SAT 5 Ayjshia Stevens Travon Epps. Chronic: Of long duration; continuing.
Interprofessional continuing education for management of chronic non-cancer pain
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Interprofessional continuing education for management of chronic non- cancer pain Michael Allen, Beverley Zwicker, Marco Chiarot, Tanya Hill Improving Patient Safety Through Informed Medication Prescribing and Disposal Practices Portland ME October 2007 Physicians Pharmacists Dentists
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Physicians Pharmacists Dentists. Interprofessional continuing education for management of chronic non-cancer pain. Michael Allen, Beverley Zwicker, Marco Chiarot, Tanya Hill Improving Patient Safety Through Informed Medication Prescribing and Disposal Practices Portland ME October 2007. - PowerPoint PPT Presentation
Transcript of Interprofessional continuing education for management of chronic non-cancer pain
Interprofessional continuing education for management of
chronic non-cancer pain
Michael Allen, Beverley Zwicker, Marco Chiarot, Tanya Hill
Improving Patient Safety Through Informed Medication Prescribing and Disposal Practices
Portland ME
October 2007
Physicians
Pharmacists
Dentists
2
In partnership with
Cape Breton Community Partnership
on Drug Abuse
Waiting period for pain specialists in DHA 8 approx. 16 monthsNova Scotia Chronic Pain Working Group (July, 2006)
Oxycontin
5
Supporting Organizations
Addictions Services
Nova Scotia Prescription Monitoring Program
6
Acknowledgements
Funding Drug Strategy Community Initiatives Fund
Nova Scotia Department of Health
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Acknowledgements
Michael Allen Dalhousie CMEJohn Malcom Cape Breton District Health AuthorityBeverley Zwicker Dalhousie Continuing Pharmacy EdMarco Chiarot Dentistry Carol Critchley Community Partnership on Drug AbuseStacey Black NS Prescription Monitoring ProgramCameron Little NS College Physicians & SurgeonsDawn Frail NS Dept of Health Christiane Poulin Community Health & Epidemiology Stephen Graham Methodologist
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Outline
Development
Program objectives
Delivery
Evaluation (methods & results)
Conclusions
Further developments
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Program Development
Two focus groups: Patients Physicians, dentists and pharmacists
Questionnaire data: Headache/craniofacial pain Back pain Neuropathic pain Identify patients who might benefit from opioids Identify patients at risk of developing dependence Recognizing strategies used to obtain opioids Potential for abuse of various opioid preparations
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Program Objectives
Increase self-efficacy (confidence) in management of chronic painImprove communication among health professionalsIncrease use of NS Prescription Monitoring Program (PMP) and Addictions ServicesChange prescribing of opioids
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Program DeliveryCase-based panel discussion
Cases Cranio-facial pain Low back pain / opioid abuse Neuropathic pain
Panel Halifax and local pain specialists Halifax addiction specialist Nova Scotia Prescription Monitoring Program Addiction Services
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Program Delivery
Two sessions May 2006 Face-to-face format in Sydney, NS (N=38) Videoconference (N=28) Physicians 15 Pharmacists 26 Dentists 13 Not specified/other 12
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Evaluation - methods
Satisfaction questionnaire
Pre/post program self-efficacy questionnaire
Self-reported practice change – 3 months
Prescribing changes – 6 and 12 months
Focus groups – attitudes and practice – 1yr
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Evaluation – satisfaction
3.7
3.9
3.8
3.9
3.9
4.6
4.8
4.13.9
1 2 3 4 5
Content wasapplicable to
practice
Adequatetime for
discussion
Gained newknowledge
Physicians
Pharmacists
Dentists
1 = strongly disagree 5 = strongly agree
N=44
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Evaluation – satisfaction
4.3
4.2
4.3
1 2 3 4 5
Overallevaluation
Physicians
Pharmacists
Dentists
1 = strongly disagree 5 = strongly agree
N=44
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Evaluation – self-efficacy Communicate with other HCPs
3.9
2.9
4
3.3
4.1
3.8
1 2 3 4 5
1 = little ability 5 = excellent ability
Pre
