Improving the Attitudes to Homeless Persons in a Family Medicine Residency.

INTRODUCTION: Family medicine providers are at the forefront of serving homeless persons. It is important to prepare family medicine residents for this responsibility during residency. In the current study, we aimed to assess the effect of a series of enrichment activities on the attitudes toward homeless persons held by residents, faculty, and staff in a rural family medicine residency program. METHODS: The residency program implemented a 6-month enrichment activities series that provided various educational experiences and aimed to improve the participants' knowledge of and attitudes toward homeless persons. Participants completed 2 anonymous online surveys before and after the enrichment series: (1) the Health Professional's Attitude Toward the Homeless Inventory (HPATHI) and (2) a short survey assessing the understanding of local issues that affected homeless persons. Two-tailed Student t tests were used to compare the survey results. RESULTS: Of the 48 eligible participants, 42 (88%) completed the surveys before enrichment activities and 41 (85%) completed the surveys afterward. Engagement in the enrichment series was associated with a significant improvement in attitudes supporting social advocacy, but it did not affect self-reported levels of cynicism or personal advocacy. Participant knowledge of local homelessness issues improved, but the difference was not statistically significant. CONCLUSIONS: The longitudinal enrichment activities series, which was implemented in a rural family medicine residency program and aimed to provide experiences working with homeless individuals, was effective in improving attitudes supporting social advocacy among participants.

An Institutional Approach to Managing the Opioid Crisis.

The opioid crisis is a major concern of most health care institutions, including our large academic center. In this article, an organized approach to managing the epidemic institutionally is discussed. An Opioid Stewardship Program was instituted at our tertiary-care center with multiple sites and states of practice, which included diverse membership and expertise. Charges of the program included reviewing current practice, workflows, and external and internal guidelines and evaluating and standardizing prescribing practices. The development of an Opioid Stewardship Program resulted in: (1) an understanding of our diverse prescribing practices and the formation of patient- and procedure-specific guidelines to manage them, (2) education tools for our patients and providers, and (3) workflows and practice advisories within the electronic health record to support appropriate prescribing and monitoring of patients. This ongoing work continues to evolve in response to the needs of our patients, changing regulatory environments, and our improved understanding of our practices.