Effects of Educational Programs on Non-Opioid Analgesic Utilization in Mexican Family Medicine Clinics

1. Effects of two educational programs aimed at improving the utilization of non-opioid analgesics in family medicine clinics in Mexico Svetlana V. Doubova Dolores Mino-Leon Hortensia Reyes Morales Sergio Flores-Hernández Ricardo Pérez-Cuevas

2. Problem Statement: • There is a high frequency of prescription of non-opioid analgesics (NOAs), second only to cardiovascular drugs. • Several studies have reported that medical doctors do not prescribe properly and patients do not use the NOAs appropriately. • This finding is evidenced by overutilization rates of up to 41%and by the frequent appearance of preventable adverse events. -42% of the medical doctors are unaware of the adverse events that NOAs cause. -34% of patients are unsure about the proper method of taking NOAs,despite the fact that these are among the most common self-medicated drugs.

3. Objectives: • To develop and test two educational programs (interactive and passive) aimed at improving family doctors’ (FDs) prescribing practices and patient’s knowledge and use of NOAs. Methods: • The educational programs were conducted in two family medicine clinics belonging to the Mexican Institute of Social Security in Mexico City. The study was performed in three stages: 1) Baseline evaluation 2) Implementation of educational activities 3) Post-program evaluation.

4. EDUCATIONAL PROGRAMS PASSIVE (PEP) INTERACTIVE(IEP) FAMILY DOCTORS PATIENTS FAMILY DOCTORS PATIENTS WORKSHOPS, DISCUSSION GROUPS, IN-SERVICE TRAINING VIDEO, LIFLET, INTERACTIVE EDUCATIONAL SESSION CLINICAL GUIDELINE LIFLET 1 MOUNTH 1 OCASION PER PATIENTE 1 OCASION 1 OCASION

5. Methods: All FDs working at the clinics were invited to participate in the programs, and most (99%) of them accepted the invitation. • There were 58 FDs in the IEP group and 52 FDs in the PEP group. The eligibility criteria for patients were: • age ≥ 50 years, suffered from non-malignant pain syndrome, had received at least one NOA prescription for a period of ≥ 7 days, were under the care of the participating FDs, and were able to answer the questions posed during the interview. • The baseline and post-program evaluations included 300 patients by group.

6. Methods: The effect of the programs: • on the FDs was measured through the appropriateness of prescriptions of NOA and analyzed using the differences-in-differences estimator (D-in-D) • on patients through changes in self-medication and in their knowledge about the proper use and adverse events by analyzing the inter- and intra-group differences before and after the programs.

7. Table 1. Characteristics of non-opioid analgesic prescriptions, according to the type of the educational program *p<0.05 between groups A comparison of data from the IEP and PEP groups (i.e., baseline and post-program evaluation data) revealed that prescription of paracetamol increased and NSAIDs decreased in the IEP group (p < 0.05), particularly with regard to prescriptions for elderly patients.

8. Table 2. Effect of educational programs on the prescription of non-opioid analgesics by family doctors. *The model was adjusted according to baseline evaluation data and seniority of the family doctors. **p < 0.0001 between pre- and post-intervention stages, within groups. †p < 0.0001 between IEP and PEP. In the IEP group, the mean difference in the proportion of appropriately prescribed NOAs between the baseline and post-intervention stages was 17.8% (p < 0.05), whereas the mean difference in the PEP group was 6.0% (p > 0.05).

9. Table 3. Effect of educational programs on patients’ use of non-opioid analgesics. *Abbreviation: NOA, non-opioid analgesics. * p < 0.05. The percent differences in IEP and PEP patients reporting self-medication were –9.1% and –13.4%, respectively. The percent difference in knowledge of proper NOA administration was 8.5% in both groups, while awareness of adverse events was 39.6% in the IEP group and 9.2% in the PEP group

10. Key lessons from the study • The IEP aimed at patients and family doctors are superior to PEP in improving family doctors’ prescribing patterns and enhancing patients’ knowledge of NOA-associated adverse events. • Our findings suggest that programs aimed at improving medication use should focus on interactive educational activities. • The IEP had a positive effect on patients’ awareness of NOA-associated adverse events even though the intervention did not improve the ability of patients to identify gastrointestinal adverse events. • The IEP should be improved in this aspect, and novel programs should be developed to specifically educate patients about NOAs gastrointestinal adverse events.