Purpose (209/250): The majority of providers in the pain practice community have not fully incorporated evidence-based and clinical consensus recommendations for preventing, recognizing, and managing substance misuse and addiction in pain patients. This problem exists despite the fact that the recommendations are not difficult to understand, resources exist, and the risk of mistreatment is obvious [and deleterious for the physician as well as patient]. The majority of these providers did not receive adequate training to detect, prevent, and manage patients at the interface of pain and addiction. More specifically, the problems include: 1) Existing training programs give little attention to the problem of substance misuse and addiction in pain patients, 2) Addiction potential is not seen as a comprehensive understanding of the varying risk in addiction potential, severity, type, history, impact, or duration, 3) Existing training typically focuses on knowledge acquisition rather than skills training, and, 4) Pain treatment providers have little time thus they need quick and simple access to high quality addiction resources when managing pain patients.
To address these problems we have created an online environment that enables pain management providers to better manage co-morbid substance misuse and addiction or risk for addiction in patients suffering from pain, using contract funding from the National Institute on Drug Abuse.
Method(s) (160/250): During 2008 we assembled a panel of 12 pain and addiction expert consultants, including physicians, nurses, researchers, and a psychologist. An extensive needs analysis was conducted with primary care providers and with pain and addiction experts (N=56); they provided feedback about the target audience's educational needs and online learning preferences and the proposed education plan.
Usability tests with two different groups of pain management providers (physicians, and nurse-practitioners) were conducted during 2009. The primary focus was to assess the interface of the online "chat-based" standardized patient (SP) interview experience using mixed methods including "think aloud", qualitative surveys and open ended interview questions. Additionally, participants were asked to provide feedback on a "self-assessment" tool which will be included in the training program.
Iterative rounds of review from experts were employed to assess the educational content of the continuing education modules, SP cases, and the informational Guides. Resources were added to an online database based on expert recommendation, Google(R), and PubMed searches.
Results (217/300): We have designed an online environment for pain management providers that provides a unique combination of skills training/continuing education, resources, and collaboration related to the topic of pain and addiction. Pain managers can use the website to collaborate, answer point of care questions, and/or receive CME credit on a just-in-time basis or via standard educational curricula. To provide skills training for primary care and specialist professionals who treat patients with pain problems we created a novel SP educational experience available via Internet chat with a live SP performing the role of a patient with issues relevant to both pain and addiction.
A functional online resource has been created that responds to the usability recommendations and needs analysis work. Six online educational courses and 2 SP cases have been reviewed by experts and will be available for continuing medical education credit in Fall 2010. Over 200 resources are available, each with a short annotation, and the ability for the user to provide an additional critique.
Future work will assess if as a result of this project, the clinician will be able to: 1) reduce the risk of misuse of prescribed substances, 2) recognize and assure adequate treatment of substance misuse and addiction in chronic pain patients, and 3) provide adequate pain management in patients with substance use disorders.
Conclusion (62/100): The project has successfully built a suite of skills training courses with supportive content that offers real world challenges in the form of brief cases, more complicated cases and SPs. The curriculum includes a catalog of quality resources and a high quality search engine that gives users a quick and simple way to find the resources they need using any Internet-capable tool.