A. Sud is assistant professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8354-6153 .
G.R. Molska was research coordinator, Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada at the time this work was completed.
Acad Med. 2022 Feb 1;97(2):286-299. doi: 10.1097/ACM.0000000000004186.
Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health.
In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis.
Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement.
Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.
持续的医疗保健提供者教育（HPE）是一项重要的干预措施，得到卫生政策的支持，以应对阿片类药物流行；缺乏关于适当的方案设计和评估的知识。作者旨在全面了解阿片类药物相关持续 HPE 方案的评估及其作为改善人口健康的干预措施的适当性。
2020 年 1 月，作者对 7 个数据库进行了系统检索，以寻找有关阿片类镇痛药处方和过量预防的 HPE 方案的研究。审查员独立筛选了所有研究的标题和摘要，然后评估了所有可能符合纳入标准的研究的全文。作者使用评估复杂方案的类别提取了一系列数据：理论的使用、方案目的、投入、活动、产出、结果和行业参与。结果以叙述性综合报告。
39 份关于 32 个不同 HPE 方案的报告符合纳入标准。其中 32 个方案中有 31 个（97%）来自美国/加拿大，28 个（88%）是在 2010 年之后报告的。知识和信心变化的衡量标准很常见。绩效结果则不太常见，通常是自我报告的。大多数研究（n = 27 [84%]）使用人口健康水平上与阿片类药物相关的危害的担忧来证明教育干预的合理性，但只有 5 项（16%）直接测量与教育计划直接相关的患者或人群水平的结果。六个方案（19%）有直接或间接的阿片类药物制造商参与。
决策者和教育者将持续的 HPE 作为解决人口水平阿片类药物相关危害的重要手段加以推广，但针对阿片类药物镇痛药的 HPE 方案评估发布不足，无法评估患者或人群水平的结果。相反，它们主要侧重于自我报告的绩效结果。需要概念模型来指导旨在改善人口健康的持续 HPE 方案的制定和评估。
