The most common reason that physicians are reluctant to intervene when their patients have a substance use disorder (SUD) is a lack of institutional support, according to a study in JAMA Network Open. Other common reasons include a lack of skill and knowledge.
“These data suggest that policy, regulatory, or accreditation changes are needed to systematically address institutional barriers, as well as increases to physician reimbursement and opportunities for clinically relevant training that provides both skill development and knowledge gain,” wrote Melinda Campopiano von Klimo, M.D., of JBS International Inc., and colleagues.
The researchers reviewed 283 studies published between January 1, 1960, and October 5, 2021, assessing or surveying physician reluctance to intervene for SUDs. Intervening was defined as one or more of the following: screening patients, treating patients, offering harm reduction services, or offering recovery support.
Overall, 66,732 physicians participated in the studies. The top four specialties were general practice/primary care, internal medicine, family medicine, and general psychiatry, and the top four countries represented were the United States, United Kingdom, Canada, and Australia.
A lack of institutional support was cited as a reason for physician reluctance 81.2% of the time (173 of 213 studies). Common examples noted under the umbrella of institutional support include the following:
- A lack of trained staff or resources to train staff
- A lack of acceptance of SUD interventions leadership
- A lack of clinician backup
- Regulatory and liability concerns
- Recordkeeping or confidentiality concerns
- Staff time required for prior authorizations
- Cost to the patient or lack of insurance coverage
- Medication unavailability at pharmacies
- An absence of population-specific patient education materials
“Strategies to reduce physician reluctance related to institutional environment include greater commitment by health systems to make essential workflow and staffing changes, the breaking down of barriers between addiction services and both medical and mental health care, and commitment by insurers to provide reimbursement that covers the actual cost of providing addiction interventions,” the researchers wrote.
A lack of skill was cited 73.9% of the time (170 out of 230 studies), a lack of cognitive capacity (i.e., feeling overwhelmed with clinical tasks and the need to prioritize competing patients’ needs) was cited in 73.5% (136 out of 185 studies), and a lack of knowledge was cited in 71.9% (174 out of 242 studies).
“Trainings accessible to physicians (e.g., free or incentivized, hands-on, or delivered in clinical settings) and delivered by specialized trainers and/or mentors would facilitate the growth of a pool of experts to intervene in substance use,” the researchers wrote. “Physicians who expand their knowledge and skills should be eligible for continuing medical education credits and increased compensation.”
For related information, see the Psychiatric News article “Briefing Emphasizes Actions Needed to Address Substance Use Disorder Crisis.”
(Image: Getty Images/iStock/Khanchit Khirisutchalual)
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