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

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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

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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.

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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.

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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.

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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%