Teaching Opioid Tapering Through Guided Instruction

Austin, Rebecca Claire; Fusco, Carriedelle Wilson; Fagan, E. Blake; Drake, Evan S.; Pacious, Josh; Dickens, Hallum K.; Galvin, Shelley L.; Wilson, Courtenay Gilmore

doi:10.22454/fammed.2019.502509

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Patient and public health outcomes, evaluated in less than half of the studies, included changes in patient-reported pain scores or quality of life, 18,19 unplanned access to additional medical care for pain or related issues, [20][21][22][23][24][25] concomitant opioid and benzodiazepine prescribing, [26][27][28][29][30] prescription opioid or heroin overdose hospitalizations or trends, 26,31,32 transition from acute to prolonged use after surgical procedures, 18,[33][34][35][36][37] allcause mortality, 18 patient retention rate, 28 and changes in number of prescribers or pharmacies. 26,31,38 One study also evaluated prescriber utilization of an electronic medical record (EMR) alert tool designed to facilitate compliance with OA prescribing limits.…”

Section: Resultsmentioning

confidence: 99%

Evaluating opioid analgesic prescribing limits: A narrative review

Seitz

Janiszewski

Guy

et al. 2022

Pharmacoepidemiology and Drug

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Purpose In response to the opioid crisis, opioid analgesic guidelines and prescribing limits have proliferated. The purpose of this narrative review is to examine evidence from studies evaluating the patient or public health impact of federal and state opioid analgesic prescribing guidelines and laws, describe gaps and challenges in current research, and highlight opportunities for improving future research. Methods We focused on evidence from a literature review covering 2013 through 2019. We identified 30 studies evaluating opioid analgesic thresholds based on federal policies and guidelines, state laws, and Medicaid state plans that attempt to influence the course of patient care at or when the limit is exceeded (e.g., prior authorization). Results Most studies evaluated changes in prescribing or dispensing patterns of opioid analgesics, largely finding decreases in prescribing after policy enactment. Fewer studies evaluated patient or public health outcomes beyond changes in prescribing and dispensing patterns; results were infrequently stratified by potentially important sociodemographic and clinical factors. No studies assessed the potential for adverse patient outcomes for which we have emerging evidence of harms. Conclusions We describe knowledge gaps and propose opportunities for future research to sufficiently assess the potential impact and unintended consequences of opioid analgesic prescribing laws, regulations, guidelines, and policies.

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Section: Resultsmentioning

confidence: 99%

Evaluating opioid analgesic prescribing limits: A narrative review

Seitz

Janiszewski

Guy

et al. 2022

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

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“…In contrast, informal training allows trainees to, “put recommendations into context of patients (we) see every day.” Prior opioid education initiatives demonstrated that guided instruction (ie, informal training), with immediate application in the clinic-setting and feedback from attendings, led to greater comfort and efficiency with safe opioid tapering in residents. 41 Like in all facets of surgical education, “repeated reinforcement (leads) to recognition of patterns and learning,” and helps residents in, “seeing the effectiveness of different medications prescribed for patients on a day to day basis.” In the same way that trainees actively receive direct feedback on technical skills, opioid education should be intentional and not be considered marginal. Indeed, pedagogical research has demonstrated that deliberate practice of learned skills in a real environment, with constant feedback, is the best way to form a long-lasting, conceptual understanding of concepts.…”

Section: Discussionmentioning

confidence: 99%

“…Prior opioid education initiatives demonstrated that guided instruction (ie, informal training), with immediate application in the clinic-setting and feedback from attendings, led to greater comfort and efficiency with safe opioid tapering in residents. 41 Like in all facets of surgical education, "repeated reinforcement (leads) to recognition of patterns and learning," and helps residents in, "seeing the effectiveness of different medications prescribed for patients on a day to day basis." In the same way that trainees actively receive direct feedback on technical skills, opioid education should be intentional and not be considered marginal.…”

Section: Real-world Applicabilitymentioning

confidence: 99%

Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey

Sharif‐Askary¹,

Abdou²,

Singh³

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: The United States opioid epidemic is among this century’s most profound threats to public health and demands that all physicians consider their role in reversing its trajectory. Previous literature demonstrated that plastic surgery trainees lack vital practices that promote opioid stewardship. However, it is not understood why this practice gap exists. This is a national survey-based study evaluating the availability and effectiveness of opioid education in US plastic surgery programs. A total of 91 residents completed the survey. Our study found that there is an unmet need for practical and comprehensive training regarding safe opioid prescribing among plastic surgery trainees. “Informal training,” defined as the “learn as you go” method, was found to be more common than formal training and considerably more valuable according to trainees. Trainees cited real-world applicability of informal training and that it comes from teachers whom they know and trust as valuable attributes of this type of education. Furthermore, the severity of the opioid epidemic has not translated into improved trainee education, as there was no significant difference in knowledge on safe opioid prescribing practices between junior and senior residents. To change the course of the epidemic, plastic surgery programs need to better train younger generations who believe they are critical stakeholders. This study lays the framework for the “formalization of informal training,” and the creation of practical and efficacious educational initiatives.

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“…5,6 One family medicine residency program has demonstrated that an educational intervention utilizing guided instruction can be effective in improving residents' guideline adherence. 7,8 Other interventions have been studied in the past, but none have explored the qualitative and quantitative value of an interdisciplinary peer-review intervention in a residency program context. [9][10][11] We developed a peer-review opioid prescribing educational intervention in a family medicine residency program, incorporating guided instruction, and examined its impact on chronic opioid prescribing practices.…”

mentioning

confidence: 99%

Evaluation of a Residency Peer-to-Peer Intervention in Opioid Prescribing

Aquino

Ottney

Odom

et al. 2022

Fam Med

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Background and Objectives: Family physicians play a crucial role in addressing the opioid epidemic. We studied a novel peer-review opioid prescribing educational intervention for family medicine residents that incorporates guided instruction from an interdisciplinary care team. Methods: We used a mixed-methods study design in the setting of a family medicine residency program in the Midwestern United States. Residents participated in small group, peer-to-peer discussions of patients chronically prescribed opioids with guidance and input from faculty, a pharmacist, and pharmacy students. Discussions followed a structured approach to evaluation based on guidelines, and written recommendations were given to the patients’ resident primary care physician (PCP). For each patient, we reviewed electronic medical records to assess whether PCPs implemented the written recommendations. We used one-way analyses of variance to determine the statistical significance of changes made. The principal investigator interviewed seven participating residents to survey their satisfaction with the curriculum and collated suggestions for improvement. Results: Over a 3-year period, we reviewed 59 patients as part of the intervention; of these, 53 had complete records reviewed for this study. Patients’ morphine milligram equivalent dosage (MME) declined modestly (P=.035). The number and proportion of recommendations implemented was correlated with the decline in MME (P=.004 and P=.013, respectively). Interviewed residents unanimously evaluated the curriculum positively, citing that the structured approach helped align their practices with guidelines. Conclusions: The guided peer-review intervention effectively decreased chronic opioid use among patients, and residents positively evaluated the curriculum.

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Teaching Opioid Tapering Through Guided Instruction

Cited by 4 publications

References 7 publications

Evaluating opioid analgesic prescribing limits: A narrative review

Evaluating opioid analgesic prescribing limits: A narrative review

Are US Plastic Surgery Residents Equipped to Face the Opioid Epidemic? A National Survey

Evaluation of a Residency Peer-to-Peer Intervention in Opioid Prescribing

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