Essential components of physician health program monitoring for substance use disorder: A survey of participants 5 years post successful program completion.

BACKGROUND AND OBJECTIVES: Physician health programs (PHPs) have demonstrated efficacy, but their mechanism of influence is unclear. This study sought to identify essential components of PHP care management for substance use disorder (SUD), and to assess whether positive outcomes are sustained over time. METHODS: Physicians with DSM-IV diagnoses of Substance Dependence and/or Substance Abuse who had successfully completed a PHP monitoring agreement at least 5 years before the study (N = 343) were identified as eligible. Of the 143 (42%) that could be reached by phone, 93% (n = 133; 86% male) completed the anonymous online survey. RESULTS: Virtually all PHP program components were rated as being at least "somewhat helpful" in promoting recovery, with the plurality of respondents rating almost all components as "extremely helpful." The top-rated components were: signing a PHP monitoring agreement, participation in the PHP, formal SUD treatment, and attending 12-step meetings, with each receiving a mean rating of at least 6.2 out of 7. Notably, 88% of respondents endorsed continued participation in 12-step fellowships. Despite the significant financial burden of PHP participation, 85% of respondents reported they believed the total financial cost of PHP participation was "money well spent." DISCUSSION AND CONCLUSIONS: Components of PHP monitoring were viewed as acceptable and helpful to physicians who completed the program, and outcomes were generally sustained over 5 years. More studies are needed to confirm these preliminary findings. SCIENTIFIC SIGNIFICANCE: This study documents the perceived cost-benefit of participation in a PHP among a small sample of program completers.

Disordered Eating and Body Esteem Among Individuals with Glycogen Storage Disease.

Glycogen storage disease (GSD) is an inherited disorder that requires a complex medical regimen to maintain appropriate metabolic control. Previous research has suggested the disease is associated with decreased quality of life, and clinical experience suggests that patients are at risk for disordered eating behaviors that may significantly compromise their health. The current study assessed eating attitudes, eating disorder symptoms, and body image among 64 patients with GSD ranging from 7-52 years old (M = 18.5 years old). About half the participants were male (n = 33, 51.6%). Most participants were diagnosed with GSD Type I (n = 52, 81.3%). Quantitative and qualitative analyses were utilized. Results indicated that 14.8% of children and 11.1% of adolescents/adults with GSD met the clinical cutoff for dysfunctional attitudes toward eating, suggesting high likelihood for presence of an eating disorder. However, traditional eating disorder symptoms (e.g., binging, purging, fasting, etc.) were less prevalent in the GSD sample compared to population norms (t = -6.45, p < 0.001). Body esteem was generally lower for both children and adolescents/adults with GSD compared to population norms. These results were consistent with interview responses indicating that GSD patients experience negative feedback from peers regarding their bodies, especially during childhood and adolescence. However, they reported growing acceptance of their bodies with age and reported less negative attitudes and behaviors. Assessing mental health, including symptoms of disordered eating and low body esteem, among individuals with GSD should be an important component of clinical care.

Brief educational intervention to improve medical student competence in managing patients exposed to secondhand smoke.

BACKGROUND: Secondhand smoke (SHS) exposure may lead to the development of various diseases and conditions. One way to reduce SHS exposure is to screen for it within each primary care examination so that appropriate counseling can be directed to affected individuals. There has been little attention to improving medical education about SHS exposure and screening. The goal of this study was to develop an SHS-related educational intervention for medical students, with the purpose of improving knowledge regarding consequences of SHS exposure, and increasing intent to screen patients for exposure. METHODS: Medical students (N = 405) were given a measure assessing their knowledge of SHS exposure and intent to screen. Two groups of students served as controls (i.e., a posttest-only group and a pre/posttest group), and one group participated in the SHS education intervention. A factorial analysis with repeated measures and chi-square analyses were used to assess the differences between the groups to determine the impact of the SHS education intervention (ie, online lectures and a standardized patient interaction) on knowledge and intent to screen. RESULTS: Results of pretesting demonstrated that medical students had little knowledge of SHS exposure, averaging scores between 63% and 69% on the examination. One control group was reassessed a year later with no educational intervention. They did not demonstrate a significant change in their pre- to posttest scores, although the vast majority (∼95%) reported intending to screen future patients. Students who participated in the SHS educational intervention significantly improved their scores from pre- to posttest (P <.001), and 100% also reported intending to screen future patients. CONCLUSIONS: This study suggests that brief education regarding the consequences of SHS exposure may improve medical students' knowledge and increase intent to screen. Future research should assess the long-term impact of educational programs on improved clinical care.