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Nazari JL, Kulbokas V, Smart MH, Hensle TR, Lee TA, Pickard AS. Implementation of virtual academic detailing in North America: A qualitative study. J Eval Clin Pract 2024. [PMID: 38652541 DOI: 10.1111/jep.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
RATIONALE The shift toward virtual academic detailing (AD) was accelerated by the COVID-19 pandemic. AIMS AND OBJECTIVES We aimed to examine the role of external, contextual, and intrinsic programme-specific factors in virtual engagement of healthcare providers (HCPs) and delivery of AD. METHODS AD groups throughout North America were contacted to participate in semistructured interviews. An interview guide was constructed by adapting the Consolidated Framework for Implementation Research (CFIR). A point of emphasis included strategies AD groups employed for provider engagement while implementing virtual AD programmes. Independent coders conducted qualitative analysis using the framework method. RESULTS Fifteen AD groups from Canada (n = 3) and the United States (n = 12) participated. Technological issues and training detailers and HCPs were challenges during the transition to virtual AD visits. Restrictions on in-person activities during the pandemic created difficulties engaging HCPs and fewer AD visits. Continuing education was one strategy to incentivize participation, but credits were often not claimed by HCPs. Groups with established networks and prior experience with virtual AD leveraged connections to mitigate disruptions and continue AD visits. Other facilitators included emphasizing contemporary topics, including opioid education beyond fundamental guidelines. Virtual AD had the additional benefit of expanding geographic reach and flexible scheduling with providers. CONCLUSIONS AD groups across North America have shifted to virtual outreach and delivery strategies. This trend toward virtual AD may aid outreach to vulnerable rural communities, improving health equity. More research is needed on the effectiveness of virtual AD and its future implications.
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Affiliation(s)
- Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mary H Smart
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Tara R Hensle
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
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Arndt KR, Robinson KA, Yorkgitis B, Brat G. Retention of Knowledge After Opioid Education in Surgical Interns. Am Surg 2023; 89:5619-5625. [PMID: 36918193 DOI: 10.1177/00031348231162699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND In many academic centers, opioid prescribing is managed primarily by residents with little or no formal opioid education. The present study evaluates intern knowledge and comfort with appropriate opioid prescribing 7 months after an organized opioid education effort. MATERIALS AND METHODS A repeat knowledge and attitude survey was sent to surgical interns who had completed an initial opioid education training session 7 months before the study. Results were compared to post-education assessment results in the same cohort. SETTING 16 general surgery and podiatric surgery interns at a single academic medical center. RESULTS The mean percentage of correct answers on follow-up was 67.6% identical to the average post-session score of 67.6%. Interns reported comfort with opioid prescribing increased to a mean score of 5.9 (out of 10) on follow-up compared to post-session score of 5.19. CONCLUSIONS Surgical interns have significant gaps in knowledge for optimal prescribing and management of opioid prescriptions. Targeted education demonstrates significant and lasting improvement in opioid assessment scores, but there remains room for improvement.
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Affiliation(s)
- Kevin R Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kortney A Robinson
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian Yorkgitis
- Department of Surgery, University of Florida Jacksonville, Jacksonville, FL, USA
| | - Gabriel Brat
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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3
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Abraham O, Szela L, Rosenberger C, Birstler J, Li J, Hetzel S. Examining the Critical Need for Tailored Adolescent Opioid Education: A National Study. J Pediatr Pharmacol Ther 2023; 28:297-307. [PMID: 37795282 PMCID: PMC10547048 DOI: 10.5863/1551-6776-28.4.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/12/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Prescription opioid education can be a preventative measure for opioid misuse. However, most research focuses on adult perspectives rather than adolescents. This study aimed to understand adolescents' attitudes, perceptions, knowledge about prescription opioids, and preferences and prior educational exposure to opioid safety. METHODS Data were collected from November to December 2020. Quota sampling through Qualtrics was used to recruit a national sample of 13- to 18-year-old adolescents who lived in the United States and could understand English. RESULTS A total of 774 responses were analyzed. The most frequently reported source of opioid information was speaking with parents (72%). More than half (54.7%) of participants preferred technology-based education. Participants with a personal history of opioid prescription scored no differently on safe handling and storage of opioids. There was a strong relationship between participants who reported prior knowledge of what opioids are and stopping their friend from using an opioid medication for non-medical purposes (χ2 (1, N = 684) = 3.5; p = 0.042). Participants with prior education on opioid disposal did not know that -returning opioids to the pharmacy was correct (χ2 (1, N = 425) = 3.8; p = 0.254). CONCLUSIONS Participants were less knowledgeable about safe storage and disposal of opioids, preferred technology-based education, and were extremely likely to talk to their parents about opioid information. Findings reaffirm the significance of opioid safety education and communication between adolescents and parents. Adolescent demographic characteristics, preferences, and prior knowledge should be considered when providing opioid safety education.
