Knowledge, Perceptions and Attitudes toward Chronic Pain and Its Management: A Cross-Sectional Survey of Frontline Pharmacists in Ontario, Canada

What do people believe to be the cause of low back pain? A scoping review

OBJECTIVE

To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated.

METHODS

A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles that measured causal beliefs about non-specific LBP among adults and reported results separate from other belief domains.

RESULTS

A total of 81 studies were included, of which 62 (77%) had cross sectional designs, 11 (14%) were cohort studies, 3 (4%) randomized controlled trials, 4 (5%) non-randomized controlled trials, and 1 (1%) case control. Only 15 studies explicitly mentioned cause, triggers, or etiology in the study aim. We identified the use of 6 questionnaires from which a measure of causal beliefs could be obtained. The most frequently used questionnaire was the Illness Perception Questionnaire which was used in 8 of the included studies. The studies covered 308 unique causal belief items which we categorized into 15 categories, the most frequently investigated being causal beliefs related to "structural injury or impairment", which was investigated in 45 (56%) of the studies. The second and third most prevalent categories were related to "lifting and bending" (26 studies [32%]) and "mental or psychological" (24 studies [30%]).

CONCLUSION

There is a large variation in how causal beliefs are measured and a lack of studies designed to investigate causal beliefs, and of studies determining a longitudinal association between such beliefs and patient outcomes. This scoping review identified an evidence gap and can inspire future research in this field.

Community Pharmacy Professional's Knowledge, Attitude, and Practice with Regard to Pediatric Pain Management

Background

Effective pain relief is an essential component of high-quality healthcare delivery, and pharmacists must be well versed in pain mechanisms, assessment, and management. This study examined community pharmacy professional's (CPPs) knowledge and attitude towards pediatric pain management in Community pharmacies (CPs) and Drug Retail Outlets (DRO) of Ambo and Ginchi towns, west central Ethiopia.

Methods

A cross sectional study was conducted in Ambo and Ginchi towns, the western part of the nation's capital. All voluntary CPPs working by CPs and DRSs in the towns of Ambo and Ginchi were included in the current study. SPSS version 25 was then used to process, analyze, and interpret the data.

Results

Among the 131 CPPs who were approached for the study, 104 agreed to participate and returned the questionnaire. CPPs mean knowledge score on pediatric pain management was 6.69 ±1.92, with a minimum score of 2 and a maximum score of 17. The majority of CPPs 82 (87.2%) in the study did not correctly answer half of the questions. Most of CPPs, 98 (94.3%), admitted they had no training in pain management, and 102 (98.2%) of the respondents said the same about pediatric pain management. The finding indicated that CPPs work experience in CP or DROs had impact on their knowledge about pediatric pain management and similarly, the mean knowledge score of pharmacists was higher than that of pharmacy technicians.

Conclusion

This study revealed that CPPs have inadequate knowledge and attitude to provide effective pediatric pain management service. To bridge the knowledge gap and effectively control pediatric pain, pharmacists who are actively practicing their profession are advised to continue their medical education and training.

CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022

This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient's circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

Popcorn in the pain clinic: a content analysis of the depiction of patients with chronic pain and their management in motion pictures

The watching of films is popular and accessible to broad segments of the population. The depiction of medical conditions in films has the potential to affect the public’s perception of them and contribute to stereotypes and stigma. We investigated how patients with chronic pain and their management are depicted in feature films. Films that contained characters with or references to chronic pain were searched for using databases such as the International Movie Database. Themes that emerged from the content analysis revolved around the films’ depictions of characters with pain, their health care providers, and therapies for pain management. Patients with chronic pain were depicted in various ways, including in manners that could elicit empathy from audiences or that might contribute to the development of negative stereotypes about them. The attitudes of health care professionals toward patients with chronic pain ranged from compassionate to dispassionate. Pain management was typically depicted as lacking in breadth or using multidisciplinary approaches with a focus on pharmacological management. The variety of topics related to chronic pain depicted in feature films lends to their use in medical education strategies to better inform health care professions trainees about chronic pain management.

[Distress tolerance and experience of chronic pain]

INTRODUCTION

Chronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities.

AIMS

The first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities.

METHOD

This is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale.

RESULTS

Eighty participants were recruited (57 % women, mean age=33.09; standard deviation=12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß=-0.04; 95% CI): -0.07--0.01; t (78)=-3.06, p<0.01) or pain interference in everyday functioning (ß=-0.07; 95% CI: -0.10--0.03; t (78)=-3.97, p<0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity.

