Treating Addiction as a Terminal Disease

From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice

BACKGROUND

Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice.

METHODS

We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician-written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed.

RESULTS

We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor-patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems.

CONCLUSIONS

Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice.

Predoctoral substance use disorders curricula: A survey analysis and experiential pedagogy

Substance Use Disorders (SUD) are chronic health conditions with heritability characteristics, environmental influences, long-term management considerations and they cooccur. The US opioid epidemic is a crisis of both prescription and nonprescription opioid use. Clinicians now have access to evidence-based practices but the evolving trends require continuous attention including curriculum initiatives for dental schools. The purpose of this study was to obtain information about the content and educational strategies of current SUD curricula, beneficial educational products for a standardized curriculum and perceived barriers toward standardization. Invitations were sent to 64 US dental schools describing the purpose of this study and a link to complete the survey was provided. Fully completed responses were received from 32 (50.0%) of the schools. Descriptive statistics was used to analyze the data. Most dental schools surveyed (81.3%) have a curriculum for SUD with classroom lectures being the most commonly used teaching method (96.2%), followed by online modules (42.3%). About 30% of the responding schools provided additional educational experiences. Instruction occurred mostly in second (73.1%) and third (77.0%) academic years. Opioids, alcohol, nicotine, and marijuana were the most frequently taught substance classes. Curriculum standardization with online modules (81.3%), case-based exercises (59.4%), and simulation with standardized patients (43.8%) was considered desirable to improve student competency in the management of patients with SUD. Lack of time (62.5%), space (56.3%), and faculty (50.0%) were cited as the most common barriers to curriculum initiatives. Experiential and achievable options for improving SUD curriculum were highlighted.

Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness

BACKGROUND

The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population.

OBJECTIVE

This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment.

METHODS

A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used.

RESULTS

There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided.

CONCLUSION

PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.

Adherence of heart failure patients to heart failure medications and its determinants in the Aseer region, Southern Saudi Arabia

Background:

Heart failure is a complex clinical syndrome of cardiovascular disease. Heart failure occurs when the heart muscle is weakened and cannot pump enough blood to meet the body's needs for blood and oxygen. It is characterised by several attacks of dyspnoea, chest pain, orthopnea and pulmonary or systemic congestion. The heart inability to fulfill the demands of the body further failure of heart to pump the blood with normal efficiency. Lack of patients’ adherence to their treatment may affect their clinical compensation.

Aim:

To assess the extent of assessing the level and predictors of medication adherence among patients with heart failure in the Aseer region.

Methodology:

A descriptive cross-sectional approach was used for targeting all registered heart failure patients attending the cardio clinic and chronic diseases clinic in Aseer region hospitals. Data were collected using a direct interview questionnaire that was developed by the researchers with the help of experts. Questionnaire included the patients’ sociodemographic data, co-morbidities, disease-related data and drugs.

Results:

The study included 151 patients diagnosed with heart failure. About 66% of the patients were above the age of 60 years and 62.3% were males. Exact of 47% of the cases had the disease for less than 3 years and 43.7% of the patients had the treatment for more than 3 years. About 49% of the patients forget to have their medication at least once while 34.4% had problems remembering to take your medication. Totally, more than half of the patients had poor medication adherence and only 7.3% had a high adherence rate.

Conclusions and Recommendations:

In conclusion, the adherence rate for the patients’ medication was poor due to forgetting to have the medications. Poor adherence was related more with single patients who are not working with poor income.