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They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

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ABSTRACT

BACKGROUND

Urine drug testing (UDT) can help identify misuse or diversion of opioid medications among patients with chronic pain. However, misinterpreting results can lead to false reassurance or erroneous conclusions about drug use.

OBJECTIVE

To examine the relationship between resident physicians’ knowledge about UDT interpretation and confidence in their ability to interpret UDT results.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Internal medicine residents in a university health system in the Bronx, from 2010 to 2011.

MAIN MEASURES

We assessed knowledge using a 7-item scale (UDT knowledge score), and confidence in UDT interpretation using a single statement (“I feel confident in my ability to interpret the results of urine drug tests”). We conducted chi-square tests, t-tests, and logistic regression to determine the association between knowledge and confidence, and in exploratory analyses to examine whether resident characteristics (gender, training level, and UDT use) moderated the relationship between knowledge and confidence.

KEY RESULTS

Among 99 residents, the mean UDT knowledge score was 3.0 out of 7 (SD 1.2). Although 55 (56 %) of residents felt confident in their ability to interpret UDT results, 40 (73 %) of confident residents had a knowledge score of 3 or lower. Knowledge score was not associated with confidence among the full sample or when stratified by training level or UDT use. The association between knowledge and confidence differed significantly by gender (interaction term p < 0.01). Adjusting for training level and UDT use, knowledge was positively associated with confidence among females (AOR 1.79, 95 % CI: 1.06, 3.30), and negatively associated with confidence among males (AOR 0.47, 95 % CI: 0.23, 0.98).

CONCLUSIONS

Despite poor knowledge about UDT interpretation, most resident physicians felt confident in their ability to interpret UDT results. Gender differences warrant further exploration, but even confident physicians who use UDT should evaluate their proficiency in interpreting UDT results. Educational initiatives should emphasize the complexities of UDT interpretation.

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Acknowledgments

This work was funded by the Health Research and Service Administration (D58 HP10330) and National Institute on Drug Abuse (K23 DA027719). The authors acknowledge the contributions of Bryan Wu, MS and Adenike Esho, MPH for participant recruitment, survey administration, and data management; Yuming Ning, PhD for statistical programming and analysis; Rachel Stark, MD, MPH for help conceptualizing and implementing the project; Moonseong Heo, PhD, Julia Arnsten, MD, MPH, and Barbara J. Turner, MD, MSc, MSEd for their mentorship, and the Montefiore Division of General Internal Medicine Substance Abuse Affinity Group for feedback during manuscript preparation. This work was presented as a poster at the 35th Annual Meeting of the Society for General Internal Medicine in Orlando, FL on May 11, 2012.

Conflicts of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. General Internal Medicine, Albert Einstein College of Medicine, 111 E. 210 St, Bronx, NY, 10467, USA

    Joanna L. Starrels MD, MS, Aaron D. Fox MD, MS, Hillary V. Kunins MD, MPH, MS & Chinazo O. Cunningham MD, MS

  2. Montefiore Medical Center, Bronx, NY, USA

    Joanna L. Starrels MD, MS, Aaron D. Fox MD, MS, Hillary V. Kunins MD, MPH, MS & Chinazo O. Cunningham MD, MS

Authors
  1. Joanna L. Starrels MD, MS
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  2. Aaron D. Fox MD, MS
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  3. Hillary V. Kunins MD, MPH, MS
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  4. Chinazo O. Cunningham MD, MS
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Correspondence to Joanna L. Starrels MD, MS.

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Starrels, J.L., Fox, A.D., Kunins, H.V. et al. They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain. J GEN INTERN MED 27, 1521–1527 (2012). https://doi.org/10.1007/s11606-012-2165-7

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