The Contribution of the International Pain Policy Fellowship in Improving Opioid Availability in Georgia

Impact of Continuing Medical Education for Physicians on the Quality of Cancer Pain Treatment in China

CONTEXT

The management of cancer pain has gained attention in China since the proposal of the three-step analgesic ladder in 1986 and has been further improved after the Chinese Ministry of Health launched the campaign for "Good Pain Management Ward" in 2011. The Beijing Pain Management Center for Quality Control and Improvement was formed with the intent to improve the quality of pain management by various means such as providing continuing medical education (CME) and conducting evaluation in Beijing, the capital of China.

OBJECTIVES

The objective of this study was to investigate the impact of CME on cancer pain treatment in hospitals in Beijing, China.

METHODS

The Beijing Pain Management Center for Quality Control and Improvement carried out annual CME on cancer pain treatment for physicians in Beijing in February from 2016 to 2019. The quality of cancer pain treatment in these hospitals was evaluated in August 2015, 2017 and 2019 by using an evaluation instrument containing eight domains. The evaluation results were retrospectively reviewed to assess the impact of CME.

RESULTS

After annual CME for four successive years, a significant increase in evaluation scores for cancer pain treatment was observed in the participating hospitals. The increased trend varied widely both among the levels of hospitals (secondary and two tiers of tertiary hospitals) and among evaluation domains. These hospitals scored lowest in domains related to opioid tolerance, ongoing care, and risk of nonsteroidal anti-inflammatory drugs in the last evaluation.

CONCLUSION

CME significantly improved the quality of cancer pain treatment in the participating hospitals. Thus, standard CME courses may be adopted to improve the quality of cancer pain treatment by other regions in China and other countries.

Impact of Ambiguous and Restrictive Regulations on Opioid-Prescribing Practice in Georgia

CONTEXT

Chronic pain management with opioids in incurable patients remains a challenge of modern medicine regardless of the evidence-based effectiveness of opioids and recommendations of authorities such as the World Health Organization and International Narcotics Control Board. Many countries, including Georgia, maintain overly restrictive regulations that contribute to inadequate pain management.

OBJECTIVE

To identify barriers to pain management in Georgia caused by legislation, administrative issues, and physicians' lack of knowledge and understanding of legislative aspects governing opioid use, and their impact on opioid-prescribing practice.

METHODS

We conducted a survey among 550 primary health care physicians. In total, 302 physicians completed the questionnaire. Overall, 289 questionnaires were analyzed statistically with SPSS version 20 (Armonk, NY: IBM Corp.).

RESULTS

We found that 38% of the physicians avoid prescribing opioids and only one-third of the physicians make an independent decision to treat the patients with opioids. About one-third of the physicians know the updated liberalized legislation and even fewer follow it. Those who apply more liberal legislation and have better medical practice are investigated three to five times more by legal authorities for prescribing morphine to incurable patients than those who do not.

CONCLUSION

Ambiguous legislation negatively influences opioid-prescribing practice. Most of the physicians believe that the legislation is restrictive. Physicians who have better medical and legal knowledge and understanding are controlled and investigated more because of their opioid-prescribing practice. Physicians who are concerned that they might be investigated are less inclined to prescribe opioids or use liberalized regulations.