CONCLUSION

Tolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.

Community Pharmacists' Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria

PURPOSE

Community pharmacists (CPs) frequently attend to pediatric patients with pain but limited data exist regarding their knowledge of and attitude to effective management of pediatric pain in Nigeria. Thus, this study aimed to evaluate the knowledge of and attitude to pediatric pain management among CPs in Nigeria.

PATIENTS AND METHODS

A validated and pilot-tested questionnaire, the Community Pharmacists Survey on Pediatric Pain, was administered to 517 eligible participants at the 38th Annual National Conference of the Association of Community Pharmacists of Nigeria. Independent samples t-test and one-way analysis of variance were used for inferential statistical analyses.

RESULTS

CPs with additional higher academic qualifications and clinically related additional academic degrees had significantly higher mean knowledge scores relative to first degree only holder counterpart (t= 4.33, p< 0.05, Eta2=0.05) and those without clinically related second degrees (t= 6.34, p< 0.05, Eta2=0.27). Pain knowledge among the study cohort also varied significantly by age group, years of practicing community pharmacy, ownership structure of premises, geographical location of practice and previous exposure to pain management training (F(4370)=2.858, p=0.025, Eta2=0.03; F(3371)=3.985, p=0.008, Eta2=0.03; F(2372)=3.643, p=0.027, Eta2=0.02; F(5369)=4.497, p=0.01, Eta2=0.06; F(2372)=3.587, p=0.029, Eta2=0.02), respectively.

CONCLUSION

Community pharmacists' knowledge of and attitude to pediatric pain management in Nigeria appeared sub-optimal, and requires regular targeted educational intervention to fill the identified gaps, improve service delivery and patient outcomes.

The Role of the Pharmacist in the Care of Patients with Chronic Pain

Pharmacists across the healthcare continuum are well positioned to collaborate with patients to effectively manage their chronic pain. Evidence supports positive outcomes when pharmacists undertake these roles; however, there are barriers preventing uptake across the profession. This paper aims to expand awareness of the breadth of these roles, including pharmaceutical care provision, interprofessional collaboration, pain and medication education, support for patients in self-management and acceptance of responsibility to be culturally responsive and decrease stigma. Pharmacists are accessible healthcare professionals and can improve the care of patients with chronic pain.

A scoping review of research on Canadian team-based primary care pharmacists

OBJECTIVES

An ageing population with an increasing prevalence of chronic disease and complex medication regimens has placed a strain on healthcare systems in Canada. A limited number of team-based primary care pharmacists are integrated into primary care clinics across the country, working alongside other members of the health care team to identify and resolve drug therapy problems and improve outcomes. While many studies have been completed in the area, the extent of research on integrated team-based primary care pharmacists in Canada is unknown. The objectives of this work were to describe the literature that exists surrounding pharmacists in a primary health care team setting in Canada. A scoping review of research focusing on pharmacists in team-based primary health care settings in Canada was performed. Thematic analysis was then performed to categorize the identified studies.

KEY FINDINGS

The search identified 874 articles, of which 93 met inclusion criteria relevant to the objective. From these 93 studies, 4 themes and 23 subthemes were identified, with some studies having more than one theme or subtheme. Themes identified were the following: primary care pharmacist scope of practice (n = 79 studies), collaboration/communication within the primary care setting (n = 26), chronic disease management (n = 24) and 'other' (n = 15).

SUMMARY

This research quantified and categorized 93 studies on pharmacists in interprofessional primary care teams in Canada. As this is an expanding role for pharmacists in Canada, understanding the current state of the literature is an important consideration when developing future team-based primary care roles.

Opinions of African American adults about the use of apolipoprotein L1 (ApoL1) genetic testing in living kidney donation and transplantation

Apolipoprotein L1 (ApoL1) predictive genetic testing for kidney disease, and its emerging role in transplantation, remains controversial as it may exacerbate underlying disparities among African Americans (AAs) at increased risk. We conducted an online simulation among AAs (N = 585) about interest in ApoL1 testing and its cofactors, under 2 scenarios: as a potential living donor (PLD), and as a patient awaiting transplantation. Most respondents (61%) expressed high interest in genetic testing as a PLD: age ≥35 years (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.18, 2.60, P = .01), AA identity (aOR, 1.67; 95% CI, 1.02, 2.72, P = .04), perceived kidney disease risk following donation (aOR, 1.68; 95% CI, 1.03, 2.73, P = .03), interest in genetics (aOR, 2.89; 95% CI, 1.95, 4.29, P = .001), and genetics self-efficacy (aOR, 2.38; 95% CI, 1.54, 3.67, P = .001) were positively associated with ApoL1 test interest. If awaiting transplantation, most (89%) believed that ApoL1 testing should be done on AA deceased donors, and older age (aOR, 1.85; 95% CI, 1.03, 3.32, P = .04) and greater interest in genetics (aOR, 2.61; 95% CI, 1.41, 4.81, P = .002) were associated with interest in testing deceased donors. Findings highlight strong support for ApoL1 testing in AAs and the need to examine such opinions among PLDs and transplant patients to enhance patient education efforts.

