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Sachidanandan G, Sud A. From Two Dimensions to Multidimensions: A Mechanistic Model to Support Deliberate CPD Development, Coordination, and Evaluation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00099. [PMID: 37782259 DOI: 10.1097/ceh.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The effectiveness of continuing professional development as an intervention to improve health professional behavior and patient health is variable and contentious. To clarify the causal relationships underlying program outcomes and facilitate a necessary shift from outcomes-only-based approaches to outcome-based and theory-based approaches in program development and evaluation, we developed a model of mechanisms mapped to relevant outcomes. METHODS Mechanisms identified in a prior realist synthesis of opioid agonist therapy continuing professional development programs were iteratively tested and refined using purposive and opportunistic sampling and realist approaches against two systematic reviews of programs in analgesic prescribing and palliative care. Further testing involved practical application within programs in sustainable health care and pain management. RESULTS Ninety reports on 75 programs and practical application to multiple additional programs informed the final model consisting of five distinct mechanisms: motivation transformation, expert influence, confidence development, self-efficacy facilitation, and community of practice expansion. The mechanisms and related analysis emphasize that continuing professional development is heterogeneous, complex, and context dependent. DISCUSSION Shifting toward outcome-based and theory-based approaches facilitates further conceptual shifts at intraprogram and interprogram and interintervention levels toward more deliberate program development and evaluation, increased program complementarity and subsequent collaboration. It clarifies opportunities for intercalation of continuing professional development with other intervention sciences. The model presents a resource for practitioners, researchers, and policymakers to advance continuing professional development planning, coordination, and evaluation.
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Affiliation(s)
- Grahanya Sachidanandan
- Ms. Sachidanandan: Medical Student, Temerty Faculty of Medicine, University of Toronto. Dr. Sud: Research Chair, Primary Care & Population Health Systems, Humber River Hospital, and Assistant Professor, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto
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McEwen V, Esterlis MM, Lorello RG, Sud A, Englesakis FM, Bhatia A. A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain. Can J Pain 2023; 7:2145940. [PMID: 36874231 PMCID: PMC9980640 DOI: 10.1080/24740527.2022.2145940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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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Affiliation(s)
- Virginia McEwen
- Chronic Pain Management Program, St. Joseph's Care Group, Thunder Bay, ON, Canada.,Interventional Pain Service, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada.,Clinical Sciences Division, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | | | - R Gianni Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Wilson Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Humber River Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - F Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Anuj Bhatia
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
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Sud A, Molska GR, Salamanca-Buentello F. Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:286-299. [PMID: 34074902 PMCID: PMC8781229 DOI: 10.1097/acm.0000000000004186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health. METHOD In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis. RESULTS Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement. CONCLUSIONS Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.
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Affiliation(s)
- Abhimanyu Sud
- A. Sud is assistant professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8354-6153
| | - Graziella R. Molska
- G.R. Molska was research coordinator, Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada at the time this work was completed
| | - Fabio Salamanca-Buentello
- F. Salamanca-Buentello is a postdoctoral fellow, Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-3666-7785
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Asamoah-Boaheng M, Badejo OA, Bell LV, Buckley N, Busse JW, Campbell TS, Corace K, Cooper L, Flusk D, Garcia DA, Hossain MA, Iorio A, Lavoie KL, Poulin PA, Skidmore B, Rash JA. Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis. Am J Prev Med 2021; 60:e15-e26. [PMID: 33229143 DOI: 10.1016/j.amepre.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT This study is a systematic review of interventions to improve adherence to guideline recommendations for prescribing opioids for chronic noncancer pain. EVIDENCE ACQUISITION Investigators searched CINAHL, Embase, MEDLINE, PsycINFO, the Cochrane Library, and Joanna Briggs Institute Evid Based Pract database from inception until June 3, 2019. Interventional studies to improve adherence to recommendations made by opioid guidelines for chronic noncancer pain in North America were eligible if outcomes included adherence to guideline recommendations or change in quantity of opioids prescribed. Data were extracted independently and in duplicate. Quantitative synthesis was performed using random effects meta-analysis. Confidence in evidence was determined using the Grades of Recommendation, Assessment, Development, and Evaluation. EVIDENCE SYNTHESIS A total of 20 studies (8 controlled and 12 prospective cohort) involving 1,491 providers and 72 clinics met inclusion. Interventions included education, audit and feedback, interprofessional support, shared decision making, and multifaceted strategies. Multifaceted interventions improved the use of urine drug testing (n=2, or =2.31, 95% CI=1.53, 3.49, z=3.98, p<0.01; high-certainty evidence), treatment agreements (n=2, or =1.96, 95% CI=1.47, 2.61, z=4.56, p<0.01; moderate-certainty evidence), and mental health screening (n=2, 2.57-fold, 95% CI=1.56, 4.24, z=2.32, p=0.02; low-certainty evidence) when prescribing opioids for chronic noncancer pain. Very low-certainty evidence suggests that several interventions improved the use of treatment agreements, urine drug testing, and prescription drug monitoring programs. CONCLUSIONS Mostly very low-certainty evidence supports a number of interventions for improving adherence to risk management strategies when prescribing opioids for chronic noncancer pain; however, the effect on patient important outcomes (e.g., overdose, addiction, death) is uncertain.
