The impact of educational interventions on attitudes of emergency department staff towards patients with substance-related presentations: a quantitative systematic review
Authors: Gonzalez Miriam , Clarke Diana E. , Pereira Asha , Boyce-Gaudreau Krystal , Waldman Celeste , Demczuk Lisa , Legare Carol 
Published: August 2017

EXECUTIVE SUMMARY

Background
Visits to emergency departments for substance use/abuse are common worldwide. However, emergency department health care providers perceive substance-using patients as a challenging group to manage which can lead to negative attitudes. Providing education or experience-based exercises may impact positively on behaviors towards this patient population. Whether staff attitudes are similarly impacted by knowledge acquired through educational interventions remains unknown.

Objectives
To synthesize available evidence on the relationship between new knowledge gained through substance use educational interventions and emergency department health care providers’ attitudes towards patients with substance-related presentations.

Inclusion criteria Types of participants
Health care providers working in urban and rural emergency departments of healthcare facilities worldwide providing care to adult patients with substance-related presentations.

Type of intervention
Quantitative papers examining the impact of substance use educational interventions on health care providers’ attitudes towards substance using patients.

Types of studies
Experimental and non-experimental study designs.

Outcomes
Emergency department staff attitudes towards patients presenting with substance use/abuse.

Search strategy
A three-step search strategy was conducted in August 2015 with a search update in March 2017. Studies published since 1995 in English, French or Spanish were considered for inclusion.

Methodological quality
Two reviewers assessed studies for methodological quality using critical appraisal checklists from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Reviewers agreed on JBI-MAStARI methodological criteria a study must meet in order to be included in the review (e.g. appropriate use of statistical analysis).

Data extraction and synthesis
The data extraction instrument from JBI-MAStARI was used. As statistical pooling of the data was not possible, the findings are presented in narrative form.

Results
A total of 900 articles were identified as relevant for this review. Following abstract and full text screening, four articles were selected and assessed for methodological quality. One article met methodological criteria for inclusion in the review: use of random assignment and comparable study groups and measurement outcomes in a reliable and consistent manner. The included study was a cluster randomized controlled trial. Participants were emergency medicine residents with a mean age of 30 years. The study assessed the impact of a skills-based educational intervention on residents’ attitudes, knowledge and practice towards patients with alcohol problems. While knowledge and practice behaviors improved one year following the intervention, there were no significant differences between groups on attitudinal measures.

Conclusions
Employing educational interventions to improve the attitudes of emergency department staff towards individuals with drug and alcohol related presentations is not supported by evidence.