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Affiliation(s)
- Olufunmilola Abraham
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division (OA, LS, CR, JL), Madison, WI
| | - Lisa Szela
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division (OA, LS, CR, JL), Madison, WI
| | - Claire Rosenberger
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division (OA, LS, CR, JL), Madison, WI
| | - Jen Birstler
- University of Wisconsin-Madison Department of Biostatistics and Medical Informatics (JB, SH), Madison, WI
| | - Jenny Li
- University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division (OA, LS, CR, JL), Madison, WI
| | - Scott Hetzel
- University of Wisconsin-Madison Department of Biostatistics and Medical Informatics (JB, SH), Madison, WI
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Khadka S, Peeters MJ. Comparing Data Submitted by Public and Private Pharmacy Schools to the Opioid-Related Activities Database. Am J Pharm Educ 2021; 85:8328. [PMID: 34315703 PMCID: PMC8341228 DOI: 10.5688/ajpe8328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
Objective. This investigation compared similarities and differences in education on opioids and opioid abuse between public and private US schools and colleges of pharmacy.Methods. The American Association of Colleges of Pharmacy has created and maintains an Opioid-Related Activities database for schools and colleges of pharmacy in the United States. With data from 2019, a mixed-methods design was used to triangulate quantitative analysis with a concurrent qualitative analysis. After describing, the data were compared to national statistics of schools and colleges of pharmacy (ie, number, type of school, and program structure). Data from the database on opioid activity types (ie, education, service, practice, research, and advocacy) were compared between private and public institutions, both quantitatively and qualitatively. The quantitative analysis used odds-ratios (for effect-size) and chi-square (for statistical significance), while the qualitative analysis employed word clouds to explore opioid-related activities descriptors.Results. One-hundred-seven of 144 US schools and colleges of pharmacy (74% response rate) provided their opioid-related activities information to AACP. The institutions (55 private, 52 public) had entered 436 unique opioid-related activities in the AACP database. Results of the quantitative and qualitative analyses triangulated that private institutions focused more on education-opioid-related activities, while public institutions offered more activities that involving research. Magnified to education-type opioid-related activities, faculty from private institutions often focused narrowly on an education event alone, while faculty from institutions often focused more broadly on education and other aspects such as funding, research and published articles.Conclusion. Overall, private and public US schools and colleges of pharmacy widely engaged in combatting the US opioid epidemic by training student pharmacists in this important area.
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Affiliation(s)
- Safalta Khadka
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio
| | - Michael J Peeters
- University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio
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Baker JE, Luketic K, Niziolek GM, Freeman CM, Grannan KJ, Pritts TA, Paquette IM, Goodman MD. Attending and Resident Surgeon Perspectives and Prescribing Practices of Pain Medication During the Opioid Epidemic. J Surg Educ 2021; 78:579-589. [PMID: 32843318 DOI: 10.1016/j.jsurg.2020.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/21/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Over 67,000 individuals died in the United States due to drug overdose in 2018; the majority of these deaths were secondary to opioid ingestion. Our aim was to determine surgeon perceptions on opioid abuse, the adequacy of perioperative and graduate medical education, and the role surgeons may play. We also aimed to investigate any differences in attending and resident surgeon attitudes. DESIGN Anonymous online survey assessing surgeons' opioid counseling practices, prescribing patterns, and perceptions on opioid abuse, adequacy of education about opioid abuse, and the role physicians play. SETTING Two Accreditation Council for Graduate Medical Education accredited general surgery programs at a university-based tertiary hospital and a community hospital in the Midwest. PARTICIPANTS Attending and resident physicians within the Departments of Surgery participated anonymously. RESULTS Attending surgeons were more likely than residents to discuss posoperative opioids with patients (62% vs. 33%; p < 0.05), discuss the potential of opioid abuse (31% vs. 6%; p < 0.05), and check state-specific prescription monitoring programs (15% vs. 0%; p < 0.05). Surgeons and trainees feel that surgeons have contributed to the opioid epidemic (76% attending vs. 88% resident). Overall, attending and resident surgeons disagree that there is adequate formal education (66% vs. 66%) but adequate informal education (48% vs. 61%) on opioid prescribing. However, when attending physicians were broken down into those who have practiced ≤5 years vs. those with >5 years experience, those with ≤5 years experience were more confident in recognizing opioid abuse (61% vs. 34%) and fewer young faculty disagreed that there is adequate formalized education on opioid prescribing (45% vs. 84%). CONCLUSION AND RELEVANCE Patient education should be improved upon in the preoperative setting and should be treated as an important component of preoperative discussions. Formalized opioid education should also be undertaken in graduate surgical education to help guide appropriate opioid use by resident and attending physicians.