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Affiliation(s)
- Michael Asamoah-Boaheng
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Oluwatosin A Badejo
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Louise V Bell
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada; The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kim Corace
- The Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay Ontario, Canada
| | - David Flusk
- Department of Anesthesia, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - David A Garcia
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Mohammad A Hossain
- Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montreal, Quebec, Canada; Montreal Behavioral Medicine Centre (MBMC), Centre intégrée universitaire de santé et services sociaux de Nord de l'Ile de Montreal (CIUSSS-NIM), Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Patricia A Poulin
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Psychology and Pain Clinic, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Joshua A Rash
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
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Bakkum MJ, Tichelaar J, Wellink A, Richir MC, van Agtmael MA. Digital Learning to Improve Safe and Effective Prescribing: A Systematic Review. Clin Pharmacol Ther 2019; 106:1236-1245. [PMID: 31206612 PMCID: PMC6896235 DOI: 10.1002/cpt.1549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
With the aim to modernize and harmonize prescribing education, the European Association for Clinical Pharmacology and Therapeutics (EACPT) Working Group on education recommended the extensive use and distribution of digital learning resources (DLRs). However, it is unclear whether the complex task of prescribing medicine can be taught digitally. Therefore, the aim of this review was to investigate the effect of diverse DLRs in clinical pharmacology and therapeutics education. Databases PubMed, EMBASE, CINAHL, ERIC, and CENTRAL were systematically searched. Sixty-five articles were included in the analyses. Direct effects on patients were studied, but not detected, in six articles. Skills and behavior were studied in 11 articles, 8 of which reported positive effects. Knowledge acquisition was investigated in 19 articles, all with positive effects. Qualitative analyses yielded 10 recommendations for the future development of DLRs. Digital learning is effective in teaching knowledge, attitudes, and skills associated with safe and effective prescribing.
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Affiliation(s)
- Michiel J Bakkum
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics (EACPT) Education Working Group, Frankfurt, Germany
| | - Anne Wellink
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,European Association for Clinical Pharmacology and Therapeutics (EACPT) Education Working Group, Frankfurt, Germany
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George PP, Zhabenko O, Kyaw BM, Antoniou P, Posadzki P, Saxena N, Semwal M, Tudor Car L, Zary N, Lockwood C, Car J. Online Digital Education for Postregistration Training of Medical Doctors: Systematic Review by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e13269. [PMID: 30801252 PMCID: PMC6410118 DOI: 10.2196/13269] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022] Open
Abstract
Background Globally, online and local area network–based (LAN) digital education (ODE) has grown in popularity. Blended learning is used by ODE along with traditional learning. Studies have shown the increasing potential of these technologies in training medical doctors; however, the evidence for its effectiveness and cost-effectiveness is unclear. Objective This systematic review evaluated the effectiveness of online and LAN-based ODE in improving practicing medical doctors’ knowledge, skills, attitude, satisfaction (primary outcomes), practice or behavior change, patient outcomes, and cost-effectiveness (secondary outcomes). Methods We searched seven electronic databased for randomized controlled trials, cluster-randomized trials, and quasi-randomized trials from January 1990 to March 2017. Two review authors independently extracted data and assessed the risk of bias. We have presented the findings narratively. We mainly compared ODE with self-directed/face-to-face learning and blended learning with self-directed/face-to-face learning. Results A total of 93 studies (N=16,895) were included, of which 76 compared ODE (including blended) and self-directed/face-to-face learning. Overall, the effect of ODE (including blended) on postintervention knowledge, skills, attitude, satisfaction, practice or behavior change, and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher postintervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge scores (small to large effect size and very low quality) for the intervention, while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size and low quality), while 13 studies reported no difference in the skill scores between the groups. One study reported a higher attitude score for the intervention (very low quality), while four studies reported no difference in the attitude score between the groups. Four studies reported higher postintervention physician satisfaction with the intervention (large effect size and low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher postintervention practice or behavior change for the ODE group (small to moderate effect size and low quality), while five studies reported no difference in practice or behavior change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects or cost-effectiveness of the interventions. Conclusions Empiric evidence showed that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training practicing physicians. Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning. The quality of the evidence in these studies was found to be very low for knowledge. Further high-quality randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Pradeep Paul George
