber
Keyword(s):  
Internal Medicine ◽  
Residency Training ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Clinical Decision ◽  
University Of Pennsylvania ◽  
Teaching Hospitals ◽  
Medicine Resident ◽  
Internal Medicine Residents ◽  
The University

Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

scholarly journals Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment

2018 ◽  
Vol 183 (7-8) ◽  
pp. e299-e303 ◽  
Author(s):  
Alice E Barsoumian ◽  
Joshua D Hartzell ◽  
Erin M Bonura ◽  
Roseanne A Ressner ◽  
Timothy J Whitman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Medicine Resident

scholarly journals EMR-based handoff tool improves completeness of internal medicine residents’ handoffs

2018 ◽  
Vol 7 (3) ◽  
pp. e000188 ◽  
Author(s):  
Rebecca L Tisdale ◽  
Zac Eggers ◽  
Lisa Shieh
Keyword(s):  
Internal Medicine ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Objective Data ◽  
Code Status ◽  
Medicine Resident ◽  
Communication Breakdown ◽  
Internal Medicine Residents ◽  
Action List ◽  
Identical Fashion

BackgroundThe majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.AimTo measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.InterventionThis EMR-based handoff tool included a radio button prompting users to classify patients as stable, a ‘watcher’ or unstable. It automatically pulled in EMR data on the patient’s 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled ‘Active Issues’, ‘Action List (To-Dos)’ and ‘If/Then’ to fill in.Implementation and evaluationWritten handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.ResultsHandoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.ConclusionA simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.

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