Emergency Department‐based Opioid Harm Reduction: Moving Physicians From Willing to Doing

• Published in: Academic emergency medicine Vol. 23; no. 4; pp. 455 - 465
• Main Authors: Samuels, Elizabeth A., Dwyer, Kristin, Mello, Michael J., Baird, Janette, Kellogg, Adam R., Bernstein, Edward, Gerson, Lowell W.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-04-2016
• Subjects: Adult; Analgesics, Opioid; Attitude of Health Personnel; Clinical medicine; Drug Overdose - drug therapy; Drug Overdose - prevention & control; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Female; Harm Reduction; Health Knowledge, Attitudes, Practice; Humans; Intervention; Knowledge; Male; Middle Aged; Naloxone - administration & dosage; Narcotic Antagonists - administration & dosage; Patient Education as Topic; Physicians; Physicians - psychology; Referral and Consultation; Regression analysis; Self Efficacy; Surveys and Questionnaires
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.12910

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 (R2 = 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.