From Clinicaltools.com

Course Details

URL

Improving Patient Outcomes Through Communication and Coordinated Care

Description

When interacting with a patient at risk or diagnosed with alcohol misuse/abuse/dependence, a physician's professional role is to help patients be healthy. Thus, a natural window exists to include information about a patient's alcohol use in order to determine if it may be negatively affecting their health.

Need

Physicians may not fully understand how they can help any patient who presents with an alcohol use disorder.

Needs Analysis

(In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The results of the focus group shaped our module outline and content.)

Brief Summary: With a rating scale of 1-5, the importance of "Role of the Physician" as a topic are to be covered was rated 4.54, as was the implication that the average medical student would benefit from additional instruction in this topic and the willingness of faculty to encourage students to learn more about the topic. The willingness to include this module in current teaching was rate 4.00 and the ease of fitting the module into the institution's current curriculum was rated 3.83. The topic was deemed to align with recommended physician competencies in the area of substance abuse with a rating of 3.90. The highest number of respondents (4) were evenly split between devoting up to half an hour and an hour of lecture time to the topic. A number of aspects of the topic were requested for emphasis and these areas were taken under consideration when devising the course.

Vision

Physicians-in-training know how to use their role as physicians to improve patient health as it relates to alcohol misuse.

Mission

To demonstrate the important role that physicians play in addressing alcohol use disorders in patients.

Goal

Learners will be competent in working with patients who misuse alcohol, working with other physicians to coordinate patient care, and interviewing a patient to form a treatment plan.

Learning Objectives

Describe how to confidently interview patients for alcohol use
Recommend to patients a treatment plan that coordinates patient care with other health professionals
Facilitate treatment confidentiality in multiple contexts with multiple parties in a coordinated care effort.
Demonstrate interviewing techniques to assist screening of patients who are reluctant to disclose alcohol use.

Case Studies

Case Study 1: Tim

Educational Objectives

Case Goal: Physicians-in-training will apply their knowledge to assess for alcohol use and work as part of a multidisciplinary team, utilizing the strengths of each contributory member, in order to refer to specialist treatment.

Course Objectives Met: (1), (2), and (3)

Expected Diagnosis: Alcohol dependent

Take Home Message/Practice Tip: Physicians-in-training should work with other healthcare professionals to obtain treatment for alcohol users if warranted. In this case, Tim agrees to continue outpatient treatment in conjunction with pharmacological treatment for his withdrawal symptoms. Tim is personally motivated to seek treatment, and the physicians-in-training should pick up on this and interview Tim using this motivational information. This case also touches on follow-up appointments and discussing treatment progression with specialists. A solid professional support system can help patients seek appropriate treatment for alcohol use disorders.

Case Specifics

Patient: Tim - 32YOWM

Case Information: Tim is a 32 year old construction worker who has received his second DUI. In order to get his license back, he must got through court-ordered treatment for his alcohol use. He's been referred to you because of suspected withdrawal symptoms.

Chief Complaint: Self-realized alcohol use problem coupled with court-ordered treatment due to DUI

Relevant Past Medical, Psychosocial, Family History: Single father, Tim's mother takes care of grandchild while Tim's at work. Tim is in need of specialist treatment because of high level of alcohol use. Because of family obligations and trouble with the law, Tim is open to alcohol treatment and shows a willingness to attempt sobriety. 4 drinks about 4 nights a week; once a month drinks 6+ drinks in one sitting. Drives under the influence, scored 24 on AUDIT

Case Study 2: Rosa

Educational Objectives

Case Goal: To present physicians-in-training with a case study involved a patient who is reluctant to acknowledge an alcohol use disorder.

Course Objectives Met: (1) and (4)

Expected Diagnosis: At risk for alcohol abuse. Needs to overcome reluctance to treatment; achieved by simple first steps such as changing social situations where drinking is more prevalent

Take Home Message/Practice Tip: Not all patients will accept that they have a drinking problem. Rosa's case presents a patient reluctant to acknowledge a problem. The physician wisely suggests that Rosa try simple steps to slowly decrease alcohol consumption, putting these changes in context of helping her depression. It is not explicitly stated whether Rosa's drinking is a cause of her depression. By focusing on the problem from multiple angles, it may help the patient approach change more willingly. Give them options, small steps which they can accomplish and make them feel as if they can get a handle on the situation. Also, by not forcing them to change their patterns too drastically, the slow change may be more successful.

Case Specifics

Patient: Rosa - 26YOHF

Case Information: Rosa is a 26 year old office clerk at the courthouse downtown. At times, she's reported crying, sleeplessness, and headaches. She's had to miss work periodically because she's been unmotivated to go in and feeling very lethargic, but she quickly rebounds and returns to work as upbeat as ever the next day.

Chief Complaint: Self-described depression. Seeks treatment

Relevant Past Medical, Psychosocial, Family History: Single, multiple friends she spends most of her time with. She drinks two times a week, consuming 3 standard drinks at a time, but indulges in 6 or more drinks once a month during parties. AUDIT score of 14.