Description and Evaluation of Practice-Based Training in OUD Care for Hospital-Based Generalist Physicians

Abstract

Background:

Hospitalizations are important opportunities to deliver evidence-based opioid use disorder (OUD) care, yet most hospital-based generalist physicians receive minimal OUD training. We describe a novel OUD training for generalists and mixed-methods evaluation in a large urban hospital.

Methods:

Training Description: Hospital-based generalist physicians received a single, 1-hour, small-group, in-person OUD training (OUD diagnosis, initiating medications for OUD [MOUD], and discharge planning) and post-training support. Evaluation: We examined self-reported changes in knowledge, confidence, skill, and frequency of providing OUD care; barriers and facilitators to applying training skills; and suggestions for training modification. Data collection included the following: (1) end-of-training questionnaires; (2) 12-month follow-up questionnaires (retrospective pre-post-design); and (3) qualitative interviews and a focus group. Stuart Maxwell tests were used to examine pre-/post-differences in knowledge, confidence, and skill. Rapid qualitative analysis identified barriers and facilitators to applying training skills.

Results:

Nineteen generalist physicians participated, with 11 (58%) providing 12-month follow-up data. At 12 months, compared to pre-training, more participants agreed or highly agreed that after the training, they had adequate knowledge (100% vs 44%), confidence (100% vs 44%), and skill (89% vs 44%) in OUD care, but differences were not statistically significant. Self-reported frequency of providing OUD care was unchanged. During qualitative interviews (2 participants) and the focus group (3 participants), participants appreciated the training format but described confidence declining over time. Ongoing barriers to MOUD initiation included challenges with counseling patients about MOUD, discharge planning, accessing OUD care protocols and decision aides, lack of interprofessional collaboration, and time pressures.

Conclusion:

Generalist physicians reported increases in knowledge, confidence, and skill with OUD training, but a single session was insufficient to maintain confidence and change practice. Additional training sessions emphasizing patient counseling and discharge planning should be developed and evaluated in a larger sample. Simultaneous efforts to address systemic barriers are also needed.