University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ.
Fam Med. 2020 Feb 6;52(3):189-197. doi: 10.22454/FamMed.2020.865003.
Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management.
An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion.
Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P<.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%).
Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.
阿片类药物滥用正处于历史危机水平，全国范围内都需要加强对住院医师和临床医生的慢性疼痛管理方面的教育。迄今为止，还没有针对学习者的慢性疼痛管理知识或态度进行广泛、可扩展、综合的疼痛管理教育干预的有效性评估。
评估了 11 小时综合疼痛管理（IPM）在线课程对住院医师和教师对慢性疼痛管理的态度和知识的影响。参与者从参与综合医学住院医师计划的家庭医学住院医师中招募。有 22 个住院医师参与，其中 11 个接受课程，11 个作为对照组。评估包括医学知识的预先/后测以及疼痛患者态度、非药物治疗自我效能、职业倦怠和同情心的经过验证的测量。
43 名参与者（34.4%）完成了课程。接受课程的干预组（n=50）在医学知识、对疼痛患者的态度和开具非药物治疗处方的自我效能方面显著提高（P<.05），而对照组（n=54）则没有改善。两组的职业倦怠或同情心均无影响。该课程得到了积极评价，83%-94%的人对课程内容和教学评价非常高。所有参与者均表示他们将把课程信息纳入实践中，并且几乎所有人都认为他们在课程中学到的知识将改善患者的护理（98%）。
我们的研究结果表明，在线 IPM 课程作为一种针对当前阿片类药物危机和改善慢性疼痛管理的需求的有效且可扩展的住院医师和初级保健提供者干预措施是可行的。未来的方向包括测试可提高完成率的格式的可扩展性、在非学术环境中的实施以及评估临床结果，如减少阿片类药物处方。