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Affiliation(s)
- Jennifer E Baker
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Karla Luketic
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Grace M Niziolek
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | | | - Kevin J Grannan
- TriHealth Physician Partners, Department of Surgery, Cincinnati, Ohio
| | - Timothy A Pritts
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Ian M Paquette
- University of Cincinnati, Department of Surgery, Cincinnati, Ohio
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Schlaudecker J, Zamudio O, Goodnow K, Pallerla H, Regan S. Using Patient Voice to Personalize the Opioid Epidemic: An Evaluation of 2 Educational Interventions. J Patient Exp 2021; 7:964-968. [PMID: 33457529 PMCID: PMC7786768 DOI: 10.1177/2374373520948401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite rising opioid fatalities, attitudes remain indifferent toward those with opioid use disorder (OUD). Utilizing patient voice may be one way to move providers to action. We included persons with OUD in 2 educational sessions as an important tool of attitude change. Post-session surveys demonstrate increased compassion, deeper understanding of challenges, and positive change in attitude. Inclusion of patient voice was identified as the most useful feature of both educational sessions. Four themes emerged: value of patient voice; change in attitude; barriers to change; and enhanced provider role. Future educational sessions should include the voice of persons living with OUD.
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Affiliation(s)
- Jeffrey Schlaudecker
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA.,The Christ Hospital/University of Cincinnati Family Medicine Residency, Cincinnati, OH, USA
| | - Olivia Zamudio
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Keesha Goodnow
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Harini Pallerla
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
| | - Saundra Regan
- Department of Family and Community Medicine Research Division, University of Cincinnati, Cincinnati, OH, USA
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Riazi F, Toribio W, Irani E, Hughes TM, Huxley-Reicher Z, McBratney E, Vu T, Sigel K, Weiss JJ. Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City. Front Sociol 2021; 6:619683. [PMID: 34307540 PMCID: PMC8292929 DOI: 10.3389/fsoc.2021.619683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/03/2021] [Indexed: 05/04/2023]
Abstract
Background: In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted. Methods: From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a "train the trainer" model was implemented whereby medical students and nurses at outpatient clinics were trained to train others. Results: There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the "train the trainer" model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were "Just in case I see someone overdose" (59.3%) and "I'm worried that someone I know will overdose OR that I will overdose" (20.2%). Conclusion: The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.
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Affiliation(s)
- Farah Riazi
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Farah Riazi,
| | - Wilma Toribio
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emaun Irani
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Terence M. Hughes
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Elisa McBratney
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Trang Vu
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Prigoff JG, Titan AL, Fields AC, Shwaartz C, Melnitchouk N, Bleday R, Hawn MT, Wiechmann L. The Effect of Surgical Trainee Education on Opioid Prescribing: An International Evaluation. J Surg Educ 2020; 77:1490-1495. [PMID: 32446768 DOI: 10.1016/j.jsurg.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/29/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Up to 6% of opioid naive patients who undergo surgery become chronic opioid users. The aim of this study was to determine if formal opioid prescribing education of general surgery residents is associated with decreased opioid prescribing postoperatively. METHODS We surveyed surgery residents at 3 general surgery programs in the United States and 1 in Israel. Residents were divided into 2 groups based on whether or not they received formal opioid prescribing education. RESULTS Of those surveyed, 107 (50%) responded. 45% of residents had formal opioid prescribing education, which included instructional videos, current literature, and hospital guidelines. For the 4 operations analyzed, residents who received no formal teaching prescribed a higher number of opioids (lumpectomy p = 0.001, open inguinal hernia repair p = 0.004, laparoscopic appendectomy p = 0.007, thyroidectomy p = 0.002). The largest difference in opioid prescribing was seen in "high prescribers," defined as residents prescribing 15 or more opioid pills. For thyroidectomy, 24.4% of residents without formal education prescribed 20 or more oxycodone 5mg pills compared to 0% of residents with formal education. The Israeli cohort was less likely to receive a pain focused education and was also less likely to prescribe opioids to their patients for all 4 procedures evaluated. CONCLUSIONS Although a minority of general surgery residents are receiving an opioid prescribing education, a formal educational program was associated with significantly decreased opioid prescribing. There is a need for a generalizable educational opioid program for surgery residents.
