Mort SC, Díaz SR, Miller C, Bowlby M, Henderson D, Beverly EA. Influence of Future Prescribers’ Personal and Clinical Experiences With Opioids on Plans to Treat Patients With Opioid Use Disorder. J Am Osteopath Assoc 2019;119(12):780–792. doi: https://doi.org/10.7556/jaoa.2019.131.
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Recreational use of opioids is a growing problem in the United States, particularly in the Midwest. Educators have called for inclusion of pain- and opioid-specific courses in health professional school curricula, yet more research is needed to address future prescribers’ beliefs, experiences, and postgraduate plans related to opioids.
To examine health professional students’ perceived severity of the opioid crisis and opioid-related beliefs, experiences, and postgraduate plans.
Using a descriptive, cross-sectional design, researchers evaluated health professional students from 3 academic programs (nurse practitioner [NP], physician assistant [PA], and doctor of osteopathic medicine [DO]) using a 25-item survey that assessed perceived opioid crisis severity and opioid-related beliefs, experiences, and postgraduate plans. Demographics of respondents were assessed using descriptive statistics and frequencies. Responses were compared between academic programs with 1-way analysis of variance or Kruskal-Wallis tests, and relationships between students’ experiences and postgraduate plans were assessed.
A total of 491 students (mean [SD] age, 27.2 [5.4] years; 62.7% female; 68.2% DO students) participated in the survey (response rate, 40.4%). The opioid crisis was perceived to be severely impacting the health care system (mean [SD] score, 79.7 [16.8] out of 100), and most respondents (415 [84.5%]) reported that opioid use affected their communities. Clinical experience varied by program, with NP students (75 [81.5%]) reporting the most experience treating acute overdose. Most respondents (317 [64.6%]) agreed that their postgraduate practice would involve caring for patients addicted to opioids; however, only 232 students (47.3%) felt confident in their ability to treat patients with addiction. Experiences managing acute overdose and handling drug-seeking behavior were positively associated with a belief that postgraduate work would involve working with patients with addiction (U=38,275.5, Z=5.92, P<.001; U=25,346.0, Z=4.94, P<.001) and confidence in treating patients with opioid addictions (U=36,806.5, Z=4.96, P<.001; U=23,765.5, Z=3.66, P<.001).
Although health professional students had similar beliefs and perceptions regarding the opioid crisis, there were notable differences between academic programs. Students with clinical opioid experiences were more likely to plan on working with patients addicted to opioids and be confident in treating these patients. Thus, the inclusion of experiential learning in the medical curricula may be beneficial for both students and their future patients.
a Data are reported as No. (%) except where otherwise noted. Three repeated χ2 analyses were used to compare gender, community, and postgraduate specialty by program. Critical P values were adjusted for multiple comparisons using a Bonferroni correction. The critical P value for the χ2 analyses was set at .0167 corrected for 3 pairwise comparisons.
b Three respondents (1 physician assistant [PA] and 2 doctor of osteopathic medicine [DO] students) did not report their age. One-way analysis of variance was performed to determine differences in age by program. Nurse practitioner (NP) students were older than their PA and DO counterparts (P<.001).
c Respondents in the NP and PA programs were primarily female (NP vs PA, P=.086; NP vs DO, P<.001; PA vs DO, P=.002).
d One DO student did not report his or her race/ethnicity. Statistical analyses could not be completed for race/ethnicity because of the low number of responses for most groups.
e A “Year 5” option is included in the “year in program” category because some DO students completed dual-degree programs (eg, MBA, MS) or a primary care/osteopathic manipulative medicine fellowship, which adds an additional training year to the standard 4-year program. The PA program lasts a maximum of 2 years, and the NP program lasts a maximum of 4 years. Statistical analyses were not performed for year in program because each program has a different duration.
f The distribution of students who grew up in a metropolitan area, city, or town was different between NP and DO students. More NP students were raised in rural areas (NP vs PA, P=.027; NP vs DO, P=.014; PA vs DO, P=.208).
g Pediatrics, internal medicine, and family medicine were categorized as primary care. More NP students intended to go into a primary care specialty (NP vs PA, P=.002; NP vs DO, P<.001; PA vs DO, P=.519).
Abbreviation: NA, not applicable.
a The perceived severity subscale was measured on a scale from 0 to 100, where 0 was not at all severe and 100 was extremely severe.
b One-way analysis of variance (ANOVA) was performed on each scale item. Post hoc tests with Bonferroni corrections were performed to determine differences between groups. Significance was set at P<.05.
Abbreviations: DO, doctor of osteopathic medicine; NP, nurse practitioner; PA, physician assistant.
a Mean item scores for the beliefs subscale were calculated by averaging Likert scale responses (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) across 3 health care professional graduate programs (nurse practitioner [NP], physician assistant [PA], and doctor of osteopathic medicine [DO]).
b Nonparametric Kruskal-Wallis rank comparisons were used to determine differences between academic programs. Significance was set at P<.05.
c Post hoc tests with Bonferroni corrections were performed when significance was found with the initial independent samples Kruskal-Wallis test.
a Mean item scores for the experience and post-graduate plans subscales were calculated by averaging Likert scale responses (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) across 3 medical professional graduate programs (nurse practitioner [NP] students, physician assistant [PA] students, and doctor of osteopathic medicine [DO] students).
b Nonparametric Kruskal-Wallis rank comparisons were used to determine differences between academic programs. Post hoc tests with Bonferroni corrections were performed if significance was found with the initial independent samples Kruskal-Wallis test.
c Significance for the experience subscale was set at P<.05.
d Statistically significant.
e For the postgraduate plans subscale, the 3 postgraduate plans items were compared across 6 independent variables, 1 being academic program, necessitating cutoffs for statistical significance to be adjusted to P<(.05/6=.008).
a All students (N=491) were included in these analyses. Experiences and postgraduate plans were measured with a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). Experiences were recoded into categorical variables with 2 levels based on whether the student had the experience (0=No, 1=Yes). Mann-Whitney U tests were conducted to determine differences in postgraduate plans based on personal and clinical experiences. Because the 3 postgraduate plans subscale items were compared across 6 independent variables—academic program (Table 4) and the 5 experience subscale items—cutoffs for statistical significance were adjusted to P<(0.05/6=0.008).
b Statistically significant.
Abbreviation: MAT, medication-assisted treatment.
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