Post
Pre
Post
Pre
Post
Physicians
Pharmacists
Dentists
N=44
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Evaluation – self-efficacy Use management agreement with at-risk patients
2.7
1.9
3.6
2.5
4.5
4.1
1 2 3 4 5
1 = little ability 5 = excellent ability
Pre
Post
Pre
Post
Pre
Post
Physicians
Pharmacists
Dentists
N=44
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Evaluation – self-efficacy Approach Prescription Monitoring Program
4.3
3.2
4.3
3.2
4
3
1 2 3 4 5
1 = little ability 5 = excellent ability
Pre
Post
Pre
Post
Pre
Post
Physicians
Pharmacists
Dentists
N=44
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Evaluation – Changes to practice
8
3
4
2
5
9
4
2
3
4
8
12
0 2 4 6 8 10 12 14
Make a practice agreement withpatients on opioids
Contact Addiction Services moreoften
Contact PMP more often
Better involvement with HCPs
Yes
No
NA
Physicians (n=7), pharmacists (n=4), dentists (n=7)
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Results – Prescription Monitoring Program
Could not evaluate pre/post changes in PMP contact or prescribing of opioids Consent forms
Physicians 0 Pharmacists 5 Dentists 4
Dentists/pharmacists made no PMP contact before or after program
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Results – focus groups (MD 2, DDS 4, Pharm 4)
Program satisfaction “I found that the session was very helpful. I
had hoped that there would be more.” [Dentist] Interprofessional learning
Main benefit – receive the same message
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Changes in practice Physicians: Use of management agreement Pharmacists: Increased communication with physicians and Prescription
Monitoring Program Dentists: Increased communication with pharmacists but not physicians
Interprofessional collaboration “I used to just simply phone in a prescription or fax it in, and now I pick
up and chat…And I didn’t know pharmacists were quite as knowledge as that. But I must admit, I’ve had no more communication with MDs than I did before this program. And that is really disappointing to me. ” [Dentist]
“..everybody is receptive to having a discussion now.” [Pharmacist]
Results – focus groups (MD 2, DDS 4, Pharm 4)
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Use of Prescription Monitoring Program Pharmacists:
Enhanced sense of autonomy in decision-making Act as link between PMP and physicians
Physicians: Less contact with PMP due to enhanced pharmacist/PMP patient monitoring
Dentists: Infrequent PMP contact – refer opioid request
Use of Addiction Services – no change
Results – focus groups (MD 2, DDS 4, Pharm 4)
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Topic suggestions for future CME: Managing the opioid-addicted patient
“…We have quite a lot of problem. So many people are addicted, and we don’t know what to do.” [Physician]
“I didn’t feel that we had the questions answered as to what you do with somebody with chronic pain or how you help them get it under control….Do we call the doctor first or do we approach the patient first about maybe calling Addiction Services?” [Pharmacist]
Chronic headaches Infections and treatment Antibiotics – prophylactics and cost/dosage regimens TMJ management and pharmacotherapy
Results – focus groups (MD 2, DDS 4, Pharm 4)
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Conclusions
Program well-accepted but need to include dentists and pharmacists more in discussion
Prescribing of opioids for CNCP less common in dentistry than medicine
Increased self-efficacy greatest for use of Prescription Monitoring Program
Inconsistency between self-reported practice change and PMP findings
Wide range of approaches for TMJ dysfunction
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Progress since study – five more presentations
Face-to-face Halifax Dartmouth Bridgewater New Glasgow
Videoconference (Canso, Guysborough, Pugwash, Shelburne, Springhill, Arichat, Parrsboro)
Physicians 48 Pharmacists 52 Dentists 44
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Evaluation – satisfaction
4.4
4.1
4.6
4.6
4.6
4.2
4.8
3.84.7
1 2 3 4 5
Content wasapplicable to
practice
Adequatetime for
discussion
Gained newknowledge
Physicians
Pharmacists
Dentists
1 = strongly disagree 5 = strongly agree
N=20
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Questions?
Michael Allen (Principal Investigator) [email protected]
Tanya Hill (CME Research Associate) [email protected]