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.,Joanna Briggs Institute, University of Adelaide, Adelaide, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Olena Zhabenko
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhone Myint Kyaw
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Panagiotis Antoniou
- Laboratory of Medical Physics, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Pawel Posadzki
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nakul Saxena
- Ophthalmology Team, Novartis, Singapore, Singapore
| | - Monika Semwal
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nabil Zary
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Learning, Informative, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,10I Emerging Technologies Lab, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Craig Lockwood
- Joanna Briggs Institute, University of Adelaide, Adelaide, Australia
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Vaona A, Banzi R, Kwag KH, Rigon G, Cereda D, Pecoraro V, Tramacere I, Moja L. E-learning for health professionals. Cochrane Database Syst Rev 2018; 1:CD011736. [PMID: 29355907 PMCID: PMC6491176 DOI: 10.1002/14651858.cd011736.pub2] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive. OBJECTIVES To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies. SELECTION CRITERIA Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible. MAIN RESULTS We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies. AUTHORS' CONCLUSIONS When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | - Rita Banzi
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Koren H Kwag
- IRCCS Galeazzi Orthopaedic InstituteClinical Epidemiology UnitVia R. Galeazzi, 4MilanItaly20161
| | - Giulio Rigon
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | | | - Valentina Pecoraro
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Irene Tramacere
- Fondazione IRCCS Istituto Neurologico Carlo BestaDepartment of Research and Clinical Development, Scientific DirectorateVia Giovanni Celoria, 11MilanItaly20133
| | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanSwitzerland20133
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Abstract
Prior to statutory changes in prescriptive authority for controlled substances, this study examined the knowledge gaps and prescribing limitations of Florida advanced registered nurse practitioners regarding opioids. Study results revealed statistically significant knowledge gaps in the areas of federal and state guidelines; opioid classes and proper doses; risk assessment skills; monitoring of treatment; and confidence in dealing with challenges of opioid prescribing.
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Suleiman ZA, Wahab KW, Kolawole IK. Opioid prescribing habits of physicians in Kwara State, Nigeria. Ghana Med J 2016; 50:63-7. [PMID: 27635092 DOI: 10.4314/gmj.v50i2.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although opioid analgesics are effective in the treatment of moderate to severe acute, cancer and chronic non-malignant pains, they are under-prescribed in Nigeria. The objective of this study was to assess the prescription pattern of opioids among physicians in a north central State, Nigeria.. DESIGN This was a descriptive cross sectional study. SETTING The study was conducted at the International Association for the Study of Pain (IASP)-sponsored workshops on pain and palliative care at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. PARTICIPANTS These were physicians at the monthly workshops organized by the Pain and Palliative Care Unit of the hospital between August 2011 and July, 2012. INTERVENTIONS Pre-tested semi-structured questionnaires were used to obtain responses to questions on pain management including opioids utilization in the various hospitals of the 114 participants. MAIN OUTCOME MEASURES The main outcome measure was opioid prescription by the participants. RESULTS Out of the 114 questionnaires distributed, 113 were returned with complete information giving a response rate of 99.1%. The mean age of the respondents was 42.0±10.8 years. Although 97.3% of the respondents reported that pain was a frequent complaint in their practice, 69.5% of those who reported seeing patients with moderate to severe pain on a daily basis rarely or never prescribed opioid analgesics. The reasons given for poor opioid prescription were fear of respiratory depression (86.8%), fear of addiction (85.1%) and non-availability (28.9%). CONCLUSION Opioid prescription rate for patients with moderate-severe pain is low possibly due to myths and misconceptions about their adverse effects. FUNDING International Association for the Study of Pain (IASP) Initiative for Improving Pain Education Grant awarded to Dr. K.W. Wahab in 2011.
