Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice.

Abstract

To assess the impact of hospital substance use disorder (SUD) initiative, which, beginning in October 2014, implemented an inpatient addiction consult team, a postdischarge addiction clinic, recovery coaches, and SUD treatment within primary care on general internists' attitudes, clinical practice, and preparedness to care for SUD. Pre and postintervention survey of general internal medicine physicians at Massachusetts General Hospital, in Boston, Massachusetts, in September 2014 (n = 290) and 2015 (n = 296) was conducted. There were 149 respondents for the pre and 143 respondents for the post survey. There were no significant differences between groups. In the follow-up group, 66% of physicians had a patient receive care from the initiative. These physicians were significantly more likely to have favorable attitudes towards SUD; 44% report caring for patients with SUD is as satisfying as other clinical activities versus 9% of physicians without experience with the initiative. These physicians were significantly more likely to feel very prepared to screen for SUD (27% vs 9%), diagnose SUD (23% vs 9%), deliver a brief intervention (16% vs 5%), refer to treatment (36% vs 14%), discuss medication treatments (22% vs 5%), discuss overdose prevention and naloxone (33% vs 5%), and discuss harm reduction (22% vs 7%). They were also significantly more likely to frequently prescribe naloxone (11% vs 0%), prescribe addiction pharmacotherapy (15% vs 2%), and provide addiction treatment themselves (18% vs 5%). General internists' attitudes, preparedness, and clinical practice related to SUD significantly improved after having a patient receive care from new clinical services implemented through a hospital-wide SUD initiative.