Richard L. Brown

Teaching Patient‐centered Tobacco Intervention to First‐year Medical Students

The University of Wisconsin’s Tobacco Intervention Basic Skills curriculum (TIBS) was inaugurated to begin training 147 first-year medical students in skills for promoting health behavior change. Learning activities included lecture, demonstration, reading, quiz, role-play exercises, and standardized patient interviews. After TIBS, the 69 students who provided pre- and postintervention data exhibited more therapeutic attitudes and increased knowledge and self-confidence in applying TIBS skills. Two months later, 52% of the 109 posttest respondents had applied TIBS in clinical settings, often for behaviors other than tobacco use. We conclude that medical students can gain from early training on promoting behavior change.

Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial

ABSTRACT Objective: This prospective, randomized, open-label, multicenter, community-based study was conducted to compare cyclobenzaprine 5 mg three times daily (TID) orally (CYC5) given for 7 days as monotherapy or in combination with ibuprofen 400 mg TID (CYC5/IBU400) or 800 mg TID (CYC5/IBU800) in adults with acute neck or back pain with muscle spasm. Study design: Eligible patients were 18–65 years old, had cervical or thoracolumbar pain and spasm for ≤ 14 days, and, aside from the prescribed study medications, discontinued treatment with all analgesics, anti-inflammatory agents, and skeletal muscle relaxants during the study period. Randomization was 1:1:1 to the three treatment groups. Treatment outcome was assessed after 3 and 7 days of therapy using five patient-rated scales: spasm, pain, patient global impression of change (PGIC), medication helpfulness, and Oswestry Disability Index (ODI). Results: A total of 867 patients provided postbaseline data and were included in the intent-to-treat population (CYC5, n = 288; CYC5/IBU400, n = 286; CYC5/IBU800, n = 293). All three treatment groups demonstrated significant improvements from baseline in PGIC, spasm, pain, ODI, and medication helpfulness ( p < 0.001 for all comparisons) after 3 and 7 days of therapy. There were no significant differences in mean PGIC among groups after 3 days of therapy ( p = 0.65 for treatment effect) or after 7 days of therapy (primary endpoint; p = 0.41). A PGIC responder analysis of changes from baseline showed that 88% and 93% of patients reported at least mild improvement after 3 and 7 days of therapy, respectively. All three treatments were well tolerated, with no significant differences between treatments regarding the number of adverse events (AEs) reported or number of patients reporting AEs. The most common AEs in all groups were fatigue, somnolence, dizziness, sedation, and nausea. Limitations of this study include an unblinded design and possible introduction of bias into efficacy and safety results by use of a voluntary telephone reporting system. Conclusions: This randomized, community-based clinical trial demonstrated that combination therapy with cyclobenzaprine 5 mg TID plus ibuprofen was not superior to cyclobenzaprine 5 mg TID alone in adult patients with acute neck and back pain with muscle spasm. All treatments were well tolerated.

Can substance use disorders be managed using the Chronic Care Model? Review and recommendations from a NIDA Consensus Group.

Brain imaging and genetic studies over the past two decades suggest that substance use disorders are best considered chronic illnesses. The passing of the Affordable Care Act in the United States has set the occasion for integrating treatment of substance use disorders into mainstream healthcare; and for using the proactive, team-oriented Chronic Care Model (CCM). This paper systematically examines and compares whether and how well the CCM could be applied to the treatment of substance use disorders, using type 2 diabetes as a comparator. The chronic illness management approach is still new in the field of addiction and research is limited. However comparative findings suggest that most proactive, team treatment-oriented clinical management practices now used in diabetes management are applicable to the substance use disorders; capable of being implemented by primary care teams; and should offer comparable potential benefits in the treatment of substance use disorders. Such care should also improve the quality of care for many illnesses now negatively affected by unaddressed substance abuse.

The Problematic and Risky Internet Use Screening Scale (PRIUSS) for Adolescents and Young Adults: Scale Development and Refinement.

Problematic Internet use (PIU) is a growing health concern among adolescents and young adults. The purpose of this mixed-methods study was to develop and refine a theoretically-grounded and psychometrically-validated assessment instrument for PIU specifically tailored to adolescents and young adults. An item pool was developed using concept mapping and a review of the literature, and administered to 714 students from two universities between 18 and 25 years of age. Exploratory and confirmatory factor analyses were used in a development subsample (n=500) to construct the scale. A cross-validation sample (n=214) was used to confirm the scales reliability. The Problematic and Risky Internet Use Screening Scale (PRIUSS) is an 18-item scale with three subscales: Social Impairment, Emotional Impairment, and Risky/Impulsive Internet Use. Based on its strong theoretical foundation and promising psychometric performance, the PRIUSS may be a valuable tool for screening and prevention efforts in this population.

