Trudeau Kimberlee J, Hildebrand Cristina, Garg Priyanka, Chiauzzi Emil, Zacharoff Kevin L
Inflexxion Inc, Newton, Massachusetts, MA, USA.
PatientsLikeMe, Inc, Cambridge, Massachusetts, MA, USA.
Pain Med. 2017 Apr 1;18(4):680-692. doi: 10.1093/pm/pnw271.
To improve pain management practices, we developed an online interactive continuing education (CE) program for primary care providers (PCPs). This program follows the flow of clinical decision-making through simulated cases at critical pain treatment points along the pain treatment continuum.
A randomized controlled trial was conducted to test the efficacy of this program. Participants were randomized to either the experimental condition or the control condition (online, text-based CE program).
A total of 238 primary care providers were recruited through hospitals, professional newsletters, and pain conferences.
Participants in both conditions reported significantly improved scores on knowledge (KNOW-PAIN 50), attitudes (CAOS), and pain practice behaviors (PPBS) scales over the four-month study. The experimental condition showed significantly greater change over time on the tamper-resistant formulations (TRFs) of opioids and dosing CAOS subscale compared with the control condition. Post hoc comparisons suggested that participants in the experimental condition were less likely to endorse use of opioid TRFs over time compared with the control condition. Exploratory analyses for potential moderators indicated a significant three-way interaction with time, condition, and discipline (i.e., physician vs other) for the impediments and concerns attitudes subscale and the early refill behaviors subscale. Post hoc comparisons indicated that physicians in the experimental condition exhibited the greatest change in attitudes and the nonphysicians exhibited the greatest change in reported behaviors in response to requests for early refills.
Findings suggest online CE programs may positively impact PCPs' knowledge, attitudes, and pain practice behaviors but provide minimal evidence for the value of including interactivity.
为改善疼痛管理实践，我们为初级保健提供者（PCP）开发了一个在线交互式继续教育（CE）项目。该项目通过疼痛治疗连续过程中关键疼痛治疗点的模拟病例，遵循临床决策流程。
进行了一项随机对照试验以测试该项目的疗效。参与者被随机分配到实验组或对照组（基于文本的在线CE项目）。
通过医院、专业时事通讯和疼痛会议招募了总共238名初级保健提供者。
在为期四个月的研究中，两组参与者在知识（KNOW - PAIN 50）、态度（CAOS）和疼痛实践行为（PPBS）量表上的得分均有显著提高。与对照组相比，实验组在阿片类药物的抗 tamper 配方（TRF）和给药CAOS子量表上随时间的变化显著更大。事后比较表明，与对照组相比，实验组的参与者随着时间的推移更不太可能认可使用阿片类药物TRF。对潜在调节因素的探索性分析表明，在障碍和担忧态度子量表以及提前续方行为子量表上，时间、条件和学科（即医生与其他）之间存在显著的三向交互作用。事后比较表明，实验组的医生在态度上变化最大，而非医生在回应提前续方请求时报告的行为变化最大。
研究结果表明，在线CE项目可能对初级保健提供者的知识、态度和疼痛实践行为产生积极影响，但为包含交互性的价值提供的证据很少。
