Pain Addiction Progress 2008-10
From Clinicaltools.com
Contents |
Project Guide
SBIR Phase I Contract #HHSN271200800012C
ADB Contract No. N43-DA-8-2213
Title: Web Based Training for Pain Management Providers
PI: T. Bradley Tanner, MD
Monthly Progress Report #4 of 6
Reporting Period: 10/1/08 – 10/31/08
Project Period: 6/9/08 – 12/8/08
Pain and Addiction Project Framework
Overview
This month we focused on the final needs analysis surveys of an additional group of the target audience as well as of experts in addiction and pain medicine. We started preparing for the final needs analysis which will be interviews of pain managers. We also started preparing for the evaluation of the curriculum by the expert consultants.
Progress During October 2008
Objective 1
Determination of ASAM leader, expert consultants and expert advisory panel
- Objective completed.
Objective 2
Evaluate current technologies and literature
- Resources. We continued to expand our data base of over 100 annotated websites with more resources on pain and/or addiction. They are available at http://painandaddiction.clinicaltools.com/node/134 . The resource database will eventually also include patient handouts, screening tools, and other clinical forms as well as links to physician locaters, other continuing education, and clinical guidelines.
- Technologies. We continued to expand our searchable data base of websites offering CME credit on topics complementary to those offered by our curriculum.
Objective 3
Develop needs analysis assessments
- Online surveys. We created the final three needs analysis survey instruments, which focused on the curriculum outline draft. Separate surveys were developed for 1) the target audience; 2) specialists in addiction medicine; and 3) specialists in pain medicine. The first part of the survey for target audience members asked several questions designed to narrow down information on use of a standardized patient that we obtained in previous surveys. The survey for target audience members also asked about course relevance, the effect the course was likely to have on their confidence in treating patients, their interest in taking the proposed courses, and the importance of other healthcare providers taking the courses. The surveys for specialists in addiction or pain medicine asked similar questions on the curriculum outline, but the specialists were asked to comment from the perspective of what the primary care or other non-addiction/pain specialist might need. The surveys included Likert-type, rank order, and open-ended questions. All surveys were extensively tested internally for accuracy, clarity, and length. As with earlier surveys, we produced the three surveys using Survey Monkey. The survey questions are included along with the survey results in Appendix A.
- Interviews. We created the first draft of 20 interview questions for the semi-structured interviews of the target audience that will complete the needs analysis (See Appendix B). Questions are primarily open-ended; many have followup questions for positive responses. The interview questions were taken from:
- topics that could not be covered in a questionnaire format
- results from past needs analysis surveys that need to be clarified
- the curriculum outline
Objective 4
Conduct needs analysis
We completed the final needs analysis surveys during October and analyzed the results. First, we recruited target audience members and pain medicine specialists by way of an email message sent to a convenience sample (names culled from the Internet; past users of our continuing education courses; and consultants from other projects and their colleagues). Recruitment of addiction specialists had been completed the previous month. The preferred website title for all three groups was PainandAddictionTreatment.com. Other key findings are described below and detailed results can be found in Appendix A.
Target audience "Prescriber" survey (n=9)
- All respondents would consider taking a CME course with a remote standardized patient component.
- Most would prefer an online chat as the modality for communicating with a remote standardized patient
- Most would prefer that the standardized patient interaction last between 10 and 20 minutes. This mimics the amount of time a physician is likely to spend with a real patient in their practice.
- Most physicians rated planned website features as "useful" or "very useful", including: annotated links to relevant websites, printable patient handouts, printable clinical forms, dosing algorithm flow charts, patient triage algorithm flow charts, physician finders, calendar of events, RSS feeds from PubMed, and commonly used resources.
- Most physicians agreed or strongly agreed that they would be likely to participate in the planned discussion forum and expert forum.
- All physicians agreed that the planned pain and addiction CME website seems like it would be useful for clinicians in their specialty.
