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Interprofessional continuing education for management of chronic non-cancer pain

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.

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Interprofessional continuing education for management of chronic non-cancer pain

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  1. 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

  2. In partnership with Cape Breton Community Partnership on Drug Abuse

  3. Waiting period for pain specialists in DHA 8 approx. 16 months Nova Scotia Chronic Pain Working Group (July, 2006)

  4. Oxycontin

  5. Supporting Organizations • Addictions Services • Nova Scotia Prescription Monitoring Program

  6. Acknowledgements • Funding • Drug Strategy Community Initiatives Fund • Nova Scotia Department of Health

  7. Acknowledgements • Michael Allen Dalhousie CME • John Malcom Cape Breton District Health Authority • Beverley Zwicker Dalhousie Continuing Pharmacy Ed • Marco Chiarot Dentistry • Carol Critchley Community Partnership on Drug Abuse • Stacey Black NS Prescription Monitoring Program • Cameron Little NS College Physicians & Surgeons • Dawn Frail NS Dept of Health • Christiane Poulin Community Health & Epidemiology • Stephen Graham Methodologist

  8. Outline • Development • Program objectives • Delivery • Evaluation (methods & results) • Conclusions • Further developments

  9. 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

  10. Program Objectives • Increase self-efficacy (confidence) in management of chronic pain • Improve communication among health professionals • Increase use of NS Prescription Monitoring Program (PMP) and Addictions Services • Change prescribing of opioids

  11. Program Delivery Case-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

  12. 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

  13. 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

  14. Evaluation – satisfaction 1 = strongly disagree 5 = strongly agree N=44

  15. Evaluation – satisfaction 1 = strongly disagree 5 = strongly agree N=44

  16. Pre Pre Pre Physicians Post Post Post Pharmacists Dentists Evaluation – self-efficacyCommunicate with other HCPs 1 = little ability 5 = excellent ability N=44

  17. Pre Pre Pre Physicians Post Post Post Pharmacists Dentists Evaluation – self-efficacyUse management agreement with at-risk patients 1 = little ability 5 = excellent ability N=44

  18. Pre Pre Pre Physicians Post Post Post Pharmacists Dentists Evaluation – self-efficacyApproach Prescription Monitoring Program 1 = little ability 5 = excellent ability N=44

  19. Evaluation – Changes to practice Physicians (n=7), pharmacists (n=4), dentists (n=7)

  20. 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

  21. 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

  22. Results – focus groups (MD 2, DDS 4, Pharm 4) • 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]

  23. Results – focus groups (MD 2, DDS 4, Pharm 4) • 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

  24. Results – focus groups (MD 2, DDS 4, Pharm 4) • 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

  25. 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

  26. 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

  27. Evaluation – satisfaction 1 = strongly disagree 5 = strongly agree N=20

  28. Questions? • Michael Allen (Principal Investigator) • Michael.allen@dal.ca • Tanya Hill (CME Research Associate) • Tanya@dal.ca

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