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Affiliation(s)
- Jake G Prigoff
- Department of Surgery, Columbia University Medical Center, New York, New York.
| | - Ashley L Titan
- Department of Surgery, Stanford University, Stanford, California
| | - Adam C Fields
- Department of Surgery, Brigham and Women's Hospital Boston, Massachusetts
| | - Chaya Shwaartz
- Department of Surgery, Sheba University Hospital, Tel Aviv, Israel
| | - Nelya Melnitchouk
- Department of Surgery, Brigham and Women's Hospital Boston, Massachusetts
| | - Ronald Bleday
- Department of Surgery, Brigham and Women's Hospital Boston, Massachusetts
| | - Mary T Hawn
- Department of Surgery, Stanford University, Stanford, California
| | - Lisa Wiechmann
- Department of Surgery, Columbia University Medical Center, New York, New York
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Robinson KA, Carroll M, Ward SB, Osman S, Chhabra KR, Arinze N, Amedi A, Kaafarani H, Smink DS, Kent TS, Aner MM, Brat G. Implementing and Evaluating a Multihospital Standardized Opioid Curriculum for Surgical Providers. J Surg Educ 2020; 77:621-626. [PMID: 31948867 DOI: 10.1016/j.jsurg.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE (1) To identify gaps in providers knowledge on opioid medication and dosing, patient-specific characteristics that require alterations in dosing, and patient monitoring and treatment adjustments. (2) To evaluate an educational intervention aimed at minimizing these deficits. DESIGN Observational prospective study. Providers took an anonymous paired pre-and posteducation knowledge assessment before and after participating in a 75-minute educational session. Results before and after the educational session were compared. SETTING Surgical providers included nurse practitioners, physician assistants, preinterns, and general surgery residents across 4 quaternary care hospitals in Boston. Participants There were 194 participants and 174 completed both pre- and posteducation knowledge assessments. RESULTS Average scores on the educational assessment increased from 59% before the course to 68% after the session. Posteducation, providers reported increased comfort in prescribing and 95% stated that the curriculum would impact their practice. CONCLUSIONS Surgical providers at multiple hospitals have significant gaps in knowledge for optimal prescribing and management of opioid prescriptions. A 75-minute opioid education session increased prescriber knowledge as well as comfort in prescribing. This multicenter study demonstrates how an educational initiative can be implemented broadly and result in decreased knowledge gaps.
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Affiliation(s)
- Kortney A Robinson
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Michaela Carroll
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stephanie B Ward
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Samia Osman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Karan R Chhabra
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nkiruka Arinze
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Alind Amedi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Haytham Kaafarani
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Musa M Aner
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gabriel Brat
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
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10
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Abstract
Chronic pain involves a complex mechanism that afflicts 50 million adults in the United States and incurs societal costs upwards of $560 billion annually. The consequences of this epidemic have resulted in an epidemic of its own, with the opioid crisis becoming a top priority in healthcare. Historically, the sub-optimal practices of overprescribing opioids and inadequate monitoring of iatrogenic addiction have contributed to this problem. If progress is to be made in this area, it is imperative that we examine how future physicians are being trained to manage pain. We examined internal medicine resident knowledge regarding pain as well as their satisfaction with medical school preparation in this regard using two surveys: The Knowledge and Attitudes Survey Regarding Pain (KASRP) and The Medical School Pain Curriculum Survey (MSPCS). Residents scored an overall 60.7% on the knowledge assessment survey, and less than 50% of respondents agreed that their medical school curriculum had prepared them sufficiently. This suggests that improvements can be made in medical school curricula regarding pain management education to better train physicians on how to manage pain, particularly in an era that demands expertise in this area.
