Opioid use disorder and motivational interviewing: Training physician assistants for the epidemic.

OBJECTIVES: (1) To evaluate the effectiveness of a curriculum on physician assistant (PA) students' knowledge about opioid use disorder (OUD) treatment and management and (2) present student satisfaction with the curriculum. METHODS: Three cohorts of PA students completed pre- and post-intervention questionnaires about their knowledge of motivational interviewing (MI) for OUD. One cohort of students completed the 11-item questionnaire without exposure to the intervention (control group). Students' satisfaction with the curriculum was assessed as was their pre- and post-intervention knowledge about using MI for OUD. Bivariate statistical tests were used to analyze the quantitative data. RESULTS: Three hundred complete and usable responses were obtained from the four cohorts of PA students (n = 300, 87.7 percent response rate). The intervention groups answered a higher number of items correctly (median = 7) than the control group (median = 6, Wilcoxon sign test M = 31, p < 0.0001). Among the intervention group, there was not a statistically significant between cohort difference on: (1) the number of identical pre- and post-intervention questionnaire items answered correctly (Chi-square = 3.77, DF = 2, p = 0.15), and (2) the total number of items answered correctly on the post-intervention questionnaire (Chi-square = 0.32, DF = 2, p = 0.85). Student comments suggest students were supportive of the curriculum, with improvements noted on how to deliver the material. CONCLUSIONS: An educational intervention using MI for PA students was found to be valuable, and students who completed the intervention had greater knowledge about using MI with OUD patients than those who did not complete the training. The size of the effect was small, and more research on the curriculum is necessary prior to widespread adoption.

Opioid Use Disorder and Assessment of Patient Interactions Among Family Medicine Residents, Medical Students, and Physician Assistant Students.

Introduction: In light of the opioid overdose epidemic in the US and the necessity of developing training to conduct difficult conversations around opioid dependence, three case-based videos were created to demonstrate providers using motivational interviewing (MI) with patients who have opioid use disorder (OUD). These vignettes displayed a primary care provider interacting with a patient seeking opioids. Methods: Learners-including third-year medical and physician assistant (PA) students, and family medicine residents-viewed three videos set in a family medicine clinic and assessed clinician use of MI when interacting with patients with OUD. The patients were at different levels of acknowledging their need to change their opioid use behaviors and/or pursue treatment. Learners rated each video with an MI rating scale, and a facilitator debriefed strengths, weaknesses, and omissions regarding MI. Results: Medical and PA students, and resident family physicians provided 572 ratings. Analysis of variance of mean percent incorrect was lower in residents than in all groups combined, but failed to reach statistical significance (47% + 12.0 vs 53% + 15.0, p = .43). Discussion: These case-based videos with MI ratings afforded students and residents the opportunity to assess clinician use of MI techniques with patients with OUD. The MI rating scale had clinical significance (residents scored +5 points and had more training) despite lacking statistical significance. These scenarios allowed learners to recognize how to use MI when having a difficult conversation with patients who misuse opioids. We envision individual use or use for group discussion.

Female PAs-Where are we today?

As the physician assistant (PA) profession celebrates its 50th birthday, we can be proud of the gains our profession has accomplished. However, despite the positive reports of job satisfaction, a marked increase in female PA leaders, and overall gains in PA compensation, a significant wage gap remains between male and female PAs. The PA profession is flourishing but it is time female PAs are paid equitably.

Central Application Service for Physician Assistants Ten-Year Data Report, 2002 to 2011.

PURPOSE: This study highlights the trends and data points of interest in physician assistant (PA) applicant data over the first 10 years of the Central Application Service for Physician Assistants (CASPA) (2002-2011) and PA matriculant data over the last 5 years of that 10-year period (2007-2011). METHODS: A retrospective study of data provided by applicants to all CASPA-participating PA programs between 2002 and 2011 was conducted. Applicant data analyzed over the 10-year period were provided by applicants and collected through an online CASPA applicant portal. Academic information was verified by CASPA staff through official transcript review. Matriculant data were obtained from CASPA-participating programs through the online CASPA admissions portal, which linked to applicant data in the CASPA applicant portal. RESULTS: During the first 10 years of the CASPA service, the Physician Assistant Education Association experienced a 93% increase in the number of CASPA-participating programs and a 255% increase in the number of unique applicants identified through CASPA. Relatively constant trends were identified in the major demographic features (age, gender, ethnic composition, and disadvantaged status) and the academic data of applicants. Major demographic features of matriculants (2007-2011) also remained relatively constant, whereas trends in academic data of matriculants revealed an increasing total grade point average. CONCLUSION: This 10-year comprehensive analysis of the CASPA data will benefit the profession by establishing a baseline of applicant characteristics. Ultimately, these data will help redefine recruitment strategies at program, state, and national levels by providing programs and national organizations with data needed to target applicants not previously included in recruitment activities.

Standardized patient instructors' and physician assistant students' evaluation of diabetes counseling skills.