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Affiliation(s)
- Zakari A Suleiman
- Department of Anaesthesia, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Kolawole W Wahab
- Department of Medicine, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
| | - Israel K Kolawole
- Department of Anaesthesia, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
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Donovan AK, Wood GJ, Rubio DM, Day HD, Spagnoletti CL. Faculty Communication Knowledge, Attitudes, and Skills Around Chronic Non-Malignant Pain Improve with Online Training. PAIN MEDICINE 2016; 17:1985-1992. [PMID: 27036413 DOI: 10.1093/pm/pnw029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many physicians struggle to communicate with patients with chronic, non-malignant pain (CNMP). Through the use of a Web module, the authors aimed to improve faculty participants' communication skills knowledge and confidence, use of skills in clinical practice, and actual communication skills. SUBJECTS The module was implemented for faculty development among clinician-educators with university faculty appointments, outpatient clinical practices, and teaching roles. METHODS Participants completed the Collaborative Opioid Prescribing Education Risk Evaluation and Mitigation Strategy (COPE-REMS®) module, a free Web module designed to improve provider communication around opioid prescribing. Main study outcomes were improvements in CNMP communication knowledge, attitudes, and skills. Skills were assessed by comparing a subset of participants' Observed Structured Clinical Exam (OSCE) performance before and after the curriculum. RESULTS Sixty-two percent of eligible participants completed the curriculum in 2013. Knowledge-based test scores improved with curriculum completion (75% vs. 90%; P < 0.001). Using a 5-point Likert-type scale, participants reported improved comfort in managing patients with CNMP both immediately post-curriculum and at 6 months (3.6 pre vs. 4.0 post vs. 4.1 at 6 months; P = 0.02), as well as improvements in prescribing opioids (3.3 vs. 3.8 vs. 3.9, P = 0.01) and conducting conversations about discontinuing opioids (2.8 vs. 3.5 vs. 3.9, P < 0.001). Additionally, CNMP-specific communication skills on the OSCE improved after the curriculum (mean 67% vs. 79%, P = 0.03). CONCLUSIONS Experienced clinician-educators improved their communication knowledge, attitudes, and skills in managing patients with CNMP after implementation of this curriculum. The improvements in attitudes were sustained at six months. A Web-based curriculum such as COPE-REMS® may be useful for other programs seeking improvement in faculty communication with patients who have CNMP.
