Pain Addiction Progress 2009-10
From Clinicaltools.com
Contents |
Project Guide
SBIR Phase II Contract #HHSN271200900003C
ADB Contract No. N44-DA-9-2213
Title: Web Based Training for Pain Management Providers
PI: T. Bradley Tanner, MD
Monthly Progress Report #7
Reporting Period: 10/1/09 – 10/31/09
Project Period: 4/1/09 – 3/31/11
Pain and Addiction Project Framework
Overview
During October, we focused primarily on content development of the project's website, PainandAddictionTreatment.com in consultation with expert consultants. We also continued to develop the website interface in response to last month's usability study. Finally, we began setting up a Standardized Patient Interface and sample case, which will be used in our second usability study, and began preparations for conducing that study next month.
Progress During October 2009 by Objective
Objective 1
Develop Skills Training Content
Courses: We sent the third course, Ongoing Management, to consultant, Steven Passik, for review. We continued researching and writing content for the fourth core course, Avoiding Diversion and began doing the same for the content for the SP courses on stage of addiction and pain condition. We determined that this content will be integrated into the four core courses and the SP courses will focus on the experience of practicing what was learned in core courses.
"Key Info" Guides: We continued work on content of the Evidence and Guidelines Key info guides and decided these need to be combined into one Key Info guide due to repeated content. We finished revision on the Government Regulations based on expert consultant feedback.
Objective 2
Build Supporting Functionality
- We began development of the Standardized Patient chat interface. Clinical information and medical history for the standardized patient was created to be viewed within a chat window to facilitate the standardized patient experience.
- Plus and minus toggle buttons were incorporated into the clicktip links to indicate when a box of text may be expanded to reveal more.
- The format of the homepage was redone to break up the pattern of columns and boxes, as recommended from usability. Two columns were combined into one column, and moved to the left. CME, Category II CME, and Resources sections were created within rounded color-coded clicktip boxes in the center/main area of the page so that they could be better recognized.
- Icons were created and added to the CME, Category II CME, and Resources sections of the pages to assist with branding and recognizability.
- A draft Venn diagram image was created and added to the site; the final version will illustrate the interface of pain control and addiction issues with pain and addiction treatment.
- A keyword search was added to the resource center in response to usability.
Objective 3
Evaluate Curriculum Content
- We sent several courses and Key Info Guides for expert evaluation:
- Course # 1: Initial Assessment is being evaluated by Seddon Savage.
- Course # 3: Ongoing management is being evaluated by Steven Passik.
- We completed revisions on the Government Regulations Key Info guide based on feedback from consultant Howard Heit.
Objective 4
Evaluate Interface Design (Usability)
- We started setting up a remote, live standardized patient interface in preparation for usability test #2, which we will complete next month. We selected a case to use for the test and began adapting it to the primary care physician and the online format. We began planning for the test, deciding to focus on nurse practitioners in primary care or emergency departments and to hold the test near the end of next month.
Objective 5
Obtain OMB clearance
- We prepared for a meeting with the project officer on OMB clearance application by reviewing documents she sent.
Objective 6
Conduct Summative Evaluation
- Scheduled for year 2.
Objective 7
Disseminate Results
- We completed the interface of our system for tracking website usage.
- We prepared and submitted the following abstract for the American Pain Society meeting in Baltimore in May 2010.
Abstract: Online Training Needs of Primary Care Providers in Pain and Addiction, Abstract ID#244: K. Rossie, M. Metcalf, T. Tanner
Topic: Ethical, Legal, Financial and Education Subtopic: C01 Education – Professional and Lay
The majority of primary care providers did not receive adequate training to detect, prevent, and manage patients at the interface of pain and addiction (CASA, 2005). But there are currently little data to guide training development so that it emphasizes the specific areas of greatest need. We surveyed a convenience sample of twenty-seven primary care providers (9 physicians, 9 residents, and 9 nurse practitioners) retrospectively about their training at the interface of treating pain and addiction. They were asked to rate their agreement that their clinical training adequately prepared them in 9 specific areas. The responses were very similar for each of the three groups. Sixty-four percent (64%) of participants disagreed (either strongly disagreed or disagreed) that they were adequately prepared to treat pain in patients in recovery. Sixty percent (60%) disagreed that they were prepared to treat pain in patients with current addictions. And 52% disagreed that they were adequately prepared to treat patients at risk for addiction. Perception of their training to assess pain in the context of addiction issues was more positive. Of the participants, 48% agreed or strongly agreed that they were adequately prepared to recognize addiction in a pain patient; still 28% disagreed. Similarly, 48% agreed or strongly agreed that they were adequately prepared to recognize patients at risk for addiction; but 36% disagreed. Primary care providers do not feel adequately prepared by their training in pain and addiction, especially in the areas of treatment. Training needs related to treatment increase as the risk of addiction increases. Educational curricula are needed to ensure that pain treatment providers have the skills necessary to assess and treat patients at the interface of pain and addiction.
Reference: CASA. Under the counter: The diversion and abuse of controlled prescription drugs in the U.S., 2005.
Funded by NIDA/NIH contract #HHSN271200800012C.
Work to be Performed in the Next Reporting Period
Objective 1
Develop Skills Training Content
Courses: We will finish writing the fourth course on Avoiding Diversion and send it for review. We will edit the Initial Assessment and Ongoing Management courses according to feedback from expert consultants. We will continue to develop the content for the standardized patient courses.
Resources: We will finalize a company wide taxonomy for faceted search and make changes in our resources to fit the new scheme.
Key Info Guides: We will finalize content in the Assessments Key Info Guide and combine the Evidence and Guidelines guides into one. We will revise drafts of Key Info Guides according to expert consultant feedback as they return their comments to us. We will send the remaining guides (Opioid Prescribing Guidelines and Evidence plus Assessments) to expert consultants for review.
Objective 2
Build Supporting Functionality
- The homepage will continue to be developed according to usability findings.
- The standardized patient chat interface will be developed and rendered functional in preparation for usability testing.
Objective 3
Evaluate Curriculum Content
- We will send drafts of the remaining Key info Guides (Guidelines and Evidence plus Assessment) and the 4th course (Avoiding Diversion) for expert review this month and will revise the 1st and 3rd courses based on consultant feedback once it is received.
Objective 4
Evaluate Interface Design (Usability)
- Finish a mockup of the interface for the Remote Live Standardized Patient which will be tested in the 2nd usability test.
- Recruit for the 2nd usability test
- Write and test the usability test script.
- Begin usability test 2.
Objective 5
Obtain OMB clearance
- Meet with project officer regarding OMB application and continue developing application.
Objective 6
Conduct Summative Evaluation
- Revisions as needed in Summative Assessment as part of OMB clearance application.
Objective 7
Disseminate Results
- No activity planned for November.
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.)
Appendix
Collated Usability Results and Responses
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
