An Educational Intervention for Internal Medicine PGY-1 Residents Improves Knowledge in Principles of Pain Management and Opioid Safety (S790)

Introduction: the Pain management in internal medicine ward is a common problem. Studies have shown that the evaluation of pain and its documentation by the medical staff is inaccurate and tends to underestimate the level of pain reported by patients. In addition, Physicians often report lack of knowledge and misconceptions regarding pain management. Objectives: To assess the impact of a structured pain educational program on knowledge, skills and abilities [KSA’s] of internal medicine ward physicians in pain management. Methods: Eleven physicians from Internal medicine ward B at Bnai-Zion Medical Center, a tertiary academic center in Israel, participated in a pain educational program. Questioners regarding pain KSA’s, were completed before and after the educational intervention. Concomitantly, a pain management protocol was implemented in the department. Results: There was a 55.5% (P.value = 0.003) improvement in the overall satisfaction of the physicians regarding pain management in the internal ward on a 1 to 6 Likert scale (1-strongly disagree, 6-strongly agree) .In a modified KnowPain50 [KP50] questionnaire that assesses physicians KSA, the average score for all physicians improved by 15.3% (P.value = 0.012) after the intervention. Conclusion: A targeted educational intervention on pain management can improve physician’s KSA, and this we belive may lead to a better treatment for patients suffering from pain in the hospital scenerio.

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Pain management in Internal Medicine and effects of a standardised educational intervention: the FADOI-DOMINO Study

International Journal of Clinical Practice ◽

10.1111/ijcp.12515 ◽

2014 ◽

Vol 69 (1) ◽

pp. 33-40 ◽

Cited By ~ 1

Author(s):

G. Civardi ◽

F. Zucco ◽

A. Valerio ◽

A. Fontanella ◽

M. Alessandri ◽

...

Keyword(s):

Internal Medicine ◽

Pain Management ◽

Educational Intervention

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Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians

10.21203/rs.3.rs-738857/v1 ◽

2021 ◽

Author(s):

Pankti P. Acharya ◽

Brianna Fram ◽

Jenna R. Adalbert ◽

Ashima Oza ◽

Prashanth Palvannan ◽

...

Keyword(s):

Internal Medicine ◽

Emergency Medicine ◽

Pain Management ◽

Educational Intervention ◽

General Surgery ◽

Educational Interventions ◽

Physician Education ◽

Opioid Epidemic ◽

Prescribing Habits ◽

Resident Physicians

Abstract Background The opioid epidemic is a multifactorial issue, which includes pain mismanagement. A recent study has shown that residents have received little training for opioid related patient care. Therefore, resident physician education is essential in addressing this issue. We aimed to analyze the effects of an educational intervention on the knowledge and potential prescribing habits of emergency medicine, general surgery, and internal medicine residents. Methods Resident physicians were provided with educational materials and were given pre- and posttests to complete. Descriptive statistics were used to analyze pre- and posttest responses. Chi-squared analysis was used to identify changes between the pre and posttests. A p < 0.05 value was considered statistically significant. Results Following the educational intervention, we observed improvement in correct prescribing habits for acute migraine management among emergency medicine residents (from 14.8–38.5%). Among general surgery residents, there was significant improvement in adherence to narcotic amounts determined by recent studies for sleeve gastrectomy (p = 0.01) and laparoscopic cholecystectomy (p = 0.002). Additionally, we observed a decrease in the number of residents who would use opioids as a first line treatment for migraines, arthritic joint pain, and nephrolithiasis. Conclusions Resident physicians have an essential role in combating the opioid epidemic. There was significant improvement in various aspects of opioid related pain management among emergency medicine, internal medicine, and general surgery residents following the educational interventions. We recommend that medical school and residency programs consider including opioid related pain management in their curricula.

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Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.059 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i48-i49

Author(s):

S Visram ◽

J Saini ◽

R Mandvia

Keyword(s):

Data Analysis ◽

Pain Management ◽

Cancer Pain ◽

Educational Intervention ◽

Opioid Analgesics ◽

Educational Outreach ◽

Opioid Prescribing ◽

Prescribing Trends ◽

The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

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Placebo Use in Pain Management: A Mechanism-Based Educational Intervention Enhances Placebo Treatment Acceptability

Journal of Pain ◽

10.1016/j.jpain.2015.10.017 ◽

2016 ◽

Vol 17 (2) ◽

pp. 257-269 ◽

Cited By ~ 5

Author(s):

Nkaku R. Kisaalita ◽

Robert W. Hurley ◽

Roland Staud ◽

Michael E. Robinson

Keyword(s):

Pain Management ◽

Educational Intervention ◽

Treatment Acceptability ◽

Placebo Treatment

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1319. Examining PrEP Knowledge and Prescribing Likelihood Among Medical Residents Before and After PrEP Education

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1152 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S403-S403 ◽

Cited By ~ 2

Author(s):

Elizabeth Christian ◽

Wendy Craig ◽

Kinna Thakarar

Keyword(s):