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Affiliation(s)
- Anna K Donovan
- *Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gordon J Wood
- Palliative Medicine and Supportive Care Division, Northwestern Lake Forest Hospital Midwest Palliative & Hospice CareCenter, Glenview, Illinois
| | - Doris M Rubio
- Center for Research on Health Care Data Center, Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hollis D Day
- *Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carla L Spagnoletti
- *Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
BACKGROUND Medication prescribing is a complex process where the focus tends to be on starting new medication, changing a drug regimen, and continuing a drug regimen. On occasion, a prudent approach to prescribing may necessitate ending an ongoing course of medication, either because it should not have been started in the first place; because its continued use would cause harm; or because the medication is no longer effective. OBJECTIVE To identify effective strategies for stopping pre-existing prescribing in situations where continued prescribing may no longer be clinically warranted. RESEARCH DESIGN Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951-November 2009), EMBASE (1966-September 2008), and International Pharmaceutical Abstract b (1970-September 2008). A manual search for relevant review articles and a keyword search of a local database produced by a previous systematic search for prescribing influence and intervention research were also conducted. STUDY SELECTION AND DATA EXTRACTION Following initial title screening for relevance 2 reviewers, using formal assessment and data extraction tools, independently assessed abstracts for relevance and full studies for quality before extracting data from studies selected for inclusion. RESULTS Of 1306 articles reviewed, 12 were assessed to be of relevant, high-quality research. A variety of drugs were examined in the included studies with benzodiazepines the most common. Studies included in the review tested 9 different types of interventions. Effective interventions included patient-mediated interventions, manual reminders to prescribers, educational materials given to patients, a face-to-face intervention with prescribers, and a case of regulatory intervention. Partially effective interventions included audit and feedback, electronic reminders, educational materials alone sent to prescribers, and distance communication combined with educational materials sent to prescribers. CONCLUSIONS It appears possible to stop the prescribing of a variety of medications with a range of interventions. A common theme in effective interventions is the involvement of patients in the stopping process. However, prescribing at the level of individual patients was rarely reported, with data often aggregated to number of doses or number of drugs per unit population, attributing any reduction to cessation. Such studies are not measuring the actual required outcome (stopping prescribing), and this may reflect the broader ambiguity about when or why it might be important to end a prescription. Much more research is required into the process of stopping pre-existing prescribing, paying particular attention to improving the outcomes that are measured.
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12
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Abstract
OBJECTIVE To design, implement and evaluate a novel intervention, utilizing electronic media, to improve benzodiazepine use in specific geographical areas in Australia. METHODS An educational intervention about benzodiazepine use, using email, a website and bookmarks, targeted consumers, GPs, nurses (in aged care facilities) and pharmacists in two areas in Australia over a 6-month period. Two control areas, which received no aspect of the intervention, were used to compare and contrast. A drug use evaluation was conducted in aged care facilities before and after the study (in the intervention areas) and after the intervention (in the control areas) to assess quality of benzodiazepine use. Benzodiazepine dispensing data were obtained for each area before, during and after the intervention to quantitate use. Interviews were conducted with nurses and pharmacists involved in the intervention and website statistics were recorded. RESULTS A significantly smaller number of aged care residents were on benzodiazepines for 6 months or more (P < 0.05) after the intervention compared with before. However, other indices, such as number of residents taking benzodiazepines or taking them for a long time, did not change significantly before compared to after the intervention and there were no significant differences between the control and intervention areas after the intervention. Quantitative use of benzodiazepines did not change after the intervention. Many health care professionals in the intervention areas remembered seeing the electronic educational material for benzodiazepines. The website was viewed 115 times during the study. CONCLUSIONS The study was easy and inexpensive to administer and attracted high participation rates by health care professionals. There was a change in the use of benzodiazepines in aged care facilities (less long-term benzodiazepine use) in the intervention areas. The electronic educational materials (emails and website) were read and informations (especially the key messages) were able to be recalled after the intervention. However, no large changes in benzodiazepine overall use (either between control and intervention areas or before and after the intervention) were recorded.
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Affiliation(s)
- Alesha J Smith
- School of Pharmacy, University of Queensland, Brisbane, Queensland 4072, Australia.
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13
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Tolchard B, Thomas L, Battersby M. GPs and problem gambling: can they help with identification and early intervention? J Gambl Stud 2007; 23:499-506. [PMID: 17453326 DOI: 10.1007/s10899-007-9062-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 04/02/2007] [Indexed: 12/28/2022]
Abstract
General Practitioners (GPs) are well placed to identify problem gamblers and provide early intervention. To date there is no evidence to suggest that GP's are routinely screening patients for potential gambling problems. This paper discusses the prevalence of problem gambling, the links with other health problems and ways that GPs can assist. Results from a pilot project that provided educational resources to GPS are also discussed. Suitable screening tools are available that could easily be used by GPs to assess the possibility of gambling problems in patients who may be at increased risk but do not seek help. Early identification and intervention may help prevent a gambling habit escalating to a serious problem. More work needs to be done to increase awareness with GPs of the extent of problem gambling in our community and to alert patients to the fact that gambling can affect their health and that GPs can help.
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Affiliation(s)
- Barry Tolchard
- Department of Health & Human Sciences, University of Essex, Colchester, UK.
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