Introduction In light of the opioid overdose epidemic in the US and the necessity of developing training to conduct difficult conversations around opioid dependence, three case-based videos were created to demonstrate providers using motivational interviewing (MI) with patients who have opioid use disorder (OUD). These vignettes displayed a primary care provider interacting with a patient seeking opioids. Methods Learners—including third-year medical and physician assistant (PA) students, and family medicine residents—viewed three videos set in a family medicine clinic and assessed clinician use of MI when interacting with patients with OUD. The patients were at different levels of acknowledging their need to change their opioid use behaviors and/or pursue treatment. Learners rated each video with an MI rating scale, and a facilitator debriefed strengths, weaknesses, and omissions regarding MI. Results Medical and PA students, and resident family physicians provided 572 ratings. Analysis of variance of mean percent incorrect was lower in residents than in all groups combined, but failed to reach statistical significance (47% + 12.0 vs 53% + 15.0, p = .43). Discussion These case-based videos with MI ratings afforded students and residents the opportunity to assess clinician use of MI techniques with patients with OUD. The MI rating scale had clinical significance (residents scored +5 points and had more training) despite lacking statistical significance. These scenarios allowed learners to recognize how to use MI when having a difficult conversation with patients who misuse opioids. We envision individual use or use for group discussion.

Multiple sclerosis (MS) is an autoimmune inflammatory disorder that affects more than 900,000 Americans. Patient presentations vary widely; therefore, symptom recognition and an understanding of diagnostic criteria are critical in providing timely patient referrals. This article describes recognition and diagnosis of MS using the updated 2017 criteria, and offers an overview of epidemiology, prognosis, and treatment strategies.

Objectives: (1) To describe dispensing of FDA-approved medications used in medication-assisted treatment (MAT) in Medicare Part D beneficiaries during 2013-2017; (2) to identify yearly dispensing associated with physician assistants (PAs) and nurse practitioners (NPs) during 2013-2017; and (3) to examine how Comprehensive Addiction and Recovery Act (CARA) of 2016 impacted dispensing of medications used in MAT in 2016-2017.Method: Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets during the years 2013-2017. Generalized estimating equations (GEEs) were used to analyze the data.Participants: Providers whose national provider identifier is associated with at least one FDA-approved medication used in MAT during 2013-2017 and paid for by Medicare Part D.Main outcome measure: Per-prescriber population-adjusted number of claims for buprenorphine, buprenorphine/naloxone, and naltrexone.Results: There were 4,657,233 claims for medications used in MAT from 2013 to 2017 (mean = 2,374.48 per 100,000). PAs and NPs combined for 254,543 claims during 2013-2017 (mean = 127.58 per 100,000). In the first full year after CARA, prescriptions for medications used in MAT by PAs and NPs increased a population-adjusted 46.96 percent. In the GEE regression model, there were significantly fewer per-provider claims in the years 2013-2015 (pre-CARA) compared with 2017 (post-CARA) (all p 0.05).Conclusion: The year after CARA was passed, claims for medications used in MAT from PAs and NPs increased.