Understandings, Attitudes, and Barriers About Diabetes Care: Analysis of Factors Influencing Community Pharmacists in China

PURPOSE

Diabetes mellitus (DM) has been known as a major chronic health problem in China. Suboptimal management of diabetic patients may incur serious complications, even death. The quality of post-hospital care has a good relationship with community pharmacists. However, data describing the current situation from care between community pharmacists and patients in China are lacking. Our article is to investigate community pharmacists' activities, evaluate their attitudes towards providing diabetes care, assess their understandings, and identify perceived barriers.

METHODS

A survey divided into four parts was carried out randomly in China. The part of basic characteristics, understandings, and pharmacists' perceived barriers was rated with a few listed choices scales, while the Likert scale was used to identify on the part of attitudes. Quantitative data were shown in frequency and valid percent. One-way analysis of variance (ANOVA) and non-parametric test conducted on data. A P-value ≤0.05 was considered statistically significant.

RESULTS

A total of 737 surveys were collected. The respondent pharmacists maintained a simply moderate understanding of diabetes care and the pharmaceutical services provided met basic needs rather than clinical ones, though they showed a good momentum towards providing better service. The respondent pharmacists considered patients lacking knowledge on self-management, shortage of funds as the main barriers.

CONCLUSION

Efforts are supposed to make to expand pharmacists' scope of practice, lessen patients' reluctance, and create platforms for pharmacists receiving further education.

Exploring influenza vaccine hesitancy in community pharmacies: Knowledge, attitudes and practices of community pharmacists in Ontario, Canada

Background

Vaccine hesitancy (VH) remains a prime contributor to poor influenza vaccine uptake. This study explores the knowledge, attitudes and practices of community pharmacists toward influenza VH, including their personal influenza immunization attitudes and behaviours.

Methods

A web-based cross-sectional survey questionnaire was administered to community pharmacists practising in Ontario, Canada. A 38-question survey tool explored 5 domains, including pharmacists' personal attitudes and behaviour toward influenza immunization, their self-reported knowledge of influenza, its vaccine and vaccine hesitancy, and their attitudes, practices and experiences with influenza VH at the community pharmacy. The data were analyzed descriptively.

Results

A total of 5530 survey invitations were e-mailed, and 885 responses were collected (response rate 16%). Two-thirds (n = 568, 65.7%) of the respondents reported receiving the influenza vaccine in the preceding season. The most frequent reasons for personal influenza immunization were prevention of disease transmission to patients, friends and family, and contribution to herd immunity. In addition to their confidence and perceived ability to identify and address influenza VH, respondents' self-reported knowledge across a 15-item Likert questionnaire was high. Respondents reported coming across an average of 16 (SD 28) individuals hesitant to receive the influenza vaccine each week. Regular workload (n = 419, 65.6%) and insufficient time (n = 406, 65.3%) were reported as the most limiting barriers to engagement in influenza vaccine conversations.

Conclusion

Facilitating optimal practice scope for pharmacists, and capitalizing on the convenience and accessibility of the community pharmacy setting, presents a promising means to address influenza VH. However, barriers to pharmacist-initiated engagement on influenza vaccine must be explored and addressed. Can Pharm J (Ott) 2020;153:xx-xx.

Community pharmacists and chronic pain: A qualitative study of experience, perception, and challenges

Background: Patients suffering from chronic pain frequently ask pharmacists for advice.

Aims: This study was prompted by inadequacies in the available body of literature reporting on pharmacists’ experiences with providing care for patients with chronic pain in the community setting.

Methods: A qualitative investigation of Ontario community pharmacists’ experiences was carried out. Participants were interviewed using a semistructured guide. Interviews were analyzed using thematic analysis, influenced by grounded theory.

Results: This study revealed that pharmacists were knowledgeable and empathetic toward patient concerns. Challenges in their role included financial factors, patient access to multimodal treatment options, potential for harm associated with opioid use, inadequate monitoring, and gaps in training.

