Dewey Charlene M, Ghulyan Marine V, Swiggart William H
a Vanderbilt University Medical Center , Nashville , Tennessee , USA.
Subst Abus. 2016 Jul-Sep;37(3):412-418. doi: 10.1080/08897077.2015.1096318. Epub 2015 Nov 16.
Controlled prescription drug (CPD) abuse has reached epidemic proportions in the United States. Most physicians attending a 3-day continuing medical education (CME) professional development program (PDP) lack training in identifying risk and in managing patients who misuse CPDs. To address this issue, the authors conducted an evaluation of a PDP that trains physicians on proper prescribing, identifying substance abuse, utilizing screening, brief intervention, and referral to treatment (SBIRT), and implementing motivational interviewing (MI).
The authors conducted a program evaluation to assess the efficacy and impact of the PDP on physicians' knowledge and prescribing behaviors.
Participants (N = 174) were typically middle-aged (average age of 53 years), male (89%), and physicians (82%) and other health care professionals (18%). Many physicians practice in solo primary care settings (46%). Course evaluations were completed by n = 155 (89%) participants who rated the course and presenters highly (mean 4.8/5 respectively). Physicians' knowledge scores on pre/post assessments increased significantly: pretest (M = 58.7, SD = 13.12) and posttest (M = 78.28, SD = 9.83) (t(173) = 20.06, P ≤ .0001, 95% confidence interval, CI: [-21.51, -17.65]). Almost half of the participants, n = 83/174 (48%), completed the follow-up survey, and 93% agreed/strongly agreed (A/SA) they made professional practice changes. Of participants practicing with an active DEA (Drug Enforcement Administration) registration (n = 57), most agreed/strongly agreed they implemented changes to align their practices with current guidelines (89%), used CPD more appropriately (87%), implemented office policies on prescribing (81%), identified and referred more substance abuse patients to treatment (80%), shared new information/experience from course with other 25 health professionals (93%), and felt the course positively impacted their behaviors personally and professionally (90% and 96%, respectively).
This is the first known study evaluating a PDP in this population. Results demonstrated participant satisfaction and improvement in prescribers' knowledge and self-reported prescribing behaviors. However, further study is needed to assess actual clinical practice changes, direct impact on patient outcomes, and rates of recidivism.
在美国，受控处方药（CPD）滥用已达到流行程度。参加为期3天的继续医学教育（CME）专业发展计划（PDP）的大多数医生缺乏识别风险以及管理滥用CPD患者的培训。为解决这一问题，作者对一个PDP进行了评估，该计划培训医生正确开处方、识别药物滥用、利用筛查、简短干预和转介治疗（SBIRT）以及实施动机性访谈（MI）。
作者进行了一项计划评估，以评估PDP对医生知识和开处方行为的有效性和影响。
参与者（N = 174）通常为中年（平均年龄53岁），男性（89%），医生（82%）和其他医疗保健专业人员（18%）。许多医生在单独的初级保健机构执业（46%）。n = 155名（89%）参与者完成了课程评估，他们对课程和授课者评价很高（平均分分别为4.8/5）。医生在课前/课后评估中的知识得分显著提高：预测试（M = 58.7，SD = 13.12）和后测试（M = 78.28，SD = 9.83）（t(173) = 20.06，P ≤.0001，95%置信区间，CI：[-21.51，-17.65]）。几乎一半的参与者，n = 83/174（48%），完成了后续调查，93%的人同意/强烈同意（A/SA）他们在专业实践中做出了改变。在拥有有效的药品执法管理局（DEA）注册的参与者中（n = 57），大多数人同意/强烈同意他们实施了改变以使自己的实践符合当前指南（89%），更恰当地使用CPD（87%），实施了处方办公室政策（81%），识别并转介了更多药物滥用患者接受治疗（80%），与其他25名卫生专业人员分享了课程中的新信息/经验（93%），并且认为该课程对他们的个人行为和专业行为产生了积极影响（分别为90%和96%）。
这是已知的第一项评估该人群中PDP的研究。结果表明参与者满意度较高，开处方者的知识和自我报告的开处方行为有所改善。然而，需要进一步研究来评估实际临床实践的变化、对患者结局的直接影响以及复发率。
