Combined interprofessional education and system intervention to improve screening older adults for dementia and falls.

The objective of this study was to increase screening for falls and dementia by improving interprofessional (IP) providers' and staffs' knowledge and attitudes toward the care of older patients and team-based care. An intervention, including education about screening and an electronic health record (EHR) flowsheet, was rolled-out across eight Federally Qualified Health Centers (FQHC). Participants were 262 IP health providers who served 6670 patients ≥ age 65 > age 65 . An EHR flowsheet with two-item screeners for falls and dementia triggered automatically for patients ≥ age 65. Documentation of screening for falls and dementia was abstracted from the EHR for the year prior to and the year after the interventions began. Baseline screening rates for falls and dementia were flat; from the start of education intervention until EHR live date, screening rates increased significantly; after EHR live date, the screening rates continued increasing significantly. A combined education-system intervention can improve screening for falls and dementia in FQHC.

How a Medication for Opioid Use Disorder Curriculum Translates into Experiences and Internal Medicine Residents' Understanding of Patients with Opioid Use Disorder.

PROBLEM: The number of people with an Opioid Use Disorder (OUD) continues to outpace access to associated medication. Ninety-six percent of states report higher rates of OUD than access to medications, and, despite being the standard of care, only 3% of physicians currently prescribe medication for opioid use disorder (MOUD). Prior studies have shown that decreasing barriers, such as a lack of knowledge about MOUD, increased physicians' willingness to prescribe. However, most internal medicine residency programs do not have a required addiction curriculum. As a result, we created a curriculum and conducted qualitative interviews with residents to better understand experiences with the curriculum. INTERVENTION: In an effort to overcome physician-centered barriers associated with prescribing MOUD, we developed and implemented a week-long curriculum, Addiction Week, for second and third year Internal Medicine Residents at Indiana University School of Medicine in a safety-net clinic. The curriculum included the following: didactics on substance use disorder (SUD), including OUD and alcohol use disorder, and MOUD (mostly buprenorphine), and mostly web-based, peer-reviewed and guideline based readings about addiction, direct observation of addiction counselors, direct discussion with people receiving MOUD, observation of a group therapy session, informal discussion with providers who prescribe MOUD, and, for some residents, observation of a physician prescribing MOUD. After completing the curriculum, the residents participated in an hour long audio-recorded interview to better understand their experiences with the curriculum. CONTEXT: This study was completed at a residency program where residents were not previously exposed to outpatient MOUD prescribing. Due to limited availability of faculty treating patients with MOUD, residents spent the majority of their time shadowing a social worker. IMPACT: Residents described gaining a deeper understanding of OUD by having the opportunity to interact with patients in a stable outpatient setting, which for many led to increased confidence and willingness to prescribe MOUD for people with OUD. LESSONS LEARNED: The greater understanding of addiction and willingness to prescribe MOUD described by residents in this study indicate that this type of curriculum may be a promising way to increase MOUD prescribing. Further studies are needed to evaluate whether this intervention can change prescribing behaviors.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1897597.

'Asking' but Not 'Screening': Assessing Physicians' and Nurses' Substance-Related Clinical Behaviors.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is a promising public health approach for problematic substance use. A core component of SBIRT is the use of formal screening tools to categorize a patient's likely level of risk in order to provide an appropriately-matched service. Training in formal screening is included in many SBIRT training programs, but infrequently is emphasized. OBJECTIVES: To assess pre-training levels of SBIRT-related clinical behaviors, including screening, this study examined a secondary dataset collected from internal medicine residents and graduate nurse practitioner students. METHODS: Learners (n = 117) completed 13 self-report items assessing use of SBIRT-related behaviors. Researchers used exploratory factor analysis to identify underlying concepts in the questionnaire, then used mixed ANOVA to compare mean frequency of utilization of each factor (asking, screening, and intervening) by academic program. RESULTS: Learners reported asking about substance use frequently, intervening some of the time, and infrequently using formal screening tools. Interaction and between-academic-program effects were significant but small. CONCLUSIONS: Prior to SBIRT training, most clinical practitioners reported asking patients about substance use, but few reported regularly using formal substance use screening tools. This may have implications for the importance of SBIRT training as part of curricular work, and for the internal content foci of SBIRT curricula.

Screening, Brief Intervention, Referral to Treatment (SBIRT), and Motivational Interviewing for PGY-1 Medical Residents.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) for alcohol use in primary care-often using motivational interviewing (MI)-is an effective preventive service. Medical residency programs have begun offering training in these areas, but little research has been conducted to examine the impact of SBIRT/MI training length on residents' satisfaction, affect, and behavioral intentions. OBJECTIVE: We measured residents' satisfaction with their training in addition to variables shown in previous research to predict medical professionals' intention to perform SBIRT. METHODS: This study focused on 2 SBIRT/MI training structures: a 4- to 6-hour training using didactic, experiential, and interactive methods and a brief 1-hour session explaining the same principles in a noninteractive format. Immediately following each training intervention, participating residents from internal medicine (IM), pediatrics (PEDS), medicine-pediatrics (IM-PEDS), and emergency medicine (EM) programs completed a 22-item instrument derived from established questionnaires; responses to each item were dichotomized, and comparisons were conducted between the training groups using Fisher exact test. RESULTS: Of 80 participating residents, 59 IM, PEDS, and IM-PEDS residents completed the longer training, and 21 EM residents completed the shorter training. All participating residents reported high levels of satisfaction, although EM residents were comparatively less satisfied with their shorter training session. CONCLUSIONS: Both SBIRT/MI training structures were feasible and were accepted by learners, although the 2 groups' perceptions of the training differed. Future research into the underlying causes of these differences may be useful to the application of SBIRT/MI training during residency.

Training requirements for DXA technologists in the United States.

The purposes of this study were to determine, by state, the requirements for dual-energy X-ray absorptiometry(DXA) operators' training, knowledge of these state requirements, and factors that predicted state and International Society of Clinical Densitometry (ISCD) certification of DXA technologists. Seventeen states required registered technologist (RT) certification or authorized/licensed limited certification for DXA operators, 16 had no certification requirements, 12 required RT certification, and 5 had state-specific requirements. There were 9745 surveys mailed toDXA users including 50% Hologic Inc., 50% GE Lunar, and 100% Norland; 3148 surveys are included in this analysis. Among responders who indicated that their state did not have any certification requirements (n=1673), 1095(65.5%) were incorrect; there were requirements. Possession of state and ISCD certification was significantly correlated with the number of patients scanned per week (p