Academic medicine : journal of the Association of American Medical Colleges · 2026
Development of an addiction medicine clinic integrated into an internal medicine ambulatory practice.
СтатьяНазвание и аннотация: Перевод в очереди
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Binder Michael C, Brizzi Marisa B, Santen Sally A, Chan Carolyn A
Аннотация
PROBLEM: Substance use disorders (SUDs) are widespread, yet few individuals receive treatment. Internal medicine (IM) residents need clinical training on how to provide SUD treatment.
APPROACH: In 2023, the authors used a structured approach to develop an addiction clinic integrated into the University of Cincinnati IM resident primary care practice to provide SUD treatment. A formative logic model with output measures to evaluate the short-term outcome of the first 15 weeks of clinic was used. Output measures included no-show rates, number of patient visits, and primary SUD diagnosis. Short-term outcomes of residents' experiences were evaluated using a retrospective pre-post survey and the McNemar paired test to assess their confidence in performing addiction-related clinical tasks before vs after their rotation.
OUTCOMES: Eighteen learners were sent a survey from December 2023 to March 2024, with 11 responding (61%). Short-term outcomes included resident-reported confidence as moderate, quite, or extremely confident in the listed tasks before vs after their clinic experiences: making an SUD diagnosis (4 [36%] vs. 10 [91%], P = .03), interpreting urine drug screen results (4 [36%] vs. 10 [91%], P = .03), starting buprenorphine for opioid use disorder (OUD) (1 [9%] vs. 8 [73%], P = .02), titrating buprenorphine for OUD (0 [0%] vs. 8 [73%], P = .01), starting medications for alcohol use disorder (4 [36%] vs. 7 [64%], P = .36), and harm reduction counseling (4 [36%] vs. 9 [82%], P = .06). In the first 15 weeks of this clinic, there were 73 patient visits. Primary SUD diagnoses were OUD (37 [51%]), alcohol use disorder (18 [25%]), other (7 [9%]), stimulant use disorder (6 [8%]), and nicotine (5 [7%]).
NEXT STEPS: Next steps include further evaluation of the clinic rotation's impact on resident clinical behaviors, attitudes on SUD, and patient SUD outcomes.
APPROACH: In 2023, the authors used a structured approach to develop an addiction clinic integrated into the University of Cincinnati IM resident primary care practice to provide SUD treatment. A formative logic model with output measures to evaluate the short-term outcome of the first 15 weeks of clinic was used. Output measures included no-show rates, number of patient visits, and primary SUD diagnosis. Short-term outcomes of residents' experiences were evaluated using a retrospective pre-post survey and the McNemar paired test to assess their confidence in performing addiction-related clinical tasks before vs after their rotation.
OUTCOMES: Eighteen learners were sent a survey from December 2023 to March 2024, with 11 responding (61%). Short-term outcomes included resident-reported confidence as moderate, quite, or extremely confident in the listed tasks before vs after their clinic experiences: making an SUD diagnosis (4 [36%] vs. 10 [91%], P = .03), interpreting urine drug screen results (4 [36%] vs. 10 [91%], P = .03), starting buprenorphine for opioid use disorder (OUD) (1 [9%] vs. 8 [73%], P = .02), titrating buprenorphine for OUD (0 [0%] vs. 8 [73%], P = .01), starting medications for alcohol use disorder (4 [36%] vs. 7 [64%], P = .36), and harm reduction counseling (4 [36%] vs. 9 [82%], P = .06). In the first 15 weeks of this clinic, there were 73 patient visits. Primary SUD diagnoses were OUD (37 [51%]), alcohol use disorder (18 [25%]), other (7 [9%]), stimulant use disorder (6 [8%]), and nicotine (5 [7%]).
NEXT STEPS: Next steps include further evaluation of the clinic rotation's impact on resident clinical behaviors, attitudes on SUD, and patient SUD outcomes.