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Evaluation of pediatric residents' alcohol and other drug (AOD) clinical skills
January 1993
ABSTRACTS OF PAPERS PRESENTED
COST-EFFECTlVENESS OF PREVACCINATIQN MEPATI SERCDU)CII IN A HIGH RISK ADOLESCENT POPULATIQN. Luis Pineiro, M.D., Sheryl Ryan, M.D., Linda Roochvarg, M.D., and Marianne Felice, M.D., Department of Pediatrics, University of Maryland at Baltimore, Baltimore, Maryland. Compliance with recent recommendations to immunize all high risk adolescents agairst the Hepatitis B virus can be both difficult and costly. The objective of this study was to explore the possibility that prevaccination Hepatitis B serology testing of high risk adolescents could identify a significant number of immune subjects not requiring vaccination. The study population consisted of 172 adolescents between the ages of 12 and 19 years attending an inner city hospital-based adolescent clinic over a three month period. Mean age of the study population was 16.1 years with 77% females and 90% African-American. Subjects screened were considered high risk based on a history of sexually transmitted diseases, multiple sexual partners, injectable drug abuse and/or those living in areas with high prevalence rates of Hepatitis B, such as inner city Baltimore. Six patients (3.5%. 95% C.I. 1.3-7.5) of the total sample were positive for Hepatitis B Core Antibody (HBcAb). No significant differences were found between those with positive vs. negative HBcAb for 4 risk factors (sexual activity, injectable drug use, history of STD’s, and history of residential placement). The cost of the 3 dose Recombivw vaccine per subject is $55.26 as compared to the cost of a single HBcAb test ($5.20). Total cost of screening all subjects and immunizing those who were non-immune was $10,067 as compared to universal immunization without prescreening which was $9,504. With these figures as a model, a screening program would require at least a 9.0% seropositivity rate to result in cost savings. These figures do not take into consideration the additional costs of clinic visits (e.g. nursing, overhead, facility charge, etc.). We conclude that in our population, using vaccine and screening costs only, it is not cost-effective to screen prior to immunization.
EVALUATION OF PEDIATRIC RESIDENTS’ ALCOHOL AND OTHER DRUG (AOD) CLINICAL SKILLS. Patricia K. Kokotailo, MD. MPH, Rebecca Langhough. hlS. Beth Neary, MD. Steven C. Matson, MD, Hnward Stone. PhD. and Michael Flcmmg. MD. MPH. University of WisconsmUedison Medic-1 Schoo! Uad~son, WI and Medical College of Wisconsin. Milwaukee. WI. There IS documented need for training physicians to screen adolescent patients’ use of AOD Evaluating changes m clinical behavior is often difticult. yet assessingimprovement in clinical skills as wrll as knowledge is key to evaluating training. This study tested if first and second year pediatric residents who participated in an experiential AOD curriculum (study group) learned about the risks and implicetiens of adolescent substanceuse. leamed specific AOD screening ter.hniques.and used these technique in patient interviews more than a control group of residents who did not receive a curriculum. BOUI the study (n45) and co&o! (n=!?) groups received a written test and were videotaped conducting 3 standardized patient interviews (pre-test). Standardized patient scenarios were developed to cr~co~npass a variety of clinical situattonsinvolving AOD risk behaviors. Study group residents then receivec an AOD curriculum that included participating in a community-based adolescent AOD assessmentand intervention program, receiving interactive lectures and practicing interviewing skills and role playing. Contro0l.s did not receive a curriculum. To determine the effect of the curricutum, all residentsrepealedIhetest and interviews approximately 2 months after the pre-test (post-test). All video interviews were scored by 3 MD’s or PhD’s with substanceabuse experience using a standardizedscoring process. Baseline comparisons of written knowledge and clinical skills as assessedon the videotapesshowed no significant differences between the study and control groups. Written knowledge of AOD problems. screening techniques and management resources increased significantly for the study group (w.001). Evaluation of the videotapes showed significant improvement in use of specific screening techniques. interviewing skills and clinical management (~~05). Pediatric residents receiving an experiential AOD curriculum increased their knowledge and clinical skills in AOD screening significantly more than a group of residents receiving no formal AOD Wining. Similar curriculae and evaluation techniquesmay be valuable in the development of physician education programs in other areas of high risk adolescentbehavior.
