Department of Family Practice, University of British Columbia, 3rd floor David Strangway Building, 5950 University Blvd., Vancouver, BC, V6T 2A1, Canada.
School of Occupational and Public Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
Fam Pract. 2022 Nov 22;39(6):1024-1030. doi: 10.1093/fampra/cmac044.
Prescribing rates of some analgesics decreased during the public health crisis. Yet, up to a quarter of opioid-naïve persons prescribed opioids for noncancer pain develop prescription opioid use disorder. We, therefore, sought to evaluate a pilot educational session to support primary care-based sparing of opioid analgesics for noncancer pain among opioid-naïve patients in British Columbia (BC).
Therapeutics Initiative in BC has launched an audit and feedback intervention. Individual prescribing portraits were mailed to opioid prescribers, followed by academic detailing webinars. The webinars' learning outcomes included defining the terms opioid naïve and opioid sparing, and educating attendees on the (lack of) evidence for opioid analgesics to treat noncancer pain. The primary outcome was change in knowledge measured by four multiple-choice questions at the outset and conclusion of the webinar.
Two hundred participants attended four webinars; 124 (62%) responded to the knowledge questions. Community-based primary care professionals (80/65%) from mostly urban settings (77/62%) self-identified as family physicians (46/37%), residents (22/18%), nurse practitioners (24/19%), and others (32/26%). Twelve participants (10%) recalled receiving the individualized portraits. While the correct identification of opioid naïve definitions increased by 23%, the correct identification of opioid sparing declined by 7%. Knowledge of the gaps in high-quality evidence supporting opioid analgesics and risk tools increased by 26% and 35%, respectively.
The educational session outlined in this pilot yielded mixed results but appeared acceptable to learners and may need further refinement to become a feasible way to train professionals to help tackle the current toxic drugs crisis.
在公共卫生危机期间，一些止痛药的处方率有所下降。然而，多达四分之一的初次使用阿片类药物治疗非癌性疼痛的患者会发展为处方阿片类药物使用障碍。因此，我们试图评估一项试点教育课程，以支持不列颠哥伦比亚省（BC）的初级保健机构减少初次使用阿片类药物的患者开具阿片类药物治疗非癌性疼痛。
不列颠哥伦比亚省治疗倡议已经启动了一项审计和反馈干预措施。个体处方画像被邮寄给阿片类药物处方医生，随后是学术细节网络研讨会。网络研讨会的学习成果包括定义术语“阿片类药物初次使用者”和“阿片类药物节约”，并向与会者传授治疗非癌性疼痛的阿片类药物镇痛缺乏证据。主要结果是通过网络研讨会开始和结束时的四个多项选择题来衡量知识的变化。
200 名参与者参加了四个网络研讨会；124 名（62%）人回答了知识问题。来自城市地区（77/62%）的社区基层医疗保健专业人员（80/65%）自我认同为家庭医生（46/37%）、住院医师（22/18%）、护士从业者（24/19%）和其他人员（32/26%）。12 名参与者（10%）回忆收到了个性化画像。虽然正确识别阿片类药物初次使用者的定义增加了 23%，但正确识别阿片类药物节约的定义却下降了 7%。对支持阿片类药物镇痛的高质量证据的差距以及风险工具的认识分别增加了 26%和 35%。
该试点中概述的教育课程产生了混合结果，但似乎为学习者所接受，可能需要进一步改进，以成为培训专业人员以帮助应对当前毒瘾危机的可行方法。
