HIV Insight: Emergency Department-Based Opioid Harm Reduction: Moving Physicians from Willing to Doing

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. Identify barriers and facilitators in translating willingness to action METHODS: 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:

200/278 (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 out of 5 [95% CI 2.94, 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 out of 5 [95% CI 4.18, 4.32]).

CONCLUSION:

Compared to prior studies, EM 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.

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By: Samuels EA1, Dwyer K2, Mello MJ1, Baird J1, Kellogg A3, Bernstein E2.

1Brown University Department of Emergency Medicine, Providence, RI, USA.
2Boston Medical Center Department of Emergency Medicine, Boston, MA, USA.
3Baystate Medical Center Department of Emergency Medicine, Springfield, MA, USA.
Acad Emerg Med. 2016 Jan 27. doi: 10.1111/acem.12910