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Emergency Department‐based Opioid Harm Reduction: Moving Physicians From Willing to Doing
Author(s) -
Samuels Elizabeth A.,
Dwyer Kristin,
Mello Michael J.,
Baird Janette,
Kellogg Adam R.,
Bernstein Edward
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12910
Subject(s) - medicine , psychological intervention , referral , (+) naloxone , cronbach's alpha , family medicine , confidence interval , emergency department , harm reduction , emergency medicine , opioid , nursing , clinical psychology , psychometrics , receptor , human immunodeficiency virus (hiv)
Objectives Develop and internally validate a survey tool to assess emergency department ( ED ) physician attitudes, clinical practice, and willingness to perform opiate harm reduction ( OHR ) interventions and to identify barriers and facilitators in translating willingness to action. Methods This study was an anonymous, Web‐based survey based on the Theory of Planned Behavior of ED physicians at three tertiary referral centers. Construction and internal validation of scaled questions was assessed through principal component and Cronbach's alpha analyses. Stepwise linear regression was conducted to measure impact of physician knowledge, attitudes, confidence, and self‐efficacy on willingness to perform OHR interventions including opioid overdose education; naloxone prescribing; and referral to naloxone, methadone, and syringe access programs. Results A total of 200 of 278 (71.9%) physicians completed the survey. Principal component analysis yielded five components: attitude, confidence, self‐efficacy, professional impact factors, and personal impact factors. Overall, respondents were willing to perform OHR interventions, but few actually do. Willingness was correlated with attitude, confidence, and self‐efficacy (R 2 = 0.50); however, overall physicians lacked confidence (mean = 3.06 of 5, 95% confidence interval [CI] = 2.94 to 3.18]). Knowledge, time, training, and institutional support were all prohibitive barriers. Physicians reported that research evidence, professional organization recommendations, and opinions of ED leaders would strongly influence a change in their clinical practice to incorporate OHR interventions (mean = 4.25 of 5, 95% CI = 4.18 to 4.32). Conclusions Compared to prior studies, emergency medicine physicians had increased willingness to perform OHR interventions, but there remains a disparity between willingness and clinical practice. Influential factors that may move physicians from “willing” to “doing” include dissemination of supportive research evidence; professional organization endorsement; ED leadership opinion; and addressing time, knowledge, and institutional barriers.