Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

Alford, Daniel P.; Carney, Brittany L.; Brett, Belle; Parish, Sharon J.; Jackson, Angela

doi:10.4300/jgme-d-15-00273.1

Cited by 27 publications

(30 citation statements)

References 29 publications

(29 reference statements)

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“…Although patients with cancer—especially those receiving palliative care or hospice care—often are exempt from more stringent authorization requirements, these requirements nonetheless create a trickle‐down effect of increasing paperwork and phone calls to speak to a representative and explain the clinical justification for the prescribed opioid in a patient with cancer. Finally, although there is a movement to teach physicians‐in‐training how to manage pain, educational initiatives often focus on identifying aberrant drug‐seeking behaviors and understanding the management of nonmalignant pain . This is quite different from teaching physicians how to safely and effectively use opioids to manage pain secondary to active malignant disease.…”

Section: Barriers To Adequate Pain Managementmentioning

confidence: 99%

“…Finally, although there is a movement to teach physicians-in-training how to manage pain, educational initiatives often focus on identifying aberrant drug-seeking behaviors and understanding the management of nonmalignant pain. 32 This is quite different from teaching physicians how to safely and effectively use opioids to manage pain secondary to active malignant disease.…”

Section: System and Regulatory Barriersmentioning

confidence: 99%

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Optimal pain management for patients with cancer in the modern era

Scarborough

Smith

2018

CA A Cancer J Clinicians

245

174

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Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population. CA Cancer J Clin 2018;68:182-196.

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Section: Barriers To Adequate Pain Managementmentioning

confidence: 99%

Section: System and Regulatory Barriersmentioning

confidence: 99%

Optimal pain management for patients with cancer in the modern era

Scarborough

Smith

2018

CA A Cancer J Clinicians

245

174

View full text Add to dashboard Cite

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“…11 Recent studies demonstrated the use of skills-based and simulated learning to reinforce content taught via direct instruction. [12][13] This study expands this by assessing the impact of an opioid tapering curriculum on the following primary endpoints: the number of patients on chronic opioid therapy (COT), average morphine equivalent daily (MED) per patient, percentage of patients on >50 MED and >90 MED, and number of patients on concomitant benzodiazepines.…”

Section: Reportsmentioning

confidence: 99%

Teaching Opioid Tapering Through Guided Instruction

Austin

Fusco

Fagan

et al. 2019

Fam Med

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Background and Objectives: Given the current opioid epidemic, national practice guidelines and many state laws are shifting the treatment paradigm for chronic, noncancer pain to a judicious use of opioids. This has prompted a need to teach family medicine residents how to appropriately taper opioids. We created a multifaceted approach to integrate teaching of opioid tapering into a family medicine curriculum with an emphasis on guided instruction. We assessed the degree to which this curriculum affected guideline-concordant opioid prescribing within the family medicine practice. Methods: A retrospective chart review of 707 patients on chronic opioid therapy (COT) for noncancer pain was conducted before and after the incorporation of a guided instruction experience to the residency curriculum. The primary outcomes included the number of patients on chronic opioids, the average morphine equivalent daily (MED) per patient, the percentage of patients on >50 MED or >90 MED, and the number of patients on concomitant benzodiazepines. Results: Of the original 707 patients, 188 tapered off COT. Of those remaining on COT, the average MED did not change (53.4±76.9 vs 58.5+89.1, P=0.053). The percentage of patients on >50 MED and >90 MED decreased significantly (30.6% vs 25.0%, P=0.001; 19.4% vs 14.0%, P=0.027). The total number of patients on concomitant benzodiazepine decreased from 212 to 131. Conclusions: Providing opportunities for guided instruction with opioid tapering allowed for an increased concordance with national practice guidelines.

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“…9–15 Four of these educational interventions are skills based, 10,13–15 three are case based, 9,11,12 and one focuses on faculty development regarding teaching residents in the primary care clinic. 13 These publications demonstrate that education can improve residents' attitudes, 14 knowledge, 10,15 and confidence 10 in regard to safe opioid prescribing. However, to our knowledge, there have been no publications to date in MedEdPORTAL focusing on the interface between chronic pain and opioid use disorder or reporting actual improved patient-level outcomes in addition to improved educational results.…”

Section: Introductionmentioning

confidence: 99%

Effective Chronic Pain Management and Responsible Opioid Prescribing: Aligning a Resident Workshop to a Protocol for Improved Outcomes

2018

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IntroductionEffective chronic pain management is a core competency of internal medicine. Opioid use in the United States, both therapeutic and nonmedical in origin, has dramatically increased, as has the number of deaths due to opioid overdose. Despite this, formal training in pain management and responsible opioid prescribing is lacking for internal medicine residents.MethodsOur educational workshop for PGY 1-PGY 3 internal medicine residents was designed to provide a functional knowledge base and improve motivation to change behaviors in chronic pain management and responsible opioid prescribing. A secondary aim was to align our intervention with our new clinic opioid-prescribing protocol with the goal of increasing the adoption of opioid risk-reduction strategies in our resident clinic, specifically, use of urine drug screening (UDS). We collected data using pre- and postsession knowledge and motivation to change questionnaires as well as pre- and postintervention data regarding UDS in our ambulatory clinic.ResultsSixty-three residents participated in a workshop session. Based on pre- to posttest results, medical knowledge of principles of responsible opioid prescribing increased overall (p = .01). Most residents reported high motivation to change behaviors around management of chronic pain and opioid prescribing. There was also a significant postintervention ordering of UDS in patients on long-term opioid therapy.DiscussionOur workshop resulted in a short-term improvement in knowledge of principles of responsible opioid prescribing, a significant motivation to change behaviors, and increased adoption of opioid risk-reduction strategies in our resident clinic.

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Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

Abstract: Background Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.

Cited by 27 publications

References 29 publications

Optimal pain management for patients with cancer in the modern era

Optimal pain management for patients with cancer in the modern era

Teaching Opioid Tapering Through Guided Instruction

Effective Chronic Pain Management and Responsible Opioid Prescribing: Aligning a Resident Workshop to a Protocol for Improved Outcomes

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