利用 "社区医疗保健成果推广项目 "加强初级医疗中的药物使用障碍护理:混合方法研究。

IF 3.2 Q1 EDUCATION, SCIENTIFIC DISCIPLINES JMIR Medical Education Pub Date : 2024-04-01 DOI:10.2196/48135
MacKenzie Koester, Rosemary Motz, Ariel Porto, Nikita Reyes Nieves, Karen Ashley
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引用次数: 0

摘要

背景:在美国,药物使用和用药过量导致的死亡在与伤害相关的死亡中占很大比例,俄亥俄州的药物使用障碍(SUD)诊断率居全国之首。俄亥俄州日益严重的疫情表明,有必要通过多学科医疗服务提供者的参与以及采用综合护理方法来改善初级医疗环境中的药物滥用障碍护理:本研究旨在评估魏茨曼社区医疗保健成果扩展项目(ECHO)的能力:目的:本研究旨在评估 "威茨曼社区医疗保健成果推广计划(ECHO):药物使用障碍综合护理 "项目在处理和实现 7 个系列学习目标以及处理物质方面的能力,具体方法是分析(1)在病例讨论中接触学习目标主题和物质类型的频率,以及(2)参与者在治疗药物使用障碍前与治疗药物使用障碍后在知识、自我效能、态度和技能方面的变化。7 个系列的学习目标主题包括减少伤害、团队护理、行为技术、药物辅助治疗、创伤知情护理、共患疾病和健康的社会决定因素:我们采用了混合方法,根据系列学习目标和物质进行了概念内容分析,并对参与者自我报告的学习成果进行了双尾配对样本 t 检验。内容分析测试了学习目标主题以及学员案例陈述和讨论中提到的非法和非非法药物的频率和剂量,配对样本 t 检验比较了学员从系列学习前到系列学习后与学习目标和药物管理相关的知识、自我效能、态度和技能:内容分析结果表明,3 个学习目标主题--基于团队的护理、减少伤害和健康的社会决定因素--出现的频率和剂量最高,在 100%(n=22)的病例介绍和讨论中都有出现。在非法和非非法物质中,酒精出现的频率和剂量最高,出现在 81% (n=18)的病例陈述和讨论中。配对样本 t 检验的结果表明,与多种物质使用(P=.02)、了解其他学科在 SUD 护理中使用的方法(P=.02)以及尼古丁(P=.03)和阿片类药物使用障碍(P=.003)的药物管理策略相关的知识领域陈述在统计学上有显著增加。在尼古丁(P=.002)和酒精使用障碍(P=.02)的药物管理方面,2 项自我效能领域陈述有统计学意义的增长。此外,在技能领域,关于在干预中使用变化阶段理论(P=.03),观察到 1 项统计学意义上的显著提高:这些研究结果表明,ECHO 项目的内容符合其既定的学习目标;在 3 个主题上达到了学习目标,并取得了显著的进步;在案例介绍和讨论中达到了解决多种物质问题的目的。这些结果表明,"ECHO 项目 "是教育多学科医疗服务提供者采用综合方法治疗 SUD 的潜在工具。
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Using Project Extension for Community Healthcare Outcomes to Enhance Substance Use Disorder Care in Primary Care: Mixed Methods Study.

Background: Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorder (SUD). Ohio's growing epidemic has indicated a need to improve SUD care in a primary care setting through the engagement of multidisciplinary providers and the use of a comprehensive approach to care.

Objective: The purpose of this study was to assess the ability of the Weitzman Extension for Community Healthcare Outcomes (ECHO): Comprehensive Substance Use Disorder Care program to both address and meet 7 series learning objectives and address substances by analyzing (1) the frequency of exposure to the learning objective topics and substance types during case discussions and (2) participants' change in knowledge, self-efficacy, attitudes, and skills related to the treatment of SUDs pre- to postseries. The 7 series learning objective themes included harm reduction, team-based care, behavioral techniques, medication-assisted treatment, trauma-informed care, co-occurring conditions, and social determinants of health.

Methods: We used a mixed methods approach using a conceptual content analysis based on series learning objectives and substances and a 2-tailed paired-samples t test of participants' self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and nonillicit substances mentioned in participant case presentations and discussions, and the paired-samples t test compared participants' knowledge, self-efficacy, attitudes, and skills associated with learning objectives and medication management of substances from pre- to postseries.

Results: The results of the content analysis indicated that 3 learning objective themes-team-based care, harm reduction, and social determinants of health-resulted in the highest frequencies and dose, appearing in 100% (n=22) of case presentations and discussions. Alcohol had the highest frequency and dose among the illicit and nonillicit substances, appearing in 81% (n=18) of case presentations and discussions. The results of the paired-samples t test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for 2 self-efficacy domain statements regarding medication management for nicotine (P=.002) and alcohol use disorder (P=.02). Further, 1 statistically significant increase in the skill domain was observed regarding using the stages of change theory in interventions (P=.03).

Conclusions: These findings indicate that the ECHO program's content aligned with its stated learning objectives; met its learning objectives for the 3 themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to educate multidisciplinary providers in a comprehensive approach to SUD care.

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来源期刊
JMIR Medical Education
JMIR Medical Education Social Sciences-Education
CiteScore
6.90
自引率
5.60%
发文量
54
审稿时长
8 weeks
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