strategic prevention framework/ state incentive grant
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Strategic Prevention Framework/State Incentive Grant
Kristie R. Schmiege, MPH, CCS, CADC, CPC-M Director of Substance Abuse Services
Genesee County Community Mental Health
2007 Physician Survey: Findings and Recommendations
Facilitated by Hurley Research Dept.
BACKGROUNDOn-going Needs Assessment is important to our
work as the Substance Abuse Coordinating Agency
Two major study objectives:
1) Review existing data on consumption patterns and consequences of substance use problems; &
2) Collect new information to better define intervening variables, contributing factors, and readiness for change.
This data is used to maximize our efforts to reduce substance use and abuse in Genesee County
BACKGROUND For collecting new information—the following key sectors in the community have been targeted:
Government → Law Enforcement Education → Teaching Faculty Young Adults → College Students Medical → Physicians
continued
PHYSICIAN SURVEY• Conducted a review of published literature on physicians’
views of substance use/abuse and barriers to treatment
• Identified key barriers to physician ‘aid’
• Developed a companion underage drinking survey
• Subcommittee met and revised surveys
PHYSICIAN SURVEY
• Mailed survey in November 2007 with ‘strong’ cover letter signed by Dr. Allen Ebert, Addiction Specialist, plus a return incentive
• Targeted all area physicians (survey mailed to 1115 area practitioners)
• Sought those interested in Focus Group participation
continued
DemographicsNumber of years in practice: 32.6% < 10 Years 29.5% 10 – 19 Years 25.3% 20 – 29 Years 12.6% > 30 YearsType of practitioner:
– 57.9% MD– 25.3% DO– 4.2% PA– 2.1% NP– 1.1% PsyD– 9.4% Other
We received a total of 101 responses.
2007 Physician Survey Findings
Training / Education
• Most physicians do not feel: competent to treat alcohol- and drug-related disorders. 70.4% Agreed or Strongly Agreed
• Or, that there is adequate curriculum time devoted to substance abuse disorders during residency training. 28.1% Neutral56.3% Disagreed or Strongly Disagreed
Professional Satisfaction• Professional satisfaction caring for patients with
substance problems is lower than that for other illnesses.
72.2% Agreed or Strongly Agreed
14.4 % Neutral• Many physicians are skeptical about the
probability of influencing or improving outcomes for this group of patients.
77.3% Agreed or Strongly Agreed
14.4% Neutral
Appropriateness• Physicians generally approach addiction as a
treatable medical illness.
38.7% Agreed or Strongly Agreed
23.6% Neutral
39.7% Disagreed or Strongly Disagreed• The diagnosis and treatment of alcohol- and drug-
related disorders are generally considered peripheral to or outside medical matters.
41.9% Agreed or Strongly Agreed
10.2% Neutral
47.9% Disagreed or Strongly Disagreed
Legal System• Information learned about patient illegal drug use by
physicians should not be used for prosecution, so that drug users will be more likely to seek help.
68.4% Agreed or Strongly Agreed
17.3% Neutral• Involvement of the legal/justice system in dealing with
alcohol and drug use serves to threaten the communication and trust with a patient.
58.2% Agreed or Strongly Agreed
19.4% Neutral
22.4% Disagreed
Patient Population• It is important that physicians have an open,
nonjudgmental attitude about patients who struggle with addiction. 89.8% Agreed or Strongly Agreed10.2% Neutral
• Patients who present with problems related to illegal drug use generally generate a significant workload. 83.7% Agreed or Strongly Agreed
Community Resources• Many physicians experience a ‘learned feeling of
helplessness’ in working with substance abuse patients because there are inadequate services available to meet their patient’s needs. 77.6% Agreed or Strongly Agreed17.3% Neutral
• A lack of insurance coverage prevents many patients from seeking treatment for addiction.
74.5% Agreed or Strongly Agreed
17.3% Neutral
Screening / Recognition• Few physicians routinely screen and counsel patients about
prevention of substance abuse and alcoholism. 58.2% Agreed or Strongly Agreed21.4% Neutral20.4% Disagree or Strongly Disagree
• Lack of time prevents physicians from intervening in a patient’s substance abuse problems.71.9% Agreed or Strongly Agreed14.6% Neutral
• I routinely ask patients about . . . .Use of tobacco: 98.9%Use of alcohol: 96.8% Use of other drugs: 90.5%If there is a family history of addiction: 34.7%
Impact on System• Patients with substance use disorders are
prevalent in most hospitals and emergency departments. 90.6% Agreed or Strongly Agreed
• Alcohol, tobacco, and other drug abuse undermine the physical and psychological wellbeing of patients, contributing to many illnesses that result in admission to acute care settings. 98.9% Agreed or Strongly Agreed
Useful Tools
• What tools might help you in your practice with substance abuse prevention and treatment?
