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: 8000786
• 负责人: Emil J. Chiauzzi
• 金额: $ 43.99万
• 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 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8000786
• 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）：第二阶段建议为初级保健医生开发和测试在线 CME 计划，称为初级保健中的成瘾和疼痛管理 (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，但医生在治疗慢性疼痛方面的处方仍然不足。许多医生担心患者可能滥用药物、潜在的责任以及监管机构的谴责。初级保健医生（PCP）不愿意开阿片类药物的情况尤其明显，因为他们治疗的疼痛患者比例很高。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，并为患者（尤其是那些潜在或过去有药物误用/滥用的患者）带来更成功的疼痛治疗结果。 FDA 推广阿片类药物风险评估和缓解策略 (REMS) 可能需要进一步制定医生继续教育计划。不幸的是，治疗慢性疼痛患者的医生缺乏此类培训。随着互联网和业务逻辑（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) 提高有阿片类药物滥用或误用风险的疼痛患者的疼痛管理和成瘾医学技能； (2) 就患者是否适当使用阿片类药物做出明智的决定； (3) 应对阿片类药物疼痛治疗过程中出现的临床挑战。第二阶段，我们将完成MAP-PC的开发和研究措施。功效研究将涉及两种条件的随机化：(1) 实验 (MAP-PC) 和 (2) 对照（基于在线文本的 CME）。实验组和对照组将接受基线评估、干预后和三个月的随访。第二阶段涉及测试假设，相对于对照条件，接触 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）增强管理慢性疼痛患者阿片类药物风险的自我效能，以及（3）改善在识别和解决疼痛患者阿片类药物风险问题方面的临床实践行为。我们还将测试次要假设，即相对于对照条件，接触 MAP-PC 的医生将显着感知：（1）为慢性疼痛患者开阿片类药物的障碍更少，以及（2）减少为慢性疼痛开阿片类药物的不愿意性（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：由于初级保健医生担心患者可能滥用药物或对药物上瘾，因此对开阿片类药物的态度矛盾，因此疼痛往往得不到充分治疗。对于潜在或过去滥用药物的患者尤其如此。该研究项目最终将开发和测试互动式继续医学教育 (CME) 课程，即初级保健中的成瘾和疼痛管理 (MAP-PC)，该课程向初级保健医生传授有关阿片类药物滥用或误用风险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，从而增强公众健康。