Addiction specialist survey (n=9)
- Respondents felt that primary care physicians need additional training on the topics which planned for the core course modules and four of the five course modules based on common pain diagnoses:
- Detecting Substance Use Disorders (and Risk) at Initial Evaluation of Pain Patients
- Preventing Substance Use Disorders When Prescribing Opioids to Pain Patients
- Managing Addiction Issues in Ongoing Treatment of Chronic Pain Patients
- Preventing and Detecting Diversion of Pain Medications
- Addiction Issues in the Treatment of Osteoarthritis with Opioids in Primary Care
- Addiction Issues in the Treatment of Back Pain with Opioids in Primary Care
- Addiction Issues in the Treatment of Headache with Opioids in Primary Care
- Addiction Issues in the Treatment of Neuropathy with Opioids in Primary Care
- Addiction Issues in the Treatment of Fibromyalgia with Opioids in Primary Care
- Addiction Issues in the Treatment of Acute Pain with Opioids in Primary Care
- Managing Patients who Have Untreated Addiction
- Managing Pain Patients who are in Addiction Treatment
- Managing Pain Patients who are in Addiction Recovery
- Most addiction experts reported that the important issues include:
- pain relief being adequate for the patient
- dealing with issues of tolerance and dependence
- oversight and regulatory requirements
- risk of addiction for the patient
- risk of misuse by the patient
- All addiction experts reported that they would be likely to participate in the online forum and expert forum (planned website features).
Pain specialist survey (n=5)
- Like the Addiction specialists, respondents felt that primary care physicians need additional training on all the topics planned for the four core course modules and all five course modules based on common pain diagnoses. Two specialists felt strongly that additional training on back pain was not needed, however.
- Most pain experts reported that the important issues include:
- oversight and regulatory requirements
- risk of addiction for the patient
- risk of misuse by the patient
- diversion of opioids I prescribe
- being manipulated by a deceptive patient
Objective 5
Determine the content and design (“framework”) of the proposed educational training modules
- Curriculum. We further refined the curriculum Pain and Addiction Courses in response to the results of the latest needs analyses (See Appendix C). The primary change was that we decided to present the courses based on pain diagnosis rather than the stage of addiction or recovery, because the target audience response was strongly in favor of this arrangement. However, because the target audience is also interested in treating patients in pain who are in various stages of addiction or recovery, and because the pain and addiction specialists confirmed the importance of these topics, we will include cases at various stages of addiction and recovery within the courses that are organized by pain diagnosis.
Objective 6
Evaluate curriculum plans with advisory panel and revise as needed
- We developed a survey consisting primarily of open-ended questions on the curriculum that will be used to have the project's expert consultants conduct their review during November. The survey is nearly completed at this time.
Objective 7
Create Phase II project plan, including delivery, methodology, system architecture, and contents of training program (outline complete design of product and content areas)
- During October we developed an outline of the final Phase I report and developed a plan for writing the Phase II proposal.
- We made minor changes in the website homepage framework in response to needs analysis survey results. The planned website content is described at http://painandaddiction.clinicaltools.com and a screenshot is available in Appendix D.
Work to be Performed in the Next Reporting Period
Objective 1
Determination of ASAM leader, expert consultants and expert advisory panel
- Work completed.
Objective 2
Evaluate current technologies and literature
- Describe technologies to be used for standardized patient and networking components
Objective 3
Develop needs analysis instruments
- Finalize needs analysis interview questions and test internally
Objective 4
Conduct needs analysis
- Complete recruitment of target audience members for the needs analysis inteviews
- Conduct interviews
- Transcribe and analyze interview data
- Develop action plans based on results
Objective 5
Determine the content and design (“framework”) of the proposed educational training modules
- Revise curriculum and website design in response to needs analysis results and expert consultation
Objective 6
Evaluate curriculum plans with advisory panel and revise as needed
- Finalize online survey for the expert panel to evaluate the curriculum plan
- Conduct curriculum survey with expert consultants
- Analyze survey results and implement suggested changes
Objective 7
Create Phase II project plan, including delivery, methodology, system architecture, and contents of training program (outline complete design of product and content areas)
- Write Phase II Proposal
Contact
Please feel free to contact me if you have any questions or concerns. I can be reached at (919) 960-8118 or tanner at clinicaltools dot com.
T. Bradley Tanner, MD (President, Clinical Tools, Inc.)
Other Progress Reports
Phase I Pain Addiction Progress • April 2009 • May 2009 • June 2009 • July 2009 • August 2009 • September 2009 • October 2009 • November 2009 • December 2009 • January 2010 • February 2010 • March 20010