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Affiliation(s)
- Jose Garcia
- Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Levonti Ohanisian
- Orthopaedic Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Angel Sidley
- Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Allison Ferris
- Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - George Luck
- Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
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McCauley JL, Nelson JD, Gilbert GH, Gordan V, Durand SH, Mungia R, Meyerowitz C, Leite RS, Fillingim RB, Brady KT. Prescription Drug Abuse Among Patients in Rural Dental Practices Reported by Members of the National Dental PBRN. J Rural Health 2019; 36:145-151. [PMID: 31385367 DOI: 10.1111/jrh.12386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study compared rural to nonrural dentists with respect to opioid prescribing practices, perceptions about prescription drug abuse among patients, and training relevant to pain management and addictions. METHODS A web-based, cross-sectional questionnaire was administered to practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822) and linked with network enrollment questionnaire data regarding practitioner demographics and practice characteristics. Pain management prescribing practices and perceptions regarding relevance and scope of addiction and drug diversion among patients were assessed. Rural practice was defined as a practice whose ZIP Code has more than 50% of its population in either a nonmetropolitan county and/or a rural Census tract. FINDINGS Rural dentists were significantly more likely than their nonrural counterparts to recommend nonsteroidal anti-inflammatory agents/acetaminophen in combination with prescribing an opioid [F (1,820) = 4.59, P = .03]. Compared to nonrural dentists, rural dentists were more likely to report that opioid abuse/diversion was a problem in their practices [χ2 [1, n = 807] = 6.85, P < .001], were more likely to have suspected a patient of abuse or diversion [χ2 [1, n = 807] = 10.12, P = .001], and were more likely to have refrained from prescribing due to suspicions of abuse or diversion [χ2 [1, n = 807] = 12.49, P < .001]. CONCLUSION Rural dentists may be disproportionately impacted by patients' opioid abuse and represent a viable target for educational outreach that encourages screening, identification, and referral of patients in need of drug abuse treatment.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joni D Nelson
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valeria Gordan
- Department of Restorative Dental Sciences, University of Florida, Gainesville, Florida
| | | | - Rahma Mungia
- Department of Periodontics, University of Texas Health Science Center, San Antonio, Texas
| | - Cyril Meyerowitz
- University of Rochester, Eastman Institute for Oral Health, Rochester, New York
| | - Renata S Leite
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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- The National Dental PBRN Collaborative Group includes practitioner, faculty, and staff investigators who contributed to this activity. A list is available at:, http://nationaldentalpbrn.org/collaborative-group.php
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McCauley JL, Reyes S, Meyerowitz C, Gordan VV, Rindal DB, Gilbert GH, Leite RS, Fillingim RB, Brady KT. Training experiences regarding pain management, addiction, and drug diversion of dentists enrolled in the National Dental Practice-Based Research Network. Subst Abus 2019; 40:344-349. [PMID: 30829128 DOI: 10.1080/08897077.2019.1576085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The purpose of this study was to describe dentists' training experiences relevant to pain management, addiction, and prescription opioid drug diversion and examine associations between these training experiences and dentists' opioid prescribing practices. Methods: A Web-based, cross-sectional survey was conducted among practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822). The survey assessed pain management prescribing practices and training experiences related to pain management and assessment for addiction and drug diversion. Survey data were linked with National Dental PBRN Enrollment Questionnaire data regarding practitioner demographics and practice characteristics. Results: The majority of dentists (67%) reported prior training in pain management; however, a minority of dentists reported prior training regarding identification and assessment of drug abuse or addiction (48%) or identification of prescription drug diversion (25%). The majority of training experiences across all topics occurred through continuing dental education participation. Dental school training relevant to pain management, addiction, and identification of drug diversion was more prevalent among more recent dental school graduates. Training experiences were associated with prescribing practices. Conclusions: Results suggest that across multiple levels of training, many dentists are not receiving training specific to addiction assessment and identification of drug diversion. Such training is associated with greater consistency of risk mitigation implementation in practice.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie Reyes
- Department of Periodontics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, Gainesville, Florida, USA
| | - D Brad Rindal
- HealthPartners Institute, Bloomington, Minnesota, USA
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Renata S Leite
