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

描述（由申请人提供）：此第二阶段提出了一个在线CME计划的开发和测试，为初级保健医生称为管理成瘾和疼痛的初级保健（MAP-PC）。多项研究支持阿片类药物在治疗急性疼痛和癌症相关疼痛中的效用，但医生对慢性疼痛的处方仍然不足。许多医生担心可能被病人滥用，潜在的责任，以及监管机构的谴责。不愿意开阿片类药物在初级保健医生（PCP）中尤其明显，他们治疗高比例的疼痛患者。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阿片类药物的更适当使用，沿着患者更成功的疼痛治疗结果，特别是那些潜在或过去药物误用/滥用的患者。FDA对阿片类药物的风险评估和缓解策略（REMS）的推广可能需要进一步制定医生的继续教育计划。不幸的是，治疗慢性疼痛患者的医生缺乏这种培训。随着互联网和商业逻辑（决策分支）软件的出现，有技术可以吸引和教育寻求建立疼痛治疗技能的医生。利用这项技术，MAP-PC将帮助医生：（1）提高疼痛管理和成瘾药物技能，帮助有阿片类药物滥用或误用风险的疼痛患者;（2）就阿片类药物的适当使用做出明智的决定;（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的开发和研究措施。有效性研究将涉及随机分配至两种条件：（1）实验（MAP-PC）和（2）对照（基于在线文本的CME）。实验组和对照组将进行基线评估、干预后和三个月随访。第二阶段涉及测试假设，相对于对照条件，暴露于MAP-PC的医生将：（1）提高管理慢性疼痛患者阿片类药物风险的专业知识，（2）提高管理慢性疼痛患者阿片类药物风险的自我效能，（3）改善识别和解决疼痛患者阿片类药物风险问题的临床实践行为。我们还将检验次要假设，即相对于对照条件，暴露于MAP-PC的医生将显著感知：（1）为慢性疼痛患者开阿片类药物的障碍较少，（2）不愿意为慢性疼痛开阿片类药物（改变信念）。最后，我们将测试用户对MAP-PC的满意度和接受度。 公共卫生相关性：由于初级保健医生对处方阿片类药物的矛盾心理，担心患者可能滥用或对药物上瘾，疼痛往往治疗不足。对于潜在或既往药物误用/滥用的患者尤其如此。该研究项目将最终开发和测试一个互动的继续医学教育（CME）课程，在初级保健中管理成瘾和疼痛（MAP-PC），该课程教授初级保健医生疼痛管理和成瘾药物技能，疼痛患者有阿片类药物滥用或误用的风险。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误用/滥用的风险，从而加强公共卫生。

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.