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

描述(由申请人提供)：这一阶段第二阶段建议开发和测试一个在线继续医学教育计划的初级保健医生称为管理成瘾和疼痛在初级保健(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方面的效用，但医生对慢性疼痛的处方仍然不足。许多医生担心患者可能会滥用职权，可能会承担责任，并受到监管机构的谴责。不愿开阿片类药物在初级保健医生(PCP)中尤为明显，他们治疗疼痛患者的比例很高。初级保健医生采用疼痛管理和成瘾药物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，特别是那些可能或过去有药物滥用/滥用的患者。FDA推广阿片类药物的风险评估和缓解策略(REMS)可能需要进一步发展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样的培训。随着互联网和商业逻辑(决策分支)软件的出现，可以使用技术来吸引和教育寻求建立疼痛治疗技能的医生。使用这项技术，MAP-PC将帮助医生：(1)提高面临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药物技能；(2)就患者适当使用阿片类药物做出明智的决定；以及(3)管理阿片类药物治疗疼痛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。疗效研究将包括两个条件的随机化：(1)实验(MAP-PC)和(2)对照(基于在线文本的继续医学教育)。试验组和控制组将接受基线评估、干预后和三个月的随访。第二阶段包括测试假设，相对于控制条件，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，以及(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。我们还将测试二级假设，即与对照条件相比，暴露于MAP-PC的医生将显著感受到：(1)为慢性疼痛患者开阿片类药物的障碍减少，以及(2)减少不愿为慢性疼痛开阿片类药物(改变的信念)。最后，我们将测试用户对MAP-PC的满意度和接受度。 与公共卫生相关：由于初级保健医生对开阿片类药物的矛盾心理，担心患者可能滥用或对药物上瘾，疼痛往往得不到充分治疗。对于可能或过去有药物滥用/滥用史的患者尤其如此。这项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，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疼痛管理和成瘾药物技能，帮助面临阿片类药物滥用或误用风险的疼痛患者。如果成功，这一计划可以帮助医生为慢性疼痛患者提供必要的治疗，同时更有效地管理阿片类药物滥用/滥用的风险，从而加强公共健康。

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.