Referral Information: 71.6%
Brochures: 50.5%
Kits: 32.6%
Website: 29.5%
Other: 6.3%
BARRIERS: SUMMARY
• TRAINING: Not adequately prepared; low feelings of competency to treat.
• PROFESSIONAL SATISFACTION: Low satisfaction; high skepticism.
• APPROPRIATENESS: Not approached as a treatable medical illness; seen as peripheral to medical management.
BARRIERS SUMMARY
• LEGAL SYSTEM: Separate ‘systems’ (patient data should not be used for prosecution); threatens trust of patients.
• PATIENT POPULATION: Champions nonjudgmental approach, but view patients as generating significant workload.
• COMMUNITY RESOURCES: Inadequate services; inadequate insurance coverage.
continued
BARRIERS SUMMARY
• SCREENING/RECOGNITION: Low routine screening/counseling about prevention (lack of time plays a role); but they do ask about use of alcohol, tobacco and other drugs.
• IMPACT ON SYSTEM: Patients prevalent in emergency rooms; use seen as contributor to many illnesses.
continued
UNDERAGE DRINKING SUMMARY
• ATTITUDES: High recognition of problem; high interest to help.
• KNOWLEDGE: Low confidence in recognition of red flags; low understanding of referral options.
UNDERAGE DRINKING SUMMARY
• CONTRIBUTING FACTORS: Lack of parental supervision and peer pressure rated highest.
• INTERVENING: Create gathering places; educate teens about the dangers.
continued
UPDATED PHYSICIAN SURVEY
Today’s survey includes:
• Previous survey questions for trending and evaluation of our efforts
• New questions regarding prescription drug misuse
Please complete the survey
• Survey is confidential
• Results will help us prioritize problems, identify gaps & maximize efforts & resources
Thank You• The updated, 2-sided surveys are light blue
and on your tables• Please complete a survey and leave it on
your table or at the registration desk, when you leave
• Your assistance is greatly appreciated!
• Data available upon request
UNDERAGEDRINKING
Attitudes / Knowledge• There is a significant problem in this community with underage drinking
and driving. 78.6% Agreed or Strongly Agreed18.4% Neutral
• There would be interest among area physicians to aid community efforts to reduce underage drinking and driving. 72.4% Agreed or Strongly Agreed19.4% Neutral
• I feel confident in my knowledge of ‘red flags’ that might signal a young patient is experiencing problems with alcohol or drugs. 57.1% Agreed or Strongly Agreed26.5% Neutral
• Do you know where to make referrals for young patients who are struggling with alcohol or drugs?57.9% No
Factors That Play A Role in Underage Drinking
Very Important• Risk-taking/impulsive
behavior (64%)• Early exposure to alcohol
(62%)• Lack of parental
supervision (79%)• Peer pressure (73%)
Important• Personality characteristics
(51%)• Hereditary or genetic
factors (53%)• Low perceived risks (54%)• Increased stress (54%)• Negative influence of media
(51%)• Easy retail access (58%)
Results of Underage Drinking
Very Likely
• Hangover (73%)• Poor judgment
(76%) • Future drinking
problems (64%)
Likely
• Suicide (57%)• Homicide (52%)
Interventions as a Community
• Educate young people about the dangers of underage drinking. (n=103)
• Create friendly, alcohol-free places where teens can gather (n=109)
• Create programs, including volunteer opportunities, where young people can grow and succeed. (n=86)
• Stiffen penalties for those adults who provide alcohol to minors. (n=58)
• Support programs that help teens already involved with drinking. (n=67)
Numbers greater than 57 represent an area that the majority (>50%) of respondents identified as an optimal strategy to reduce underage drinking.
Useful Tools
• What tools might help you in your practice with substance abuse prevention and treatment?
Website 32.3%
Kits 35.5%
Brochures 52.7%
Referral Information 69.9%
Other 3.3%
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