The development and evaluation of a provider-focused educational intervention about alcohol use disorder in patients with cirrhosis

Author:

Johnson Emily1,Ghosh Monty2,Daniels Vijay John2,Wild T Cameron3,Campbell-Scherer Denise45,Mellinger Jessica6,Winder Gerald S7,Fernandez Anne C7,Kirkwood Jessica5,Tandon Puneeta14

Affiliation:

1. Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

2. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada

3. School of Public Health, University of Alberta, Edmonton, Alberta, Canada

4. Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada

5. Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada

6. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbour, Michigan, United States

7. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States

Abstract

Background:Alcohol use disorder (AUD) is a leading cause of cirrhosis. Insufficient clinician knowledge and comfort managing AUD impacts access to treatment. Using Kern’s Framework for Curriculum Development, we aimed to (i) develop and evaluate the effect of an “AUD in cirrhosis” educational intervention on clinicians’ knowledge, attitudes, comfort, preparedness, and intention (practice habits) to integrate AUD management into their practice, and (ii) assess clinicians’ motivation using Self Determination Theory.Methods:Kern’s approach was used for curriculum development. Pilot session feedback informed a three-part flipped-classroom series conducted by interdisciplinary clinicians in hepatology, psychiatry, primary care, and addiction psychology. Participants watched a video followed by a live session focused on (a) withdrawal, (b) screening and brief intervention, and (c) prescribing pharmacotherapy. Questionnaires assessing knowledge and practice habits were adapted from the literature. Attitudes were evaluated using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Self Determination Theory informed motivation questions.Results:Paired sample t-tests on pre-post questionnaires ( n = 229 clinicians; 95 completed questionnaires) revealed significant improvements in preparedness and comfort screening, providing a brief intervention, prescribing pharmacotherapy, and SAAPPQ domains. No significant changes were observed in the intention to prescribe pharmacotherapy. Effect size analysis showed medium to large effects across most topic areas.Conclusions:The developed sessions improved knowledge, attitudes, and practice habits of clinicians caring for this patient population. Given the rise in AUD and significant consequences in cirrhosis, this data offers promise that interactive education may improve practice habits of clinicians interfacing with this patient population.

Publisher

University of Toronto Press Inc. (UTPress)

Subject

Hepatology

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