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

描述（由申请人提供）：这个快速通道提议为初级保健医生开发一个在线继续医学教育（CME）项目，称为初级保健中的成瘾和疼痛管理（MAP-PC）。多项研究证实了阿片类药物在治疗急性疼痛和与癌症相关的疼痛方面的有效性，但医生仍未充分开处方。许多医生担心病人可能滥用药物（例如，转用、药物过量和死亡）、潜在的责任和监管机构的谴责。不愿意开阿片类药物在初级保健医生（pcp）中尤其明显，他们治疗的疼痛患者比例很高。初级保健医生采用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，以及患者更成功的疼痛治疗结果，特别是那些有潜在或过去药物滥用的患者。不幸的是，对于治疗疼痛患者的医生来说，缺乏成瘾药物培训。医生在培训期间接触到的此类信息有限，目前的CME课程侧重于阿片类药物处方、诊断和疼痛管理问题，而不是在疼痛治疗背景下提供对成瘾药物的全面理解。此外，这些课程中的绝大多数都没有经过测试，提供的体验仅仅是基于文本的，很少或没有互动，并且仅仅关注知识的改变而不是行为的改变。随着互联网的出现，有技术可以吸引和教育寻求建立成瘾医学技能的医生。管理初级保健中的成瘾和疼痛（MAP-PC）的目标是帮助初级保健医生通过在线，互动，技能建设CME课程来学习成瘾医学技能，以治疗慢性非癌症疼痛患者。使用虚拟患者技术，MAP-PC将：(1)提高成瘾医学技能，例如识别、管理、治疗和转诊有成瘾风险或有成瘾证据的疼痛患者；(2)帮助医生对患者使用阿片类药物做出明智的决定；(3)管理阿片类药物治疗疼痛过程中出现的临床挑战，例如突破性疼痛、急性疼痛、阿片类药物滥用和非法药物使用。公共卫生相关性：疼痛往往得不到充分治疗，主要是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。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一门互动式继续医学教育（CME）课程，向初级保健医生传授持续疼痛管理技术，包括安全和负责任地使用阿片类药物。这门课程将重点放在如何处理有药物滥用史的病人，或者有很高成瘾风险的病人。

DESCRIPTION (provided by applicant): This Fast Track proposes the development of an online Continuing Medical Education (CME) program for primary care physicians called Managing Addiction and Pain in Primary Care (MAP-PC). Multiple studies have confirmed the usefulness of opioids in the treatment of acute pain and pain related to cancer, but they continue to be under-prescribed by physicians. Many physicians are concerned about possible abuse by patients (e.g., diversion, drug-related overdoses, and death), 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 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 abuse. Unfortunately, there is a lack of addiction medicine training for physicians treating pain patients. Physicians receive limited exposure to such information during their training and current CME courses focus on opioid prescribing, diagnosis, and pain management issues rather than providing a comprehensive understanding of addiction medicine in the pain treatment context. In addition, the great majority of these courses are not tested, offer an experience that is simply text-based with limited or no interactivity, and are focused simply on knowledge change rather than behavior change. With the advent of the Internet, there is technology available to engage and educate physicians seeking to build addiction medicine skills. The goal of Managing Addiction and Pain in Primary Care (MAP-PC) is to help primary care physicians learn addiction medicine skills through an online, interactive, skill- building CME course for treating chronic non-cancer pain patients. Using virtual patient technology, MAP-PC will: (1) increase addiction medicine skills, e.g., identification, management, treatment, and referral for pain patients at risk of or evidencing addiction, (2) help physicians make informed decisions about the use of opioids for their patients, and (3) manage clinical challenges that arise during the course of pain treatment with opioids, e.g., breakthrough pain, acute pain, opioid misuse, and illicit substance use. PUBLIC HEALTH RELEVANCE: Pain is often under-treated primarily due to primary care physician's ambivalence to 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 abuse. This research project will culminate in the development of an interactive Continuing Medical Education (CME) course that teaches primary care physicians ongoing pain management techniques, including the safe and responsible use of opioids. The course will place an emphasis on how to manage cases where the patient has a history of substance abuse, or is at high risk of becoming addicted.