Dataset Information

The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs.

ABSTRACT:

Objective

To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage.

Data source

Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011.

Study design

We used generalized linear regression models to examine associations between directors' characteristics and methadone dose, adjusting for program and patient factors.

Data collection

Data were collected through telephone surveys of program directors.

Principal findings

The proportion of OAT programs with an African American director declined over time, from 29 percent in 1995 to 16 percent in 2011. The median percentage of patients in each program receiving <60 mg/day declined significantly, from 48.5 percent in 1995 to 29 percent in 2005 and 23 percent in 2011. Programs with an African American director were significantly more likely to provide low methadone doses than other programs. This association was even stronger in programs with an African American director who served populations with higher percentages of African American patients.

Conclusions

Demographic characteristics of OAT program directors (e.g., their race) may play a key role in explaining variations in methadone dosage across programs and patients. Further research should investigate the causal pathways through which directors' characteristics affect treatment practices. This may lead to new, multifaceted managerial interventions to improve patient outcomes.

SUBMITTER: Frimpong JA

PROVIDER: S-EPMC5583309 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs.

Frimpong Jemima A JA Shiu-Yee Karen K D'Aunno Thomas T

Health services research 20160912 5

<h4>Objective</h4>To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage.<h4>Data source</h4>Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011.<h4>Study design</h4>We used generalized linear regression models to examine associations between directors' characteristics and methadone dose, adjusting for program and patie ...[more]

PMID: 27618580

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Project description:Background Training future clinicians in safe opioid prescribing (SOP) and treatment of opioid use disorder (OUD) is critical to address the opioid epidemic. The Accreditation Council on Graduate Medical Education requires all programs to provide instruction and experience in pain management and will mandate addiction medicine clinical experiences for internal medicine trainees. Objective Assess residents’ training in SOP and treatment of OUD and identify training barriers. Design Cross-sectional nationally representative survey was emailed in 2019. Participants Four hundred twenty-two Association of Program Directors in Internal Medicine members in US internal medicine residency programs. Main Measures Program opportunities and challenges to developing or implementing training in SOP, treatment of OUD, and buprenorphine waiver training, and perceived curricular effectiveness. Key Results The response rate was 69.4% (293/422). Most programs required didactics in SOP (94.2%) and treatment of OUD (71.7%). Few programs required clinical experiences including addiction medicine clinics (28/240, 11.7%), inpatient consult services (11/240, 4.6%), or offsite treatment rotations (8/240, 3.3%). Lack of trained faculty limited developing or implementing curricula (61.5%). Few respondents reported that their program was “very effective” in teaching SOP (80/285, 28.1%) or treatment of OUD (43/282, 15.3%). Some programs offered buprenorphine waiver training to residents (83/286, 29.0%) and faculty (94/286, 32.9%) with few mandating training (11.7% (28/240) and 5.4% (13/240) respectively). Only 60 of 19,466 (0.3%) residents completed buprenorphine waiver training. Primary care programs/tracks were more likely to offer waiver training to residents (odds ratio [OR], 3.07; 95% CI, 1.68–5.60; P < 0.001) and faculty (OR, 1.08; 95% CI, 1.01–3.22; P = 0.05). Conclusions In this nationally representative survey, few internal medicine residency programs provided clinical training in SOP and treatment of OUD, and training was not viewed as very effective. Lack of effective training may have adverse implications for patients, clinicians, and society. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07102-y.

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Dataset Information

The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs.

Objective

Data source

Study design

Data collection

Principal findings

Conclusions

Publications

The Role of Program Directors in Treatment Practices: The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs.

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