Conclusions: This study reports community and Family Health Team pharmacists’ experiences caring for patients with chronic pain and perceptions of their professional role, including strengths and limitations, and identifies perceived challenges in the health care system.

Community Pharmacist's Role in Detecting Low Back Pain, and Patient Attitudes-A Cross-Sectional Observational Study in Italian Community Pharmacies

BACKGROUND

Low back pain (LBP) is one of the most frequent diseases for which patients seek advice in a community pharmacy. The study aimed to evaluate the feasibility of the administration by community pharmacists of questionnaires to assess the LBP intensity and disability degree in patients entering community pharmacies and the attitudes they have toward pain management by pharmacological and non-pharmacological strategies.

METHODS

An explorative, cross-sectional, observational, and quantitative study was performed. Twelve Italian community pharmacists were asked to submit a questionnaire on LBP to patients visiting their pharmacies. The questionnaire included a pain intensity scale, and two validated tools: the Roland and Morris Disability Questionnaire (RMDQ) and the Start Back Screening Tool (SBST) to determine the degree and risk of patient disability, respectively.

RESULTS

872 patients filled out the questionnaires in 6 months. No statistical differences between genders (p > 0.30) were recorded for pain intensity (Female: median score 6, IQR 4-7; Male: median scores 5, IQR 4-7; p > 0.30) and disability associated with LBP (RMDQ high-disability level: Females, 14.7%, Males, 15.0%; p > 0.90). Most of the patients (69%) reported a low degree of disability, but the risk of disability was medium and high in 36% and 18% of them, respectively (p < 0.05). About 14% of patients declare to never seek for physician's advice despite their medium-high degree of disability.

CONCLUSION

The study demonstrated the feasibility of validated tools for assessing the degree and risk of disability in LBP patients administrable in community pharmacies. Moreover, the community pharmacy resulted in an important care portal for patients suffering from moderate LBP and for intercepting patients who suffered from severe LBP but had never reported their problem to their physician.

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain-A Pilot Study

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists' extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

What predicts pharmacists' engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy

Background Pharmacists have a key role to play in identifying and responding to emerging clinical problems with prescribed opioids. A pilot study in Australia examined the implementation of screening and brief intervention (Routine Opioid Outcome Monitoring [ROOM]) to identify and respond to opioid-related problems in community pharmacies. In this implementation study, the rate of screening varied considerably between pharmacies. Objective The aim of this study was to examine pharmacist characteristics associated with implementation of ROOM. Setting Community pharmacies in Victoria and New South Wales, Australia. Methods We implemented a validated computer-facilitated screening (ROOM), combined with brief intervention for opioid-related problems based on a widely accepted framework for monitoring outcomes. In this analysis, we examined the correlates of ROOM completion for individual pharmacists. Negative binomial regression was used to identify baseline predictors of greater screening, with the number of ROOM screens as the dependent (outcome) variable and pharmacist demographics, knowledge, confidence and comfort responding to prescription opioids problems, and attitudes towards evidence based practice examined as independent (predictor) variables. Main outcome measure Number of screens completed by an individual pharmacist as reported in follow-up surveys by pharmacist. Results Fewer years of practice was associated with a greater number of screenings conducted. On average, each additional decade of practice was associated with a 31% (95% CI 0%, 53%) reduction in the number of screenings undertaken by pharmacists. A multivariable analysis revealed that each additional decade practicing, lower knowledge of naloxone and lower confidence in identifying unmanaged pain were all independently associated with reduced engagement in screening after controlling for other variables. Conclusion Findings from this pilot study identified potential barriers to implementing opioid outcome monitoring. Further studies could test different groups of community pharmacists' experience of different barriers when implementing monitoring outcomes with prescribed opioids, to inform future implementation and clinical practice.

Pharmaceutical practices before and throughout the opioid crisis: A scoping review

METHODS

Opioid misuse has reached epidemic status in many countries. This crisis-recognized since 2014-questions the practices of prescribing and dispensing. Did this public health issue change pharmaceutical practices? This literature review presents pharmaceutical practices regarding treatment of noncancer pain. We will assess whether these practices changed after the declaration of the crisis. We will also present barriers and facilitators to their implementation in real life to understand the distance between them and current practices. A scoping review of the literature was conducted on PubMed, Medline, and Embase for references dealing with pharmaceutical practices regarding noncancer pain management, in French and English, from 2000 to 2018.

