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Concept mapping to generate items for the Patient Opioid Education Measure (POEM)
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Concept mapping to generate items for the Patient Opioid Education Measure (POEM) Lorraine S. Wallace 2 , R.K. Wexler 2 , W.F. Miser 2 , L. McDougle 2 , James D. Haddox 1 1 Health Policy, Purdue Pharma L.P., Stamford, CT, United States 2 Family Medicine, The Ohio State University, Columbus, OH, United States
Aims: Although there are screening tools to aid clinicians in assessing the risk of opioid misuse, an instrument to assess opioidrelated knowledge in patients is not currently available. The aim of this study was to report the preliminary development of the POEM to assess patients’ understanding of opioid safety information. Methods: Concept mapping was used to guide POEM development. Fourteen clinicians caring for patients with chronic pain participated in the brainstorming phase and responded to the following focus prompt: “Thinking as broadly as possible, please list specific need-to-know information for patients prescribed opioids.” Once statements (n = 388) from the brainstorming phase were collected, duplicate items were removed. Thirty-seven individuals (primary care physicians, n = 24; pain specialists, n = 9; pharmacists, n = 2; clinical psychologist, n = 1; medical librarian, n = 1) completed a “free” sort of 131 non-duplicate statements based on similarity and rated each statement on a 5-point importance scale. Data were entered and analyzed using Concept Systems® software. Results: Clinicians generated an average of 24.1 ± 7.3 statements. Concept mapping identified 7 clusters addressing knowledge and expectations associated with opioid use, including: (1) medicolegal issues, (2) prescribing policies, (3) safe use and handling, (4) expected outcomes, (5) side effects, (6) pharmacology, and (7) warnings. A total of 48 statements (36.6%) had an importance rating of ≥4.00 and were included within the POEM. Conclusions: The POEM shows promise in allowing clinicians to quickly pinpoint patients’ knowledge-related gaps related to opioid therapy. Further validity, reliability, and readability testing of the POEM is pending. Financial support: Supported by a grant from Purdue Pharma L.P. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.652 Nasal naloxone rescue kits in an emergency department overdose education program Alexander Y. Walley ∗ , A. Sorensen-Alawad, K. Dwyer, B. Langlois, P. Mitchell, S. Lin, J. Cromwell, S. Strobel, E. Bernstein Boston University School of Medicine/Boston Medical Center, Boston, MA, United States Aims: Due to increasing opioid-related overdoses (OD), our emergency department (ED) provided OD education (OE) to patients at risk or likely to witness an OD. OE included how to prevent, recognize, and respond to ODs. We hypothesized that OE with nasal naloxone rescue kits (OEN) compared to OE only was associated with (1) non-fatal OD, (2) using illicit opioids, (3) engaging in methadone or buprenorphine (agonist) treatment and (4) responding appropriately to a witnessed OD. Methods: In this retrospective cohort, we used hospital records to telephone survey ED patients who had previously received OE between January 2011 and February 2012. Data included selfreported and witnessed ODs since OE, 30-day substance use, and witnessed OD response actions (calling 911, rescue breathing,
administering naloxone). We used chi-square tests to compare OEN to OE only groups. Results: Of 415 ED patients who received OD education, we contacted 51 (12%), a mean of 11.8 months after their ED visit. Of the 73% (37/51) in the OEN group, 76% (28/37) received naloxone kits in the ED and 24% (9/37) received them in detox, needle exchange, or methadone programs. When we compared OEN and OE only groups, 19% vs. 29% self-reported an OD (p = 0.45), 36% vs. 35% reported illicit opioid use (p = 1.0) and 49% vs. 36% reported agonist treatment (p = 0.53), respectively. Among the 53% (27/51) who witnessed an OD, 84% (16/19) in the OEN group vs. 38% (3/8)in the OE only group responded to the OD by calling 911, rescue breathing or administering naloxone (p = 0.03). Conclusions: In this first study of an ED-based OD prevention intervention, a higher proportion of patients equipped with naloxone than those not equipped responded to an OD. No significant differences were detected in self-reported ODs, illicit opioid use, or agonist treatment. OD education including naloxone is a promising intervention that warrants larger, systematic prospective studies. Financial support: Boston University Evans Medical Foundation faculty award. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.653 Gender-based violence, psychopathology and substance use disorders in a national sample of women Kate Walsh 1 , K. Keyes 1 , S. Galea 1 , B. Grant 2 , Deborah S. Hasin 1 1
