Literature Collection

INTRODUCTION: Eat, Sleep, Console (ESC) is an effective approach for evaluating and managing neonatal opioid withdrawal syndrome (NOWS). The current standard, Finnegan Neonatal Abstinence Scoring System, requires waking neonates to assess NOWS and prioritizes pharmacotherapy treatment. However, ESC focuses on infants' abilities to function and cope with opioid withdrawal, prioritizes nonpharmacologic interventions, and emphasizes the crucial role of the parent-infant relationship. We created and delivered ESC training for perinatal and neonatal staff and clinicians across an urban academic health center. METHODS: We utilized the knowledge-to-action framework to guide project design and implementation. The training program consisted of 30- to 60-minute didactic sessions for neonatal and perinatal clinicians and staff on labor and delivery and neonatal intensive care units, an ESC algorithm for care, and pre- and posttraining surveys. RESULTS: We trained 254 participants (nurses, OB/GYN, and family medicine attending physicians and residents, neonatal advanced practice clinicians, midwives, social workers) through virtual educational sessions. Eighty-eight participants completed pre- or posttraining surveys, and 11 completed both surveys. Posttraining results demonstrated statistically significant improvement in self-rated preparedness to use nonpharmacologic interventions (mean score 3.91 vs. 4.64, pre- vs. posttraining paired surveys on 5-point scale [1 = strongly disagree, 5 = strongly agree]; p = .03; ). Pre/posttraining unpaired survey results indicated high levels of preparedness implementing ESC concepts. DISCUSSION: ESC education enhanced preparedness of birthing staff and clinicians to implement the nonpharmacologic ESC tool for management of NOWS. Coordinated, multidisciplinary education and collaboration support the successful implementation of ESC in clinical settings.

BACKGROUND: Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS: An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION: PC centres of the Spanish National Health System (SNHS). PARTICIPANTS: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.

BACKGROUND: The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians' lack of experience prescribing this therapy. Little is known about US residency training programs' provision of OBOT and addiction medicine training. METHODS: The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs' beliefs about OBOT, and potential barriers to providing OBOT training. RESULTS: The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). CONCLUSIONS: Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.