Training the trainers : Substance abuse screening and intervention

Objective: Screening and brief intervention for substance abuse is effective yet underutilized by primary care physicians. This article reports on Project SAEFP (Substance Abuse Education for Family Physicians), which aimed to enhance the clinical and teaching skills and activities of U.S. family practice residency faculty. Method: Ten five-day workshops were designed and administered for 165 participants. Evaluation data included measures of participant satisfaction and pre-workshop and twelve-month post-workshop measures of the frequency of teaching, consulting, and clinical activities, and the attainment of self-identified teaching goals. Results: The participants were very satisfied with the workshops. They improved significantly in the key outcome measures. Conclusions: Several workshops may have contributed to the apparent success of Project SAEFP. Attributes of the workshops which might have facilitated their success were their duration, funding, frequency of offering, collegial learning environment, opportunities for active learning, emotionally moving exposure to recovering individuals, focus on how to modify curriculum at participant residency programs, availability of family physician role models as faculty, and readily usable instructional materials. Planners of interventions for physician educators might profit from similar attention to these attributes.

Pharmacoepidemiology of potential alcohol–prescription drug interactions among primary care patients with alcohol-use disorders

OBJECTIVE To report on the proportion of individuals with alcohol-use disorders who take prescription medications that could interact with alcohol and on the proportion who recall advice to avoid alcohol with their medications. DESIGN Secondary analysis of a randomized controlled trial of telephone counseling. SETTING 18 primary care practices in south-central and southeastern Wisconsin. PATIENTS 897 adults with alcohol-use disorders as identified by systematic survey. INTERVENTION Telephone and mail survey. MAIN OUTCOME MEASURES Patient-reported prescription medication use, potential for alcohol-drug interactions according to DrugDex, and patient-reported receipt of advice not to take alcohol with their medications. RESULTS Of the 869 patients who provided usable information on prescription medication use, 348 (40.0%) were taking medications with alcohol interactions or proscriptions; the most frequently reported were bupropion, selective serotonin reuptake inhibitors, and various acetaminophen-containing compounds. Slightly more than 20% of patients were taking medications with moderate to severe alcohol interactions; over one-third of these 184 patients did not recall advice to avoid alcohol. CONCLUSION Practitioners who prescribe or dispense medications may need to enhance their efforts to advise patients about alcohol-drug interactions. Prescribing and dispensing medications that interact with alcohol present opportunities to administer alcohol screens and interventions.

Alcohol Screening and Intervention Among United States Adults who Attend Ambulatory Healthcare

ABSTRACTBACKGROUNDThere is limited data on the extent to which indicated alcohol interventions are delivered in U.S. ambulatory care settings.OBJECTIVETo assess the receipt of alcohol-related services, including assessment of use, advice to reduce drinking, and information about alcohol treatment, during ambulatory care visits.DESIGNSecondary data analysis of the 2013 National Survey on Drug Use and Health, a cross-sectional, nationally representative survey of civilians in the non-institutionalized U.S. general population (response rate 71.7 %).PARTICIPANTSAdult ambulatory care users in the public use data file who did not obtain emergency or inpatient services (n = 17,266).MAIN MEASURESMeasurements included respondents’ alcohol consumption, heavy episodic drinking, alcohol use disorder, healthcare use, and receipt of alcohol-related interventions.KEY RESULTSApproximately 71.1 % of ambulatory care users received an alcohol assessment. Among past-month heavy episodic drinkers without an alcohol use disorder who reported receiving an alcohol assessment, 4.4 % were advised to cut back. Among individuals with alcohol abuse and alcohol dependence who reported receiving an alcohol assessment, 2.9 % and 7.0 %, respectively, were offered information about treatment.CONCLUSIONSRates of alcohol screening and assessment were relatively high among adults who attended healthcare visits, but rates of intervention were low, even when individuals were assessed for use. Efforts are needed to expand delivery of interventions when patients are identified as positive for risky drinking, hazardous alcohol use, and alcohol use disorders during ambulatory care visits.

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.

Medical students' decisions to report classmates impaired by alcohol or other drug abuse.

No abstract available.

Medical students’ need of and support for substance‐abuse prevention

Programs to prevent alcohol and other drug abuse (AODA) have been recommended for medical students. This study assessed students’ need of and support for AODA prevention at a midwestern U.S. medical school. Questionnaires were returned by 72% (N = 99) of all 4th‐y ear students. Twenty‐five percent of the respondents had possible current or previous untreated AODA, as indicated by self‐report or responses to a screening questionnaire, and an additional 15% had concerning patterns of use or significantly positive family histories of AODA. More than half indicated possible AODA by family or important household members. The students overestimated their classmates’ permissiveness regarding substance use. More than half would report to a student‐faculty impairment committee all of the classmates described in 16 scenarios. Lower intent to report was associated with higher risk for AODA by the respondent, use of only alcohol by the classmate, strong academic performance by the classmate, and absence of friendship...