- Department of Stomatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Lovecchio F, Premkumar A, Stepan JG, Albert TJ. Fighting Back: Institutional Strategies to Combat the Opioid Epidemic: A Systematic Review. HSS J 2019; 15:66-71. [PMID: 30863235 PMCID: PMC6384220 DOI: 10.1007/s11420-018-09662-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current research on opioid use within orthopedic surgery has focused on efforts to identify patients at risk for chronic opioid use. Studies addressing prevention of opioid misuse related to orthopedic care are lacking. Evidence-based interventions to reduce the reliance on opioids for post-operative pain relief will be a key component of any comprehensive institutional opioid policy. QUESTIONS/PURPOSES The purpose of this systematic review was to evaluate institutional strategies that reduce opioid administration or consumption after orthopedic surgery. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for English-language articles that analyzed interventions by physicians, nurses, pharmacists, physical therapists, or other hospital staff to reduce post-operative opioid use or narcotic prescription amounts after surgery. Studies that contained objective outcome measures (i.e., no expert opinion articles) were selected. Investigations on the effect of pharmacologic adjuvants, cryotherapy, or regional nerve blockades on opioid use were excluded. RESULTS The initial search yielded 6598 titles, of which 13 full-text articles were ultimately selected for inclusion in this systematic review. The review identified two major categories of interventions-patient-focused and provider-focused (e.g., physicians, nurses, physical therapists, pharmacists). Formal patient education programs were most effective in reducing opioid use. On the provider side, prescribing guidelines appear to decrease the overall number of pills prescribed, often without changes in patient satisfaction or requests for refills. CONCLUSIONS Researchers are just beginning to establish the most effective ways for institutions to reduce opioid use and promote responsible post-operative prescribing. Institutional prescribing guidelines, standardized bedside pain-management programs, and formal patient education curriculums are all evidence-based interventions that can achieve these goals. The available research also supports an interprofessional approach in any institutional opioid-reduction strategy.
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Affiliation(s)
- Francis Lovecchio
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ajay Premkumar
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jeffrey G. Stepan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Todd J. Albert
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Yorkgitis BK, Bryant E, Raygor D, Brat G, Smink DS, Crandall M. Opioid Prescribing Education in Surgical Residencies: A Program Director Survey. J Surg Educ 2018; 75:552-556. [PMID: 28882458 DOI: 10.1016/j.jsurg.2017.08.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Opioid abuse and misuse is a public health crisis. A national effort to reduce this phenomenon is ongoing. Residents represent a large pool of opioid prescribers but, are often not the target for opioid prescribing education (OPE). We developed a survey to assess current opioid prescribing practices and education among surgical residents. STUDY DESIGN An Institutional Review Board and Association of Program Directors in Surgery approved survey was electronically mailed to surgical program directors (PDs). The survey included questions regarding residency type, location, number of graduates per year, perceived value of OPE, residency policy on prescribing outpatients controlled substances, presence of OPE, and preferred method of OPE. MATERIALS AND METHODS A total of 248 PDs were e-mailed the survey with 110 complete responses (44.4%). Of all 104 (94.5%) allow residents to prescribe outpatient opioids with 24 (23.1%) limiting the opioid class prescribed. A total of 29 (27.9%) programs require residents to obtain their own Drug Enforcement Administration registration. Only 22 (20.0%) programs had in place mandatory OPE, 7 (6.4%) PDs were unsure if OPE was a mandatory educational requirement. Furthermore, 70 (79.5%) of programs currently without OPE are considering adding it. Didactic lecture (18, 81.8%) is the most common modality for OPE. The mode time dedicated to OPE was 1 hour. When PDs were asked about which method would be best to deliver OPE, the most common response was case-based scenarios (39, 35.5%). Bivariate statistics were performed and no association was found between OPE and program characteristics'. CONCLUSIONS Most surgical residency programs allow residents to prescribe outpatient opioids, very few require OPE. The most common method of OPE was didactic lectures. To enhance a resident's knowledge in prescribing opioids, programs should incorporate OPE into their curriculum.
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Affiliation(s)
- Brian K Yorkgitis
- Division of Acute Care Surgery, University of Florida College of Medicine, Jacksonville, Florida.
| | - Elizabeth Bryant
- Brigham and Women's Hospital, Trauma, Burns, and Surgical Critical Care, Boston, Massachusetts
| | - Desiree Raygor
- Division of Acute Care Surgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Gabriel Brat
- Beth Israel Deaconess Medical Center, Acute Care Surgery, Boston, Massachusetts
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marie Crandall
- Division of Acute Care Surgery, University of Florida College of Medicine, Jacksonville, Florida
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