RESULTS

The search yielded 250 results, with 25 studies surviving the exclusion process. Twenty studies took place in the United States, the country most affected by the crisis. Interventions took place as interprofessional collaboration (n = 14), patient counseling (6), or a combination of these (5). Although the nature of the interventions remained constant through the crisis, the number of publications greatly increased over time. The studies demonstrated pharmacists' upstream contributions regarding pain management and opioid use. Several large-scale implementation issues, including knowledge gaps and communication barriers, have been reported in these studies and in others that gathered opinions and perspectives of prescribers, pharmacists, and patients.

CONCLUSION

Our review showed that the opioid crisis did not modify the nature of pharmaceutical practices regarding pain treatment and opioid management, but the number of studies reporting these practices greatly increased since its onset. Barriers to implementing the best practices to reduce opioid harm have been identified to explain slow integration in daily practice. Adjustments to teaching and practice methods such as a reviewed pain treatment curriculum, standardized tools, and decision-making algorithms could prove beneficial.

Evaluating Pharmacy Student Consultations with Standardized Patients on Opioid Medication Use and Opioid-Specific Risks

Objective. To assess third-year pharmacy students' entry-level verbal and nonverbal communication skills when addressing sensitive topics during opioid consultations with standardized patients. Methods. Seventy-one students were video-taped while consulting with standardized patients who were receiving a one-month supply of oxycodone for lower back pain. Consults were coded quantitatively for the topics students discussed with the patient, terms used, eye contact, and filler words. Results. The majority of pharmacy students discussed common and severe opioid side effects, such as respiratory depression. However, only 30% explained that the medication being dispensed was an opioid or narcotic, and only 23% of students initiated a conversation regarding dependence, addiction, or overdose risk. Students used more filler words when discussing dependence, addiction, or overdose risk as compared to the rest of the consult. Afterwards, students expressed discomfort and the need for additional training and resources for communicating with patients about opioids. Conclusion. Many students lacked confidence with regards to educating patients about opioid-specific risks. This necessitates expanding education regarding discussing sensitive information about opioids at this school of pharmacy. Other schools of pharmacy would benefit from an evaluation of their curriculum to assess the necessity for additional education and training.

Resident Knowledge and Perception of Pain Management

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.

Development and validation of a survey instrument to measure factors that influence pharmacist adoption of prescribing in Alberta, Canada

Objective

Study objectives were to develop a questionnaire to assess factors influencing pharmacists' adoption of prescribing (i.e., continuing, adapting or initiating therapy), describe use of pre-incentive and mixed mode survey, and establish survey psychometric properties.

Methods

Questions were developed based on prior qualitative research and Diffusion of Innovation theory. Expert review, cognitive testing, survey pilot, and main survey were used to test the questionnaire. Six content experts reviewed the questionnaire to establish face and content validity. Ten pharmacists from diverse practice settings were purposefully recruited for a cognitive interview to verify question readability. Content analysis was used to analyze the results. A pre-survey introduction letter with a monetary incentive was mailed via post to 100 (i.e. pilot) and 700 (i.e., main survey) randomly selected pharmacists. This was followed by an e-mail with a personalized link to the online questionnaire, e-mail reminders, and a telephone reminder if required. The psychometric properties of scales were evaluated with an exploratory factor analysis and Cronbach's alpha. Scale responses were described.

Results

Engagement of six experts and ten pharmacists clarified definitions (e.g., prescribing), terminology, recall periods, and response options for the 34-item response scale. Fifty-six pharmacists completed the online pilot survey. Based on this data, ambiguous questions and routing issues were addressed. Three hundred and seventy-eight pharmacists completed the online main survey for a response rate of 54.6%. The factors analysis resulted in 27 questions in eight scales: (1) self-efficacy, (2) support from practice environment, (3) support from interprofessional relationship, (4) impact on professionalism, (5) impact on patient care), (6) prescribing beliefs, (7) technical use of electronic health record (EHR) and (8) patient care use of the EHR. Prescribing beliefs and technical use of the EHR scales had low reliability while the remaining six scales had strong evidence for reliability and validity.

Conclusion

Through a multi-stage process, a survey instrument was developed to capture pharmacists' perceptions of prescribing influences. This questionnaire may support future research to develop interventions to enhance adoption of prescribing and enhance direct patient care by pharmacists.

Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain

Aim

To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP).

Methodology

An online survey was carried out in 2016.

Results

Of 636 respondents (43.0% men; 54.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree), dependence (73.2%), and lack of support (75.4%) were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7%) had recently (last five years) taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training.

Conclusions

This study provides insights into Québec family physicians' concerns, practices, and needs with respect to the management of CNCP. Physicians' difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.