Pain Addiction Progress 2009-5
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 #2 of 24
Reporting Period: 5/1/09 – 5/31/09
Project Period: 4/1/09 – 3/31/11
Pain and Addiction Project Framework
Overview
This has been a productive month with substantial progress in development of the core courses, step-by-step guides (How-To Guides) and other resources, on the website PainandAddictionTreatment.com.
Progress During May 2009
Objective 1
Develop Skills Training Content
Courses: We continued to research and write the educational content for the four core courses (Initial Assessment, Initial Prescribing, Ongoing Management, and Avoiding Diversion) following the established outlines. We have also been incorporating the new guidelines for prescribing opioids published by the American Pain Society and the American Academy of Pain Management in February of 2009. Because our courses cover the interface of pain and addiction, they have a different organization from the publications from either of these specialties. Thus, we have found it most efficient to develop all four courses simultaneously as we review the literature. Didactic course content is approximately 75% completed for the four core courses.
Resources: We continued to add resources to round out our data base. Our emphasis this month was on obtaining the best and most representative resources in the categories related to the interface of pain and addiction. We added approximately 100 new resources to our data base this month, which included writing annotations for each of them. We also added publication information on abstracts and articles.
How-To Guides: We completed two guides to the key clinical skills used at the interface of pain and addiction and started work on two more guides. The completed guides are on Urinary Drug Testing and Government Regulations for Prescribing Controlled Substances. The government regulations guide was adapted from a slide presentation developed by one of our consultants, Howard Heit, MD and was used with his permission. We created the urine drug testing guide from a thorough review of the literature. We nearly completed a third guide on Assessment Tools this month which is an extensive project describing most of the major assessment tools used in Pain and Addiction (approximately 50). We also started work on a fourth guide on Patient Treatment Agreements.
Glossary: We defined approximately 50 terms and added them to a glossary data base. Terms are underlined in the text and the definition can be seen by clicking on the word. The effect was distracting while reading so we reduced the number of terms defined to 20 terms we believed would most likely be unfamiliar to primary care physicians.
Objective 2
Build Supporting Functionality
Homepage
General Technologies
- The code that supports the design of the webpages (CSS) was modified from a package theme we had imported. This included changing the color scheme of the fonts, links, backgrounds, navigational boxes, hovertips, and clicktips from the default colors that came with the theme to a color scheme of grays, blues, and purple.The customized new CSS better suits the individual content of the site.
- We rearranged the homepage sections, including the FAQ section and Forums section to improve appearance and feature the most important sections.
- We enabled and configured a glossary module. The glossary module will automatically highlight glossary terms wherever they appear in the site. The user may hover over each term to see the definition, or click the term to be directed to the entire glossary. We began adding terms to the glossary.
"We created a navigation system based on secondary links for the two major sections, How to Guides and Courses. We created a separate left navigation system based on Drupal's book function within each How to Guide and course.
Resources
- A keyword search function was added to the Resources page
- The resources page was reorganized to feature the choices of topic/category search or key word search
- Resource rating function was added which allows users to rate and comment on the resources.
- -The resource_search page was created. Search boxes for "Latest," "Most Popular," and "Favorite" resources were created. A Resource Center was created with a search box, a "Guided Search" composed of clickable tags, and a "Selected Resources" section with lists of categories containing different resources.
How-To Guides
- We also created How-to Guide pages and a navigation system.
- Navigation of the How-To Guides was improved in terms of appearance, function and standardization.
Objective 3
Evaluate Curriculum Content
- This month we provided our consultants with an update on the status of the project. We also met with some of them and observed their presentations at the ASAM meeting in Florida this month.
Objective 4
Evaluate Interface Design (Usability)
We developed a recruitment plan for the usability test scheduled for July 2009. In addition to our usual methods outlined in the proposal, we will recruit recent graduates of primary care residencies via contacts we have in several residency programs. We will also include several nurse practitioners from a waiting list we developed during Phase I.
Objective 5
Obtain OMB clearance
We started the procedure to apply for OMB clearance to use more than 9 subjects in the summative analysis by determining the latest procedures for this process and filling out the application.
Objective 6
Conduct Summative Evaluation
Scheduled for year 2.
Objective 7
Disseminate Results
We attended ASAM's 40th Annual Medical-Scientific Conference at the end of April/beginning of May. We met with consultants from this project as well as ASAM members and discussed what is needed for pain managers regarding the interface of pain and addiction. We also met with ASAM administrative staff to discuss the logistics and timeline of the curriculum and website development, since ASAM is a partner on the project.
We also attended several conference sessions about pain and addiction - a topic that was notably prevalent at the conference this year. Presenters discussed the increase in opioid use in the U.S. and the (emerging) use of buprenorphine to treat pain. Several talks focused on the need for stronger evidence for use of opioids in chronic pain management and need for more definitive clinical guidance for treating pain. We also learned more about the forthcoming REMS (Risk Evaluation and Mitigation Strategies) that the FDA is going to require pharmaceuticals to provide for some opioids.
Work to be Performed in the Next Reporting Period
Objective 1
Develop Skills Training Content
Courses: We will finish developing basic didactic educational content for the first three of the core courses (Initial Assessment, Initial Prescribing, and Ongoing Monitoring) and start creating mini-case scenarios to illustrate each step.
Resources: We will continue to build the data base by adding and cataloging more resources. We will finalize the taxonomy system for use in a faceted search and tag resources in the data base.
How To Guides: We will complete the guides on Assessment and Patient Treatment Agreements as well as develop a guide on Prescription Drug Monitoring Programs.
Objective 2
Build Supporting Functionality
General
- Add further design elements and functionality to the homepage to give the section better definition, finalizing a version that can be tested in usability testing.
- A completely automated public turing test to tell computers and humans apart, or "CAPTCHA," will be configured to prevent spamming of the message boards on the site. The CAPTCHA will automatically generate questions only a human can answer with every registration attempt
- Add CSS level design elements to the Course and How To Guides pages.
- Set up a flexible CSS page layout which will allow the widths of the middle content area to expand automatically in the absence of right and/or left sidebars. The flexibility of using from one to three sections will fit better with the different types of content available on the site..
- A "Recent News" section will be added to showcase changes in FDA regulations as well as new additions and developments to the site.
Resources
- Create a data base for Assessment Tools and design an interactive tool for selecting them.
- Improve the faceted search by developing an exhaustive list of tags and categories and incorporating them into the resource center.
Objective 3
Evaluate Curriculum Content
Send completed How to Guides to consultants for review. Consult with experts as needed while developing core courses.
Objective 4
Evaluate Interface Design (Usability)
Develop assessment tool and recruit 9 participants for usability test scheduled for July 2009.
Objective 5
Obtain OMB clearance
Develop the summative assessment to be included in the OMB clearance application.
Objective 6
Conduct Summative Evaluation
Develop the summative evaluation assessment tool for the summative evaluation that is scheduled for year 2 as described above. This assessment will be included in the OMB application.
Objective 7
Disseminate Results No activity
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
