Antonnette V. Graham

Students' perception of medical school stress and their evaluation of a wellness elective

Because medical education is known to be demanding and stressful, Case Western Reserve University developed a programme which included a wellness elective which focused on stress reduction and personal wellness.

Comparison of pregnancy-specific interventions to a traditional treatment program for cocaine-addicted pregnant women

Alcohol and drug use in pregnancy is a significant concern. There is a paucity of treatment programs for substance-abusing pregnant women, especially if indigent. Furthermore, treatment retention is compromised when the drug of choice is crack-cocaine. This paper reports the results of a study comparing treatment retention of cocaine-abusing indigent pregnant women before and after incorporating pregnancy-specific interventions. Audits were performed on 603 charts of women enrolled between 1988 and 1994 in either a traditional treatment program (n = 114) or in the Pregnancy Substance Abuse Program (PSAP) (n = 489). Differences in treatment retention were found between the two treatment groups. Drop-out rates from the inpatient component of treatment were significantly lower in the PSAP group than in the control group (11.3% vs. 38.6%, p < .001). There was a higher rate of completion of outpatient treatment in the PSAP compared to the control group (34.4% vs. 13.5%, p < .005). These results were achieved with a 2-day decreased inpatient stay. Treatment retention improved when specialized interventions were provided, at minimal additional cost. These results have implications for other publicly funded treatment programs.

Physician failure to record alcohol use history when prescribing benzodiazepines

The purpose of this pilot study was (1) to determine the proportion of patients in an ambulatory medical clinic who have an alcohol history recorded when prescribed benzodiazepines, and (2) to assess the adequacy of the alcohol history when obtained. Medical records of 35 outpatients who obtained prescriptions for benzodiazepines at a large inner-city teaching hospital medical clinic were audited. In none of the records was there evidence that the physician had sufficient knowledge of the patients alcohol use to safely prescribe a benzodiazepine. In 57% of the records, no information about alcohol use was recorded. In the remaining 15 medical records, the information recorded was limited. The implications of prescribing benzodiazepines without knowledge of drinking status are discussed.

Interdisciplinary benefits in Project MAINSTREAM: A promising health professions educational model to address global substance abuse

Our purpose was to evaluate the interdisciplinary aspects of Project MAINSTREAM, a faculty development program that trained 39 competitively selected health professional tutors in substance abuse education. Mid-career faculty fellows (tutors) from 14 different health professions across the US dedicated 20% of their academic time for two years to Project MAINSTREAM. Teams of three fellows carried out curricular enhancement and service-learning field project requirements in mentored Interdisciplinary Faculty Learning Groups (IFLGs). Formative and summative evaluations were conducted via written questionnaires and confidential telephone interviews. The importance of interdisciplinary education was rated positively (mean of 3.57 on 1 – 5 scale). Using 18 parameters, fellows preferred interdisciplinary over single disciplinary teaching (means ranged from 3.40 – 4.86), and reported high levels of benefit from their interdisciplinary collaborations (means ranged from 3.53 – 4.56). Fellows reported that interdisciplinary educational collaborations were feasible (3.31) at their home institutions. The majority (63%) said that their trainees, colleagues, supervisors and institutions valued interdisciplinary training either “highly” or “somewhat”, but 22% did not value it. The fellows identified scheduling conflicts (3.46), and lack of faculty rewards (3.46) such as pay or credit toward promotion, as two barriers that they encountered.

Miracle village: A recovery community for addicted women and their children in public housing☆

Miracle Village is a comprehensive substance-abuse treatment program for women and their children with a major goal of lasting sobriety for its clients. Recovery is built upon the principles of gender sensitive therapy and uses a family-centered perspective. Miracle Village offers an initial 3 months of intensive treatment followed by 21 months of continued comprehensive services. Located within a public housing complex, its secondary goal is the development of a core group of drug-free families to help revitalize the neighborhood. After 4 years of operation, 63% of the women who completed initial treatment are sober and living in the area.

Is screening and brief advice for problem drinkers by clergy feasible? A survey of clergy

Routine screening for alcohol abuse in primary care, with brief advice to stop drinking for those screening positive, can detect individuals with alcohol problems and reduce alcohol use and alcohol induced problems in those detected. Not everyone with alcohol problems sees a physician regularly, however, and not all respond to a physicians brief advice. To explore the feasibility of expanding screening for alcohol problems to clergy, we did a mailed survey to 315 clergy at Christian churches in Cleveland, Ohio. Clergy reported a variety of views about alcohol use and abuse, but most agreed that alcoholism is a disease. They indicated counseling a significant number of parishioners, and were receptive to learning brief screening questions to detect alcohol problems. We conclude that many clergy would be interested in a strategy of screening and then giving brief advice or referral to individuals found to have alcohol problems.

A pilot project: Continuing education for pharmacists on substance abuse prevention

The American Association of Colleges of Pharmacy advocates that pharmacists can have a significant impact on substance abuse prevention provided they receive adequate training. Continuing education programs are needed to enable practicing pharmacists to augment their limited education. This paper examines the process the Society of Teachers of Family Medicine (STFM) used to develop a pilot continuing education program for pharmacists. With limited literature and a small number of pharmacy teaching about substance abuse, input on topics and training methods was obtained from a convenience sample of practicing pharmacists to enhance the information from the pharmacist faculty regarded as content experts. Results of this pilot study revealed lack of agreement between faculty and practicing pharmacists regarding the prioritizing of content and educational methods. Consequently, input must be obtained from targeted audiences instead of relying solely on the advice of identified academic content experts when designing continuing educational programs. Other professions should consider this process when designing continuing education programs. Pharmacists are poised to play an important role in the prevention of substance abuse problems, but they need continuing education about substance abuse.

Substance Abuse Education for Clinical Nurses: A Controlled Study

BACKGROUND A study was conducted to evaluate a substance abuse component of a workshop for nurses being promoted to the position of Advanced Clinical Nurse. METHODS We compared whether the 88 nurses who received the educational intervention increased their knowledge and enhanced their feelings of competence regarding the care of chemically dependent patients more than a control group of nurses who received the promotion workshop without the substance abuse component. RESULTS The nurses in the intervention group had greater increases in knowledge and competence. CONCLUSIONS This study points out the importance of providing hospital nurses with continuing education on substance abuse to compensate for their educational deficiencies, to provide the information they need and desire, and to help them meet the ANAs practice standards.

Interdisciplinary service-learning substance abuse projects: processes and outcomes.

Abstract The purpose of this paper is to describe the development and implementation of community-based, service-learning field projects by 30 health professional faculty fellows of Project MAINSTREAM, a faculty development program on substance abuse. The fellows worked together for two years in 10 Interdisciplinary Faculty Learning Groups (IFLGs), which consisted of three academics of different disciplines. The ten projects are viewed within the context of service-learning and are based on a balance between the provision of services to the community and furthering the learning objectives of Project MAINSTREAM.

The effects on facilitators of a substance abuse education program

This retrospective‐anecdotal study was conducted to determine if involvement in a learner‐centered continuing education program in substance abuse prevention would influence the careers and work‐related activities of the facilitators. A questionnaire was sent to 33 individuals who served as facilitators of a large substance abuse prevention education project. Of the 31 who responded, 21 (67.7%) indicated that serving as a facilitator resulted in either “major changes”; or “some changes”; to their careers, and 25 (80.6%) felt that they were “much more likely”; or “more likely”; to incorporate substance abuse prevention activities into their work. Teaching in substance abuse education programs may cause changes in the career paths and work‐related activities of the facilitators. Investigators may need to incorporate evaluations of the effects of a particular program on the intended learners as well as the facilitators.