Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review

Sud, Abhimanyu; Molska, Graziella Rigueira; Salamanca-Buentello, Fabio

doi:10.1097/acm.0000000000004186

Cited by 10 publications

(6 citation statements)

References 91 publications

(309 reference statements)

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“…As such, we sought to answer the question ‘How has the Suboxone Education Programme been presented as a solution to various kinds of risk relating to OUD and the Canadian opioid crisis?’ We anticipated that the risks potentially being mitigated ranged from the ‘inherent dangerousness’ of people who use drugs14; to the pharmacological and medical risks of opioid agonists themselves; to the knowledge and behaviour of healthcare professionals given that this risk management scheme primarily took the form of an educational programme. Delineating the nature of the risks being mitigated is essential to determining the interests that the promotion of the Programme favour—especially since health professions education, including in the area of opioid prescribing, so far has limited evidence for impacting patient or population health outcomes 19 20…”

Section: Introductionmentioning

confidence: 99%

How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis

et al. 2022

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ObjectivesPharmaceutical industry involvement in medical education, research and clinical practice can lead to conflicts of interest. Within this context, this study examined how the ‘Suboxone Education Programme’, developed and delivered by a pharmaceutical company as part of a federally regulated risk management program, was presented as a solution to various kinds of risks relating to opioid use in public documents from medical institutions across Canada.SettingThese documents were issued during the Canadian opioid crisis, a time when the involvement of industry in health policy was being widely questioned given industry’s role in driving the overprescribing of opioid analgesics and contributing to population-level harms.DesignA critical discourse analysis of 69 documents collected between July 2020 and May 2021 referencing the Suboxone Education Program spanning 13 years (2007–2021) from medical, nursing and pharmacy institutions sourced from every Canadian province and territory. Discursive themes were identified through iterative and duplicate analyses using a semistructured data extraction instrument.ResultsDocuments characterised the Programme as addressing iatrogenic risks from overprescribing opioid analgesics, environmental risks from a toxic street drug supply and pharmacological risks relating to the dominant therapeutic alternative of methadone. The programme was identified as being able to address these risks by providing mechanisms to surveil healthcare professionals and to facilitate the prescribing of Suboxone. Medical institutions legitimised the Suboxone Education Programme by lending their regulatory, epidemiological and professional authority.ConclusionsAddressing risk is considered as a central, moral responsibility of contemporary healthcare services. In this case, moral imperatives to address opioid crisis-related risks overrode other ethical concerns regarding conflicts of interest between industry and public welfare. Failing to address these conflicts potentially imperils efforts of mitigating population health harms by propagating an important driving force of the opioid crisis.

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Section: Introductionmentioning

confidence: 99%

How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis

et al. 2022

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“…As an educational framework, the overarching goal of CanMEDS is to improve patient care by outlining abilities physicians should acquire to meet the needs of the patients they serve. 70 This was felt to aptly complement this scoping review in highlighting roles that PCPs and specialist colleagues need to address in medical education to holistically address gaps identified by PCPs in caring for patients with CNCP. The use of educational frameworks as a bridge between continuing health professions education intended to address complex issues and desired outcomes has been well described in other closely related chronic pain initiatives as a means for achieving demonstrable high-quality changes with regard to patient and population outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain

McEwen

Esterlis

Lorello

et al. 2023

Canadian Journal of Pain

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Introduction/Aim Primary care providers (PCPs), who provide the bulk of care for patients with chronic noncancer pain (CNCP), often report knowledge gaps, limited resources, and difficult patient encounters while managing chronic pain. This scoping review seeks to evaluate gaps identified by PCPs in providing care to patients with chronic pain. Methods The Arksey and O’Malley framework was used for this scoping review. A broad literature search was conducted for relevant articles on gaps in knowledge and skills of PCPs and in their health care environment for managing chronic pain, with multiple search term derivatives for concepts of interest. Articles from the initial search were screened for relevance, yielding 31 studies. Inductive and deductive thematic analysis was adopted. Results The studies included in this review reflected a variety of study designs, settings, and methods. However, consistent themes emerged with respect to gaps in knowledge and skills for assessment, diagnosis, treatment, and interprofessional roles in chronic pain, as well as broader systemic issues including attitudes toward CNCP. A general lack of confidence in tapering high dose or ineffective opioid regimes, professional isolation, challenges in managing patients with CNCP with complex needs, and limited access to pain specialists were reported by PCPs. Discussion/Conclusions This scoping review revealed common elements across the selected studies that will be useful in guiding creation of targeted supports for PCPs to manage CNCP. This review also yielded insights for pain clinicians at tertiary centers for supporting their PCP colleagues as well as systemic reforms required to support patients with CNCP.

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“…Opioid-focused continuing medical education (CME) opportunities and prescription drug monitoring programs (PDMPs) have also emerged during the opioid epidemic as methods of controlling opioid prescribing and related harms. 28,29 These approaches have reduced opioid prescribing in various health care settings. 24,30,31 Quality improvement efforts, regular exposure to new research, and frequent CME in the academic setting likely contributed to changes in surgeons' prescribing behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…These parallels suggest that the benefits of standardized prescribing protocols may not be isolated to their target procedures and could influence broader physician behavior surrounding opioid use. Opioid‐focused continuing medical education (CME) opportunities and prescription drug monitoring programs (PDMPs) have also emerged during the opioid epidemic as methods of controlling opioid prescribing and related harms 28,29 . These approaches have reduced opioid prescribing in various health care settings 24,30,31 …”

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing Trends After Major Pediatric Ear Surgery: A 12‐Year Analysis

et al. 2022

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Objective Postoperative opioid prescriptions tend to exceed children's analgesic needs, but awareness of the opioid epidemic may have driven changes in prescribing behaviors. This study evaluated opioid prescribing patterns after major pediatric ear surgery. Methods This study reviewed all cases of tympanoplasty, tympanomastoidectomy, mastoidectomy, cochlear implantation, otoplasty, and aural atresia repair at a pediatric hospital during 2010–2021. Regressions were conducted to identify opioid prescribing trends over time. Potential covariates were assessed. Returns to the system were reviewed as a balancing measure. Results Even without a targeted protocol, opioid prescribing declined significantly. After prescribing peaked in 2012–2013, significant negative trends yielded lower rates of opioid prescriptions, fewer doses per prescription, smaller patient‐weight‐standardized dose sizes, and less variability (all p < 0.001). In 2012, 96.1% of patients received opioid prescriptions; the rate fell to 13.5% by 2021. For patients ages, 0–6, the annual rate of opioid prescriptions dropped from a maximum of 96.3% in 2012 to 0.0% in 2021. The annual average supply of doses per prescription decreased by 68% between 2013 and 2021, reducing the total days' supply to an evidence‐based 3.1 ± 1.6 days. Regressions did not detect changes in returns to the system. Pain‐related returns were rare (0.9%) and did not vary by opioid prescriptions (p = 0.37). Prescribing trends were closely correlated with a tonsillectomy‐focused protocol that our institution implemented in 2019. Conclusion Surgeon‐driven opioid stewardship has improved with no resultant change in revisit rates. Procedure‐specific quality improvement interventions may have broader off‐target effects on prescribing behaviors. Level of Evidence IV Laryngoscope, 133:1987–1992, 2023

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Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review

Cited by 10 publications

References 91 publications

How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis

How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis

A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain

Opioid Prescribing Trends After Major Pediatric Ear Surgery: A 12‐Year Analysis

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