Epidemiology, Columbia University, New York, NY, United States 2 NIAAA, Bethesda, MD, United States Aims: Gender-based violence (GBV; physical/sexual violence, stalking) is an important public health issue (World Health Organization, 2005). Although exposure to more types of GBV is associated with increased risk for psychopathology and substance use disorders (SUDs) (Rees et al., 2011), and experiencing violence early in life (versus later) is associated with poorer outcomes (Manly et al., 2001), no studies have compared these factors. We examined whether cumulative GBV exposure or earlier GBV exposure was a stronger relative predictor of psychopathology and SUDs. Methods: Participants were 20,089 women from wave 2 (2004–2005) of the National Survey of Alcohol and Related Conditions (NESARC). GBV included sexual or physical violence and stalking. Psychopathology and SUDs were assessed with the reliable and valid AUDADIS (Grant et al., 2005). Results: One-quarter (n = 5086) of women reported any lifetime GBV: 9.3% (n = 1856) 1 type, 12.5% (n = 2489) 2 types, and 3.6% (n = 725) all 3 types. In adjusted models, those with GBV were 2.2–6.1 times more likely to report psychopathology and 2.3–6.7 times more likely to report SUDs. GBV was associated with particularly elevated risk for posttraumatic stress disorder (AOR = 6.07, 95% CI = 6.06, 6.075) and borderline personality disorder (AOR = 6.14, 95% CI = 6.13, 6.15) as well as with less common SUDs including amphetamine (AOR = 5.26, 95% CI = 5.24, 5.26) and inhalant (AOR = 6.70, 95% CI = 6.62, 6.78) use disorders. Odds of reporting psychopathology and SUDs were 1.7–4.8 times higher among those reporting 3 (versus 2) types of GBV and 1.6–3.0 times higher among those first exposed to GBV between ages 12 and 18 (versus age 19 or older). Conclusions: Any GBV was strongly related to psychopathology characterized by emotion dysregulation as well as SUDs involving more “deviant” substances. Cumulative GBV exposure was a
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Concept mapping to generate items for the Patient Opioid Education Measure (POEM) Lorraine S. Wallace 2 , R.K. Wexler 2 , W.F. Miser 2 , L. McDougle 2 , James D. Haddox 1 1 Health Policy, Purdue Pharma L.P., Stamford, CT, United States 2 Family Medicine, The Ohio State University, Columbus, OH, United States
Aims: Although there are screening tools to aid clinicians in assessing the risk of opioid misuse, an instrument to assess opioidrelated knowledge in patients is not currently available. The aim of this study was to report the preliminary development of the POEM to assess patients’ understanding of opioid safety information. Methods: Concept mapping was used to guide POEM development. Fourteen clinicians caring for patients with chronic pain participated in the brainstorming phase and responded to the following focus prompt: “Thinking as broadly as possible, please list specific need-to-know information for patients prescribed opioids.” Once statements (n = 388) from the brainstorming phase were collected, duplicate items were removed. Thirty-seven individuals (primary care physicians, n = 24; pain specialists, n = 9; pharmacists, n = 2; clinical psychologist, n = 1; medical librarian, n = 1) completed a “free” sort of 131 non-duplicate statements based on similarity and rated each statement on a 5-point importance scale. Data were entered and analyzed using Concept Systems® software. Results: Clinicians generated an average of 24.1 ± 7.3 statements. Concept mapping identified 7 clusters addressing knowledge and expectations associated with opioid use, including: (1) medicolegal issues, (2) prescribing policies, (3) safe use and handling, (4) expected outcomes, (5) side effects, (6) pharmacology, and (7) warnings. A total of 48 statements (36.6%) had an importance rating of ≥4.00 and were included within the POEM. Conclusions: The POEM shows promise in allowing clinicians to quickly pinpoint patients’ knowledge-related gaps related to opioid therapy. Further validity, reliability, and readability testing of the POEM is pending. Financial support: Supported by a grant from Purdue Pharma L.P. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.652 Nasal naloxone rescue kits in an emergency department overdose education program Alexander Y. Walley ∗ , A. Sorensen-Alawad, K. Dwyer, B. Langlois, P. Mitchell, S. Lin, J. Cromwell, S. Strobel, E. Bernstein Boston University School of Medicine/Boston Medical Center, Boston, MA, United States Aims: Due to increasing opioid-related overdoses (OD), our emergency department (ED) provided OD education (OE) to patients at risk or likely to witness an OD. OE included how to prevent, recognize, and respond to ODs. We hypothesized that OE with nasal naloxone rescue kits (OEN) compared to OE only was associated with (1) non-fatal OD, (2) using illicit opioids, (3) engaging in methadone or buprenorphine (agonist) treatment and (4) responding appropriately to a witnessed OD. Methods: In this retrospective cohort, we used hospital records to telephone survey ED patients who had previously received OE between January 2011 and February 2012. Data included selfreported and witnessed ODs since OE, 30-day substance use, and witnessed OD response actions (calling 911, rescue breathing,
administering naloxone). We used chi-square tests to compare OEN to OE only groups. Results: Of 415 ED patients who received OD education, we contacted 51 (12%), a mean of 11.8 months after their ED visit. Of the 73% (37/51) in the OEN group, 76% (28/37) received naloxone kits in the ED and 24% (9/37) received them in detox, needle exchange, or methadone programs. When we compared OEN and OE only groups, 19% vs. 29% self-reported an OD (p = 0.45), 36% vs. 35% reported illicit opioid use (p = 1.0) and 49% vs. 36% reported agonist treatment (p = 0.53), respectively. Among the 53% (27/51) who witnessed an OD, 84% (16/19) in the OEN group vs. 38% (3/8)in the OE only group responded to the OD by calling 911, rescue breathing or administering naloxone (p = 0.03). Conclusions: In this first study of an ED-based OD prevention intervention, a higher proportion of patients equipped with naloxone than those not equipped responded to an OD. No significant differences were detected in self-reported ODs, illicit opioid use, or agonist treatment. OD education including naloxone is a promising intervention that warrants larger, systematic prospective studies. Financial support: Boston University Evans Medical Foundation faculty award. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.653 Gender-based violence, psychopathology and substance use disorders in a national sample of women Kate Walsh 1 , K. Keyes 1 , S. Galea 1 , B. Grant 2 , Deborah S. Hasin 1 1
Epidemiology, Columbia University, New York, NY, United States 2 NIAAA, Bethesda, MD, United States Aims: Gender-based violence (GBV; physical/sexual violence, stalking) is an important public health issue (World Health Organization, 2005). Although exposure to more types of GBV is associated with increased risk for psychopathology and substance use disorders (SUDs) (Rees et al., 2011), and experiencing violence early in life (versus later) is associated with poorer outcomes (Manly et al., 2001), no studies have compared these factors. We examined whether cumulative GBV exposure or earlier GBV exposure was a stronger relative predictor of psychopathology and SUDs. Methods: Participants were 20,089 women from wave 2 (2004–2005) of the National Survey of Alcohol and Related Conditions (NESARC). GBV included sexual or physical violence and stalking. Psychopathology and SUDs were assessed with the reliable and valid AUDADIS (Grant et al., 2005). Results: One-quarter (n = 5086) of women reported any lifetime GBV: 9.3% (n = 1856) 1 type, 12.5% (n = 2489) 2 types, and 3.6% (n = 725) all 3 types. In adjusted models, those with GBV were 2.2–6.1 times more likely to report psychopathology and 2.3–6.7 times more likely to report SUDs. GBV was associated with particularly elevated risk for posttraumatic stress disorder (AOR = 6.07, 95% CI = 6.06, 6.075) and borderline personality disorder (AOR = 6.14, 95% CI = 6.13, 6.15) as well as with less common SUDs including amphetamine (AOR = 5.26, 95% CI = 5.24, 5.26) and inhalant (AOR = 6.70, 95% CI = 6.62, 6.78) use disorders. Odds of reporting psychopathology and SUDs were 1.7–4.8 times higher among those reporting 3 (versus 2) types of GBV and 1.6–3.0 times higher among those first exposed to GBV between ages 12 and 18 (versus age 19 or older). Conclusions: Any GBV was strongly related to psychopathology characterized by emotion dysregulation as well as SUDs involving more “deviant” substances. Cumulative GBV exposure was a