A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians

BACKGROUND: Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs...

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Autores principales: Hooker, Stephanie A., Crain, A. Lauren, LaFrance, Amy B., Kane, Sheryl, Fokuo, J. Konadu, Bart, Gavin, Rossom, Rebecca C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922036/
https://www.ncbi.nlm.nih.gov/pubmed/36774521
http://dx.doi.org/10.1186/s13722-023-00366-1
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author Hooker, Stephanie A.
Crain, A. Lauren
LaFrance, Amy B.
Kane, Sheryl
Fokuo, J. Konadu
Bart, Gavin
Rossom, Rebecca C.
author_facet Hooker, Stephanie A.
Crain, A. Lauren
LaFrance, Amy B.
Kane, Sheryl
Fokuo, J. Konadu
Bart, Gavin
Rossom, Rebecca C.
author_sort Hooker, Stephanie A.
collection PubMed
description BACKGROUND: Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs’ stigma toward people with OUD (primary) and increased intentions to treat people with OUD compared to an attention-control training (secondary). METHODS: PCCs from 15 primary care clinics were invited to complete a 30 min online training for an electronic health record-embedded clinical decision support (CDS) tool that alerts PCCs to screen, diagnose, and treat people with OUD. PCCs were randomized to receive a stigma-reduction version of the training with patient narrative videos or a control training without patient narratives and were blinded to group assignment. Immediately after the training, PCCs completed surveys of stigma towards people with OUD and intentions and willingness to treat OUD. CDS tool use was monitored for 6 months. Analyses included independent samples t-tests, Pearson correlations, and logistic regression. RESULTS: A total of 162 PCCs were randomized; 88 PCCs (58% female; 68% white) completed the training (Stigma = 48; Control = 40) and were included in analyses. There was no significant difference between intervention and control groups for stigma (t = − 0.48, p = .64, Cohen’s d = − 0.11), intention to get waivered (t = 1.11, p = .27, d = 0.26), or intention to prescribe buprenorphine if a waiver were no longer required (t = 0.90, p = 0.37, d = 0.21). PCCs who reported greater stigma reported lower intentions both to get waivered (r = − 0.25, p = 0.03) and to prescribe buprenorphine with no waiver (r = − 0.25, p = 0.03). Intervention group and self-reported stigma were not significantly related to CDS tool use. CONCLUSIONS: Stigma toward people with OUD may require more robust intervention than this brief training was able to accomplish. However, stigma was related to lower intentions to treat people with OUD, suggesting stigma acts as a barrier to care. Future work should identify effective interventions to reduce stigma among PCCs. Trial Registration: ClinicalTrials.gov NCT04867382. Registered 30 April 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04867382
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spelling pubmed-99220362023-02-13 A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians Hooker, Stephanie A. Crain, A. Lauren LaFrance, Amy B. Kane, Sheryl Fokuo, J. Konadu Bart, Gavin Rossom, Rebecca C. Addict Sci Clin Pract Research BACKGROUND: Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs’ stigma toward people with OUD (primary) and increased intentions to treat people with OUD compared to an attention-control training (secondary). METHODS: PCCs from 15 primary care clinics were invited to complete a 30 min online training for an electronic health record-embedded clinical decision support (CDS) tool that alerts PCCs to screen, diagnose, and treat people with OUD. PCCs were randomized to receive a stigma-reduction version of the training with patient narrative videos or a control training without patient narratives and were blinded to group assignment. Immediately after the training, PCCs completed surveys of stigma towards people with OUD and intentions and willingness to treat OUD. CDS tool use was monitored for 6 months. Analyses included independent samples t-tests, Pearson correlations, and logistic regression. RESULTS: A total of 162 PCCs were randomized; 88 PCCs (58% female; 68% white) completed the training (Stigma = 48; Control = 40) and were included in analyses. There was no significant difference between intervention and control groups for stigma (t = − 0.48, p = .64, Cohen’s d = − 0.11), intention to get waivered (t = 1.11, p = .27, d = 0.26), or intention to prescribe buprenorphine if a waiver were no longer required (t = 0.90, p = 0.37, d = 0.21). PCCs who reported greater stigma reported lower intentions both to get waivered (r = − 0.25, p = 0.03) and to prescribe buprenorphine with no waiver (r = − 0.25, p = 0.03). Intervention group and self-reported stigma were not significantly related to CDS tool use. CONCLUSIONS: Stigma toward people with OUD may require more robust intervention than this brief training was able to accomplish. However, stigma was related to lower intentions to treat people with OUD, suggesting stigma acts as a barrier to care. Future work should identify effective interventions to reduce stigma among PCCs. Trial Registration: ClinicalTrials.gov NCT04867382. Registered 30 April 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04867382 BioMed Central 2023-02-11 2023 /pmc/articles/PMC9922036/ /pubmed/36774521 http://dx.doi.org/10.1186/s13722-023-00366-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hooker, Stephanie A.
Crain, A. Lauren
LaFrance, Amy B.
Kane, Sheryl
Fokuo, J. Konadu
Bart, Gavin
Rossom, Rebecca C.
A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
title A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
title_full A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
title_fullStr A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
title_full_unstemmed A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
title_short A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
title_sort randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922036/
https://www.ncbi.nlm.nih.gov/pubmed/36774521
http://dx.doi.org/10.1186/s13722-023-00366-1
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