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ABSTRACTS OF PAPERS PRESENTED
COST-EFFECTlVENESS OF PREVACCINATIQN MEPATI SERCDU)CII IN A HIGH RISK ADOLESCENT POPULATIQN. Luis Pineiro, M.D., Sheryl Ryan, M.D., Linda Roochvarg, M.D., and Marianne Felice, M.D., Department of Pediatrics, University of Maryland at Baltimore, Baltimore, Maryland. Compliance with recent recommendations to immunize all high risk adolescents agairst the Hepatitis B virus can be both difficult and costly. The objective of this study was to explore the possibility that prevaccination Hepatitis B serology testing of high risk adolescents could identify a significant number of immune subjects not requiring vaccination. The study population consisted of 172 adolescents between the ages of 12 and 19 years attending an inner city hospital-based adolescent clinic over a three month period. Mean age of the study population was 16.1 years with 77% females and 90% African-American. Subjects screened were considered high risk based on a history of sexually transmitted diseases, multiple sexual partners, injectable drug abuse and/or those living in areas with high prevalence rates of Hepatitis B, such as inner city Baltimore. Six patients (3.5%. 95% C.I. 1.3-7.5) of the total sample were positive for Hepatitis B Core Antibody (HBcAb). No significant differences were found between those with positive vs. negative HBcAb for 4 risk factors (sexual activity, injectable drug use, history of STD’s, and history of residential placement). The cost of the 3 dose Recombivw vaccine per subject is $55.26 as compared to the cost of a single HBcAb test ($5.20). Total cost of screening all subjects and immunizing those who were non-immune was $10,067 as compared to universal immunization without prescreening which was $9,504. With these figures as a model, a screening program would require at least a 9.0% seropositivity rate to result in cost savings. These figures do not take into consideration the additional costs of clinic visits (e.g. nursing, overhead, facility charge, etc.). We conclude that in our population, using vaccine and screening costs only, it is not cost-effective to screen prior to immunization.
EVALUATION OF PEDIATRIC RESIDENTS’ ALCOHOL AND OTHER DRUG (AOD) CLINICAL SKILLS. Patricia K. Kokotailo, MD. MPH, Rebecca Langhough. hlS. Beth Neary, MD. Steven C. Matson, MD, Hnward Stone. PhD. and Michael Flcmmg. MD. MPH. University of WisconsmUedison Medic-1 Schoo! Uad~son, WI and Medical College of Wisconsin. Milwaukee. WI. There IS documented need for training physicians to screen adolescent patients’ use of AOD Evaluating changes m clinical behavior is often difticult. yet assessingimprovement in clinical skills as wrll as knowledge is key to evaluating training. This study tested if first and second year pediatric residents who participated in an experiential AOD curriculum (study group) learned about the risks and implicetiens of adolescent substanceuse. leamed specific AOD screening ter.hniques.and used these technique in patient interviews more than a control group of residents who did not receive a curriculum. BOUI the study (n45) and co&o! (n=!?) groups received a written test and were videotaped conducting 3 standardized patient interviews (pre-test). Standardized patient scenarios were developed to cr~co~npass a variety of clinical situattonsinvolving AOD risk behaviors. Study group residents then receivec an AOD curriculum that included participating in a community-based adolescent AOD assessmentand intervention program, receiving interactive lectures and practicing interviewing skills and role playing. Contro0l.s did not receive a curriculum. To determine the effect of the curricutum, all residentsrepealedIhetest and interviews approximately 2 months after the pre-test (post-test). All video interviews were scored by 3 MD’s or PhD’s with substanceabuse experience using a standardizedscoring process. Baseline comparisons of written knowledge and clinical skills as assessedon the videotapesshowed no significant differences between the study and control groups. Written knowledge of AOD problems. screening techniques and management resources increased significantly for the study group (w.001). Evaluation of the videotapes showed significant improvement in use of specific screening techniques. interviewing skills and clinical management (~~05). Pediatric residents receiving an experiential AOD curriculum increased their knowledge and clinical skills in AOD screening significantly more than a group of residents receiving no formal AOD Wining. Similar curriculae and evaluation techniquesmay be valuable in the development of physician education programs in other areas of high risk adolescentbehavior.
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