PURPOSE: Standardized patient instructors (SPIs) have been used in medical and physician assistant (PA) teaching and have been shown to be a valuable resource for assessing interviewing and clinical skills. This study evaluated the agreement between SPI ratings and student self-ratings in the assessment of counseling skills. METHODS: PA students in three graduating classes (2009-2011) participated in this study. SPIs received specialized training to simulate a patient with diabetes. SPIs provided feedback during simulated encounters using the Diabetes Risk Factor Interview Scale (DRFIS). The DRFIS provides a criteria-based scale for student assessment. Students completed the DRFIS as a self-assessment prior to receiving SPI feedback. Agreement between SPI evaluation and student self-evaluation using the DRFIS were evaluated. RESULTS: The total DRFIS score was generally comparable between all three graduation classes. SPI ratings of students by individual DRFIS items for all three classes indicate the highest scores occurred for Rapport and Empathy items while the lowest scores were evident for items including Reinforce Effort and Reframing Failure. The percent agreement between SPI and student self-rating was within one point for greater than 70% for all 12 DRFIS items for the cohort of three graduation classes. CONCLUSION: PA students rated themselves on average lower on the DRFIS than SPIs but within an acceptable overall percentage range. Using an evaluation scale that is focused around patient counseling skills is a viable teaching tool for students and SPIs. Acceptable agreement between students and SPI was found. The DRFIS provides an effective criteria-based scale for student assessment.

Characteristics associated with glycemic control among family medicine patients with type 2 diabetes.

BACKGROUND: As new payment models are developed for chronic diseases such as diabetes, there is a need to understand which patient characteristics impact glycemic control. This study examines the relationship between patient variables and glycemic control, defined as a hemoglobin A1c (A1c) level of <7%, in a cohort of family medicine patients with type 2 diabetes. METHODS: A total of 1,398 medical charts were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diabetes. To gather information not available through chart review, a survey was used to collect data on individual-level characteristics. Information included marital status, education level, income level, insurance status, activity level, receipt of diabetes education, living arrangement, employment status, and annual income. A cross-sectional design was used to obtain, via chart review, data about diabetes outcomes (ie, A1c level, blood pressure, and low-density lipoprotein cholesterol [LDL-C] level). RESULTS: A mailed survey was completed by 669 patients (response rate, 47.9%). Almost half of patients in this sample achieved the goal A1c level, LDL-C level (ie, <100 mg/dL), and/or blood pressure (ie, <130/<80 mm Hg). Medicare insurance (odds ratio [OR], 2.16 [95% confidence interval {CI}, 1.18-3.96]) and female sex (OR, 1.61 [95% CI, 1.01-2.56]) were associated with glycemic control. Other variables, such as annual income, education level, and receipt of diabetes education, that were expected to impact glycemic control were not significantly associated with an A1c level of <7%. LIMITATIONS: The survey response rate was <50%, the study was conducted at a single site, and the chart data were retrospective. CONCLUSIONS: Our findings indicate that Medicare insurance and female sex were associated with glycemic control. Further evaluation is needed to identify determinants that lead to achievement of optimal glycemic control among individuals with type 2 diabetes.

Working effectively with interpreters: a model curriculum for physician assistant students.

BACKGROUND: Effective patient-provider communication is crucial to achieving good health care outcomes. To accomplish this with patients of limited English proficiency, learning to work effectively with interpreters is essential. AIMS: The primary goal of this study was to determine if physician assistant students could effectively use interpreters to communicate with Spanish speaking patients after implementation of a cultural competency and Medical Spanish curriculum. METHOD: In year one of a three year implementation process, a module for teaching students to work effectively with interpreters was developed and implemented in the Wake Forest University School of Medicine Department of Physician Assistant Studies. After four hours of orientation, practice and role play, students were observed and recorded during a standardized patient assessment and evaluated by clinicians as well as by trained, bi-lingual evaluators. RESULTS: In the Class of 2007, 94% (43 students) and in the Class of 2008, 96% (47 students) demonstrated competence. CONCLUSIONS: Our findings highlight the feasibility and usefulness of training students to work effectively with interpreters. Evaluation and feedback from students and faculty have been positive. Cost for this curriculum enhancement was reasonable, making it feasible to introduce the training into a wide variety of medical and allied health programs.

Racial and ethnic disparities in self-monitoring of blood glucose among US adults: a qualitative review.

OBJECTIVE: To review existing data to determine whether racial/ethnic disparities exist for self-monitoring of blood glucose (SMBG) among adults in the United States. STUDY DESIGN: A literature search of diabetes-related studies published from 1970 through June 2005 was conducted. Our search strategy included SMBG in minority populations with diabetes. METHODS: Studies were selected for review if they reported SMBG rates from a specific racial/ethnic minority group or if there were comparisons of SMBG rates across racial/ethnic groups. RESULTS: Twenty-two studies were reviewed that met the search criteria. Twelve studies included data from a single racial/ethnic minority group, and 10 studies included comparisons between non-Hispanic Whites and at least one racial/ethnic minority group. Data represented studies conducted in a variety of settings, such as healthcare facilities in a state or region of the United States and nationally representative surveys. Most of the data indicate that SMBG rates are generally low, regardless of the population. In comparative studies, some racial/ethnic differences overall were found in SMBG rates among all racial/ethnic minority groups when compared to non-Hispanic Whites. Across studies, patients taking insulin performed SMBG more frequently than did those not taking insulin. CONCLUSIONS: Despite widespread recommendations for self-monitoring of blood glucose, compliance is reported to be low in all groups in the United States, especially among racial/ ethnic minorities.