Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review

Overview

Journal Acad Med

Specialty Medical Education

Date 2021 Jun 2

PMID 34074902

Citations 5

Authors

Abhimanyu Sud

Graziella R Molska

Fabio Salamanca-Buentello

Affiliations

Soon will be listed here.

Abstract

Purpose: Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health.

Method: In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis.

Results: Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement.

Conclusions: Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.

Citing Articles

Davis C, Carr D, Stein B J Subst Use Addict Treat. 2024; 161:209356.

PMID: 38548061 PMC: 11090708. DOI: 10.1016/j.josat.2024.209356.

A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain.

McEwen V, Esterlis M, Lorello R, Sud A, Englesakis F, Bhatia A Can J Pain. 2023; 7(1):2145940.

PMID: 36874231 PMC: 9980640. DOI: 10.1080/24740527.2022.2145940.

How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis.

Sud A, Strang M, Buchman D, Spithoff S, Upshur R, Webster F BMJ Open. 2022; 12(7):e059561.

PMID: 35820738 PMC: 9277368. DOI: 10.1136/bmjopen-2021-059561.

Development and pilot evaluation of an educational session to support sparing opioid prescriptions to opioid naïve patients in a Canadian primary care setting.

Narayan S, Rizzardo S, Hamilton M, Cooper I, MacLure M, McCracken R Fam Pract. 2022; 39(6):1024-1030.

PMID: 35543305 PMC: 9680661. DOI: 10.1093/fampra/cmac044.

A retrospective quantitative implementation evaluation of Safer Opioid Prescribing, a Canadian continuing education program.

Sud A, Doukas K, Hodgson K, Hsu J, Miatello A, Moineddin R BMC Med Educ. 2021; 21(1):101.

PMID: 33579258 PMC: 7880212. DOI: 10.1186/s12909-021-02529-7.

References

Palmer E, Hart S, Freeman P . Development and delivery of a pharmacist training program to increase naloxone access in Kentucky. J Am Pharm Assoc (2003). 2017; 57(2S):S118-S122. DOI: 10.1016/j.japh.2016.12.071. View

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M . Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2012; 50(5):587-92. DOI: 10.1016/j.ijnurstu.2012.09.010. View

Larson M, Browne C, Nikitin R, Wooten N, Ball S, Adams R . Physicians report adopting safer opioid prescribing behaviors after academic detailing intervention. Subst Abus. 2018; 39(2):218-224. PMC: 6237655. DOI: 10.1080/08897077.2018.1449175. View

Orkin A, Bharmal A, Cram J, Kouyoumdjian F, Pinto A, Upshur R . Clinical Population Medicine: Integrating Clinical Medicine and Population Health in Practice. Ann Fam Med. 2017; 15(5):405-409. PMC: 5593721. DOI: 10.1370/afm.2143. View

Allen M, MacLeod T, Zwicker B, Chiarot M, Critchley C . Interprofessional education in chronic non-cancer pain. J Interprof Care. 2011; 25(3):221-2. DOI: 10.3109/13561820.2011.552134. View

Strand M, Eukel H, Burck S . Moving opioid misuse prevention upstream: A pilot study of community pharmacists screening for opioid misuse risk. Res Social Adm Pharm. 2018; 15(8):1032-1036. DOI: 10.1016/j.sapharm.2018.07.011. View

van Melle E . Using a Logic Model to Assist in the Planning, Implementation, and Evaluation of Educational Programs. Acad Med. 2016; 91(10):1464. DOI: 10.1097/ACM.0000000000001282. View

Haig A, Dozier M . BEME guide no. 3: systematic searching for evidence in medical education--part 2: constructing searches. Med Teach. 2003; 25(5):463-84. DOI: 10.1080/01421590310001608667. View

Bounthavong M, Harvey M, Wells D, Popish S, Himstreet J, Oliva E . Trends in naloxone prescriptions prescribed after implementation of a National Academic Detailing Service in the Veterans Health Administration: A preliminary analysis. J Am Pharm Assoc (2003). 2017; 57(2S):S68-S72. DOI: 10.1016/j.japh.2016.11.003. View

10.

Alford D . Opioid Prescribing for Chronic Pain--Achieving the Right Balance through Education. N Engl J Med. 2016; 374(4):301-3. DOI: 10.1056/NEJMp1512932. View

11.

Kahn N, Chappell K, Regnier K, Travlos D, Auth D . A Collaboration Between Government and the Continuing Education Community Tackles the Opioid Crisis: Lessons Learned and Future Opportunities. J Contin Educ Health Prof. 2019; 39(1):58-63. DOI: 10.1097/CEH.0000000000000231. View

12.

Midmer D, Kahan M, Marlow B . Effects of a distance learning program on physicians' opioid- and benzodiazepine-prescribing skills. J Contin Educ Health Prof. 2006; 26(4):294-301. DOI: 10.1002/chp.82. View

13.

Behar E, Rowe C, Santos G, Santos N, Coffin P . Academic Detailing Pilot for Naloxone Prescribing Among Primary Care Providers in San Francisco. Fam Med. 2017; 49(2):122-126. View

14.

Roy P, Jackson A, Baxter J, Brett B, Winter M, Hardesty I . Utilizing a Faculty Development Program to Promote Safer Opioid Prescribing for Chronic Pain in Internal Medicine Resident Practices. Pain Med. 2019; 20(4):707-716. PMC: 6442747. DOI: 10.1093/pm/pny292. View

15.

Pasquale M, Sheer R, Mardekian J, Masters E, Patel N, Hurwitch A . Educational intervention for physicians to address the risk of opioid abuse. J Opioid Manag. 2017; 13(5):303-313. DOI: 10.5055/jom.2017.0399. View

16.

Mackenzie M, ODonnell C, Halliday E, Sridharan S, Platt S . Do health improvement programmes fit with MRC guidance on evaluating complex interventions?. BMJ. 2010; 340:c185. DOI: 10.1136/bmj.c185. View

17.

Cochella S, Bateman K . Provider detailing: an intervention to decrease prescription opioid deaths in Utah. Pain Med. 2011; 12 Suppl 2:S73-6. DOI: 10.1111/j.1526-4637.2011.01125.x. View

18.

Barth K, Guille C, McCauley J, Brady K . Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug Alcohol Depend. 2017; 173 Suppl 1:S22-S30. PMC: 5555357. DOI: 10.1016/j.drugalcdep.2016.08.641. View

19.

Tian J, Atkinson N, Portnoy B, Gold R . A systematic review of evaluation in formal continuing medical education. J Contin Educ Health Prof. 2007; 27(1):16-27. DOI: 10.1002/chp.89. View

20.

Sanchez-Ramirez D, Polimeni C . Knowledge and implementation of current opioids guideline among healthcare providers in Manitoba. J Opioid Manag. 2019; 15(1):27-34. DOI: 10.5055/jom.2019.0483. View