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(068) Pick Your Poison: Hospital Admissions with Alcohol vs. Opioid Use Disorder


Authors:

Emily Loscalzo, PsyD – Assistant Professor, Thomas Jefferson University

P. Joseph Resignato, MD – Resident Physician PGY4, Thomas Jefferson University Hospital

Jonathan Avery, MD – Director of Addiction Psychiatry, Weill Cornell Medical College

Abstract:

Attitudes of clinicians towards the patients they treat may influence the quality of care that patients receive. Clinicians may experience particular difficulty with individuals who present with highly stigmatized conditions, such as substance use disorders (Gilchrist et al., 2011; Avery et al., 2013). Improved education for clinicians may help lead to attitude changes that can increase empathy and ultimately increase quality for care for individuals with substance use disorders, particularly if the individual is presenting for treatment for a substance-related issue (Avery et al., 2015; Avery et al., 2016). Since hospitalists and physician assistants are the leaders of treatment teams overseeing patient care, it is especially important to measure their attitudes towards individuals with substance use disorders (SUD).
The Medical Condition Regard Scale was distributed to 32 clinicians, 17 of whom responded (eight hospitalists, eight physician assistants, one did not disclose) to determine baseline attitudes towards patients with alcohol use disorder (AUD) or opioid use disorder (OUD) in advance of an educational module. Due to small sample size and lack of Gaussian assumption, Wilcoxon signed ranks test was used for data analysis. Attitudes were worse towards individuals with OUD. Individuals with OUD were viewed as slightly more irritating (average rank of 5.50 vs. average rank of 7.45, p = .032) and less satisfying to work with (average rank of 4.71 vs. average rank of 3.00, p = .031) than individuals with AUD. There was a trend towards clinicians preferring not to work with individuals with OUD (average rank of 3.50 vs. average rank of 5.43, p =.058) as compared to those with AUD. Hospitalists and physician assistants did not show significant differences in attitudes towards individuals with either AUD or OUD, although there was a slight trend towards hospitalists as compared to physician assistants endorsing that treatment for OUD is a waste of medical dollars (average rank of 2.50 vs. average rank of 0.00, p = .066). Regarding interventions for SUD, clinicians seemed to have primarily positive attitudes about their ability to find something to help AUD patients to feel better (76% or respondents), but seemed slightly less confident in their ability to help OUD patients (56.3% of respondents). Clinicians seemed somewhat divided in their feelings about whether there is little they can do to help patients with SUD (53% AUD, 43.8% OUD responded “Disagree” or “Strongly Disagree”).
Conclusions from survey results indicate that more education about this population is still needed for hospitalists and physician assistants. Increased education may lead to increased empathy, thereby decreasing irritation and dissatisfaction when treating individuals with SUD, particularly OUD. Education on interventions that these clinicians can utilize in the community hospital setting would also be helpful to increase their confidence in treating symptoms of withdrawal and to improve their style of interacting with patients with SUD. Future studies will examine the impact of an educational intervention on attitudes in this cohort as well as 30-day readmissions and discharges against medical advice.


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