MAP-PC: An Addiction Medicine Training Course for Primary Care Pain Treatment

MAP-PC：初级保健疼痛治疗成瘾医学培训课程

• 批准号: 8143321
• 负责人: Kimberlee Jean Trudeau
• 金额: $ 131.53万
• 依托单位: INFLEXXION, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-15 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8143321
• 关键词: Acute Pain; Address; Adopted; Alcohol or Other Drugs use; Behavior; Behavioral; Belief; Breakthrough Pain; Businesses; Caring; Chronic; Clinical; Computer software; Consultations; Continuing Education; Control Groups; Custom; Decision Making; Development; Diagnosis; Education; Educational process of instructing; Evaluation; Exposure to; Fright; General Population; Goals; Internet; Knowledge; Lead; Learning; Logic; Malignant Neoplasms; Maps; Measures; Medicine; Methods; Monitor; Multimedia; Opioid; Pain; Pain Clinics; Pain management; Patients; Pharmaceutical Preparations; Phase; Physicians; Primary Care Physician; Primary Health Care; Procedures; Production; Public Health; Quality of Care; Quality of life; Randomized; Relative (related person); Research Project Grants; Risk; Self Efficacy; Small Business Innovation Research Grant; Solutions; Staging; Substance abuse problem; Technology; Testing; Text; Time; Training; Translating; Treatment outcome; Voice; addiction; base; brief intervention; case-based; chronic pain; clinical practice; continuing medical education; design; experience; follow-up; improved; non-cancer pain; opioid abuse; opioid misuse; overdose death; post intervention; programs; prototype; public health relevance; satisfaction; skills; tool; virtual; web site

DESCRIPTION (provided by applicant): This Phase II proposes the development and testing of an online CME program for primary care physicians called Managing Addiction and Pain in Primary Care (MAP-PC). Multiple studies have supported the utility of opioids in the treatment of acute pain and pain related to cancer, but they continue to be under-prescribed by physicians for chronic pain. Many physicians are concerned about possible abuse by patients, potential liability, and censure by regulatory agencies. The reluctance to prescribe opioids is particularly evident among primary care physicians (PCPs), who treat a high proportion of pain patients. An improvement in the ability of primary care physicians to adopt pain management and addiction medicine principles would lead to more appropriate use of opioids, along with more successful pain treatment outcomes in patients, especially those with potential or past substance misuse/abuse. The promotion of Risk Evaluation and Mitigation Strategies (REMS) for opioids by the FDA will likely require further development of continuing education programs for physicians. Unfortunately, there is a lack of such training for physicians treating chronic pain patients. With the advent of the Internet and business logic (decision branching) software, there is technology available to engage and educate physicians seeking to build pain treatment skills. Using this technology, MAP-PC will help physicians: (1) increase pain management and addiction medicine skills with pain patients at risk of opioid abuse or misuse; (2) make informed decisions about the appropriate use of opioids for their patients; and (3) manage clinical challenges that arise during the course of pain treatment with opioids. In Phase II, we will complete the development of MAP-PC and the study measures. The efficacy study will involve randomization to two conditions: (1) Experimental (MAP-PC) and (2) Control (online text-based CME). The Experimental and Control groups will undergo a baseline assessment, post-intervention, and three-month follow- ups. Phase II involves testing the hypotheses that, relative to the control condition, physicians exposed to MAP-PC will: (1) improve expertise in managing opioid risk in chronic pain patients, (2) enhance self-efficacy in managing opioid risk in chronic pain patients, and (3) improve clinical practice behaviors with respect to identifying and addressing opioid risk issues in pain patients. We will also test the secondary hypotheses that, relative to the control condition, physicians exposed to MAP-PC will perceive significantly: (1) fewer barriers to prescribe opioids for chronic pain patients, and (2) reduced reluctance to prescribe opioids for chronic pain (changed beliefs). Finally, we will test user satisfaction with and acceptance of MAP-PC. PUBLIC HEALTH RELEVANCE: Pain is often under-treated due to primary care physicians' ambivalence about prescribing opioid medications for fear that the patient might abuse or become addicted to the medication. This is particularly true for patients with potential or past substance misuse/abuse. This research project will culminate in the development and testing of an interactive Continuing Medical Education (CME) course, Managing Addiction and Pain in Primary Care (MAP-PC), that teaches primary care physicians about pain management and addiction medicine skills with pain patients at risk of opioid abuse or misuse. If successful, this program can enhance public health by helping physicians to offer needed treatment to chronic pain patient while managing the risk of opioid misuse/abuse more effectively.

描述（由申请人提供）：本第二阶段提议开发和测试在线CME计划，用于用于管理基础医疗的管理和疼痛（MAP-PC）的基础医生。多项研究支持阿片类药物在治疗与癌症有关的急性疼痛和疼痛方面的效用，但由于慢性疼痛而被医生的处方不足。许多医生担心患者可能滥用，潜在的责任以及监管机构的责任。在治疗高比例的疼痛患者的初级保健医生（PCP）中，不愿开处方的阿片类药物尤为明显。初级保健医生采用疼痛管理和成瘾医学原则的能力的提高将导致更适当地使用阿片类药物，以及患者，尤其是患者，尤其是那些具有潜在药物滥用/滥用的患者的疼痛治疗结果。促进FDA的阿片类药物的风险评估和缓解策略（REMS）可能需要进一步开发为医师的继续教育计划。不幸的是，对于治疗慢性疼痛患者的医生缺乏这种培训。随着互联网和业务逻辑（决策分支）软件的出现，有可以参与和教育寻求建立疼痛治疗技能的技术。使用这项技术，MAP-PC将帮助医生：（1）提高疼痛管理和成瘾医学技能，患有阿片类药物滥用或滥用风险的疼痛患者； （2）就患者适当使用阿片类药物做出明智的决定； （3）管理阿片类药物疼痛治疗过程中出现的临床挑战。在第二阶段，我们将完成MAP-PC和研究措施的发展。功效研究将涉及两个条件：（1）实验（MAP-PC）和（2）对照（基于文本的CME）。实验组和对照组将接受基线评估，干预后和三个月的随访。第二阶段涉及测试相对于对照条件的假设，暴露于MAP-PC的医师将：（1）提高在慢性疼痛患者中管理阿片类药物风险方面的专业知识，（2）提高慢性疼痛患者的阿片类药物风险的自我效能，以及（3）改善临床实践行为，以提高诊断和解决疼痛患者的临床实践行为。我们还将检验次要假设，相对于控制条件，暴露于MAP-PC的医生将显着感知：（1）开处方慢性疼痛患者的阿片类药物的障碍更少，（2）（2）减少不愿为慢性疼痛的阿片类药物开处方（改变信念）。最后，我们将测试用户对MAP-PC的满意度和接受。 公共卫生相关性：由于初级保健医生对开处方阿片类药物的矛盾性，由于担心患者可能虐待或沉迷于药物，因此疼痛经常受到治疗。对于潜在或过去滥用药物/滥用的患者而言，尤其如此。该研究项目将在互动式持续医学教育（CME）课程的开发和测试，管理基层医疗成瘾和疼痛（MAP-PC）方面达到顶峰，该课程教授初级保健医生有关患有阿片类药物滥用或滥用的疼痛患者的疼痛管理和成瘾医学技能。如果成功，该计划可以通过帮助医生为慢性疼痛患者提供所需的治疗，同时更有效地管理阿片类药物滥用/虐待的风险来增强公共卫生。