Internal Medicine ◽

Educational Intervention ◽

Care Center ◽

Tertiary Care ◽

Knowledge Score ◽

Medical Residents ◽

Convenience Sample ◽

Before And After ◽

Student’S T ◽

Motivating Factor

Abstract Background Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescribing rates remain low. We examined the effect of an educational intervention on PrEP knowledge and prescribing likelihood among medical residents. Methods This was a prospective study using a convenience sample of Internal Medicine and Internal Medicine-Pediatrics residents at a tertiary care center in Portland, Maine. Participants attended a resident-led teaching session on PrEP and completed pre- and post-session surveys. PrEP knowledge was measured with five questions (definition, evidence, patient selection criteria, medication choice, and guidelines), and prescribing likelihood was assessed on a Likert scale. Participants identified motivating factors and barriers to prescribing. Survey data were analyzed with McNemar’s test or a paired Student’s t test as appropriate. Results Thirty residents completed the study; of these, 24 (83%) had at least 1 patient that they considered at high risk for HIV, and 14 (46%) reported having >5 such patients. None had ever prescribed PrEP. Average PrEP knowledge score increased after the intervention (pre = 2.33 vs. post = 4.1, P < 0.001). After the intervention, more participants reported that they would be likely to prescribe PrEP (pre = 76% vs. post = 90%, P = 0.014), fewer identified unfamiliarity with PrEP guidelines as a barrier (pre = 73% vs. post = 27%, P < 0.001), and Òother residents are prescribing PrEPÓ became a significant motivating factor (pre = 47% vs. post = 70%, P = 0.04). Preceptor comfort with prescribing PrEP was a consistently important influence on prescribing likelihood (90% vs. 82%, P = 0.22). Conclusion Familiarity with PrEP is relevant to resident practice, and an educational intervention is effective in the short term for addressing inadequate knowledge as a barrier to offering PrEP. Resident practice is influenced by preceptors and peers, suggesting that it may be helpful to include attending physicians in future PrEP education efforts at our institution. Disclosures All authors: No reported disclosures.

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Use of a comprehensive survey as a first step in addressing clinical competence of physicians-in-training in the management of pain

Journal of Opioid Management ◽

10.5055/jom.2005.0023 ◽

2005 ◽

Vol 1 (2) ◽

pp. 98 ◽

Cited By ~ 6

Author(s):

Mark Chaitowitz, MBBCh ◽

William Tester, MD ◽

Glenn Eiger, MD

Keyword(s):

Internal Medicine ◽

Pain Management ◽

Residency Program ◽

Clinical Competence ◽

Initial Step ◽

Educational Interventions ◽

Pain Scale ◽

Contributing Factors ◽

Management Interventions ◽

Comprehensive Survey

Deficiencies in practice, knowledge, and competence among physicians are important contributing factors to the unsatisfactory level of analgesic care in hospitalized patients. By way of a comprehensive survey, we characterized these deficiencies within an internal medicine residency program as an initial step in designing remedial educational strategies. To do so, an anonymous 43-item survey was administered to residents in an internal medicine program. A total of 61 residents (69 percent) responded.The results indicated that patient-controlled analgesia (PCA), a standardized pain scale, and an opioid equivalence table were underused. Competence in opioid conversion was suboptimal, but completion of an oncology rotation and familiarity with the opioid equivalence table predicted greater competence in this area (p = 0.007 and p = 0.001, respectively).Self-perceptions of adequacy of training and painmanagement competence were predictors of knowledge (p = 0.026 and p = 0.038, respectively). Attitudes regarding opioid analgesia were generally satisfactory (i.e., low “opiophobia” score), although the risk of addiction was still overestimated.The characterization of deficiencies in pain management in a residency program is an essential step in the design and implementation of educational interventions. Administration of a comprehensive survey is a simple and effective method of gathering this data and has the additional benefit of promoting awareness of pain management issues. Our experience served to establish, among other findings, the didactic value of experience on an oncology floor; this result substantiates the value of practical experience in the gaining of clinical competence in pain management. Interventions that capitalize on the findings of the survey and the interest in pain management generated by its administration are currently ongoing at our institution.

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A multifactorial intervention for hospital opioid management

Journal of Opioid Management ◽

10.5055/jom.2014.0223 ◽

2014 ◽

Vol 10 (5) ◽

pp. 337 ◽

Cited By ~ 2

Author(s):

Mehmet Akce, MD ◽

Anupam Suneja, MD ◽

Cheryl Genord, RPh ◽

Bonita Singal, MD, PhD ◽

John A. Hopper, MD

Keyword(s):

Internal Medicine ◽

Decision Support ◽

Decision Support System ◽

Pain Score ◽

Educational Intervention ◽

Support System ◽

Training Session ◽

Secondary Outcome ◽

Analgesic Dose ◽

Over Time

Objective: To determine whether an educational intervention combined with a voluntary decision support system improves inpatient pain control.Design: Retrospective serial cross-sectional study.Setting: Community teaching hospital.Patients: Patients admitted to internal medicine teaching service from October to December 2011 and 2012. The study cohorts consisted of a random sample of 75 patients each from both time periods.Interventions: Beginning in August 2012, internal medicine residents participated in an interactive training session on the use of opioids for hospitalized patients and concurrently, a user initiated voluntary computerized decision support system (CDSS), in the form of computer order entry (COE) and pocket cards were introduced. The COE options correspond to the standardized opioid dosing regimen on the pocket card. Pain scores and opioid doses and demographic information were obtained from administrative databases. Additional covariates were abstracted via programmed electronic medical record (EMR) review.Main outcome measures: Pre- and postintervention, maximum reported pain score in every 8-hour period from first analgesic dose, to 72 hours after the first analgesic dose, were compared by fitting a multivariable linear mixed model. Naloxone use was a surrogate measure for secondary outcome of opioid overdose.Results: The intervention had no effect on maximum pain score (MPS) over time, p = 0.0930. The estimated mean MPS (95% confidence interval) was 4.7 (3.9, 5.5) preintervention and 5.2 (4.4, 6.0) postintervention.Conclusions: A combination of a resident educational intervention, CDSS, and pocket cards did not improve MPSs over time for patients on an internal medicine teaching service.

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