Pain Addiction Progress 2009-8
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 #5 of 24
Reporting Period: 8/1/09 – 8/31/09
Project Period: 4/1/09 – 3/31/11
Pain and Addiction Project Framework
Overview
During August we made substantial progress on the Resources section of the website and began our first usability test with the target audience. We continued to develop the website PainandAddictionTreatment.com's CME course content and user interface, completed drafts of the final "Key Info" guide.
Progress During August 2009
Objective 1
Develop Skills Training Content
Courses: We completed the support sections on the first three courses, that is, the posttest, quiz questions, course summaries, Key Points on each page. We also started adding mini-case scenarios to illustrate course content and completed an edit of the first two courses. They are now ready to send to consultants for review.
Resources: This month we focused on implementing the new taxonomy system for use with the faceted (refinable) search of the several hundred Resources we have collected. This involved applying new tags to all of the resources. We continued to combine categories in order to reduce them to a less overwhelming number.
"Key Info" Guides: We completed the final two guides: (Opioid Prescribing guidelines, Assessment Tools) and expert consultant Nancy Wiedemer completed a review of the guide on Informed Consent and Treatment Agreements.
Objective 2
Build Supporting Functionality
Building and refining website functionality was a key focus this month as we finished responding to the results of our internal heuristic usability test and prepared for the first usability test with the target audience. The following issues were addressed:
General
- A glossary link was added to the home and resource pages. The color of glossary terms was changed to a more visible color based on internal usability.
- A heart icon was added to the "add to favorites" link.
- CSS classes were created for tables so that the color of tables can be controlled centrally, rather than having to edit each one.
- Various aspects of the site have been streamlined to make the site less busy, and more user friendly. This includes editing the spacing between various elements and removal of Drupal's default "tags," "add to favorites," "e-mail," and "printer friendly version" from every resource on some pages.
- In response to internal usability, the CAPTCHA was modified so that they are less difficult for human users to interpret.
- The Register and Account links were modified so that only the appropriate links appear on the site for different types of users (unregistered vs. registered users).
- The Abuse Moderation module was configured so that administrators of the site may view abuse history and generate abuse reports.
Resources
- Breadcrumb-link functionality was added to the faceted search. Now users can remove a search term from their current search by clicking an "x" icon next to the term they wish to remove from a menu box.
- An "Add Your Own Resource" link was added to the Resource Center so that registered users can add their own resources.
CME courses
- The book navigation for the courses section of the site was redone. A book was created for each individual course rather than all courses combined. This has made the default left navigation less overwhelming to the user.
- The mini-vignette section of the course pages was styled. CSS classes for doctor, nurse, and patient roles were created and we began adding vignettes to some of the courses.
- A Course Resources content type was created. This content type will allow us to enter an unlimited number of additional reources for up to eight topics to the last page of each course.
- CSS classes for checkmarks were added throughout the courses to separate and organize content there.
Objective 3
Evaluate Curriculum Content
- Expert reviewers were for the most part not available this month due to summer vacations. One review was completed by Nancy Wiedemer on the Informed Consent/Treatment Agreement Key Info guide and we are in the process of revising it accordingly.
Objective 4
Evaluate Interface Design (Usability)
- We finished resolving issues identified in our internal usability test. We developed a usability script for use with the target audience and tested it internally. We recruited participants from medical societies via Facebook and direct email, and from participants of usability studies from prior projects. We had two participants scheduled for usability testing starting the first week of September.
Objective 5
Obtain OMB clearance
Submitted draft version of 60-day notice to Project Officer 5/20/09. Awaiting response.
Objective 6
Conduct Summative Evaluation
Scheduled for year 2.
Objective 7
Disseminate Results
We submitted an abstract to the American Academy of Pain Medicine (AAPM) for presentation at their 26th in Annual Meeting San Antonio Texas. The full abstract is included in the Appendix.
Work to be Performed in the Next Reporting Period
Objective 1
Develop Skills Training Content
Courses: We will finish editing the third core course (Ongoing Patient Management) and creating mini-case scenarios to illustrate each step. Then we will send all three of the core courses (Initial Assessment, Initial Prescribing, and Ongoing Monitoring) to consultants for review. We will also focus on completing content for the fourth core course (Avoiding Diversion) and continue to develop the content for the standardized patient courses.
Resources: Due to negative feedback on the design for the faceted search, some resources will need to be re-tagged to fit into the revised design.
Key Info Guides: 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 and Assessments) to expert consultants for review.
Objective 2
Build Supporting Functionality
General
- JQueryUI widgets will be researched and added to the site to increase the interactivity of the courses.
- A "Recent News" section will be added to showcase changes in FDA regulations or recommendations from professional organizations, such as opioid prescribing guidelines, as well as new additions and developments to the site.
- A warning message will be configured to display when the site is viewed in Internet Explorer 6 to warn users that they are viewing the site using an outdated browser that is no longer being supported. The message will contain a link for updating their version of Internet Explorer.
- Google Analytics will be enabled on the site so that reports on usage can be generated.
Resources
- In response to usability, the Resource Center will be re-organized. The users will be able to navigate through two pages which help narrow down their search before entering the Faceted Search. This new layout will also help make the faceted search aspect more straight forward and less overwhelming.
- The Resource Center will continue to be developed in response to usability. Styling of the new resource center will take place after usability.
Objective 3
Evaluate Curriculum Content
We will send drafts of the first three core courses to consultants for review and revise according to feedback. We will reconnect with consultants who have not had time to work on reviews of Key Info guides due to summer vacations and ask for completion of these reviews this month.
Objective 4
Evaluate Interface Design (Usability)
Finish recruitment for 1st usability test with target audience. Conduct usability test with 5 to 9 participants. Analyze data and develop an action plan in response to results. Revise website according to action plan. Write a usability script for Usability Round 2.
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 planned for September.
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
Abstract
Submitted to the American Academy of Pain Medicine (AAPM) for presentation at the 26th Annual Meeting in San Antonio Texas.
Abstract Title: Perceived Need for Training and Skills Development Related to Addiction Risk for Patients with Pain Introduction: The need for better skills training related to addiction risk associated with pain treatment is understood (CASA, 2005;; Merrill, 2002; Lin, 2007). But data to guide such development so that it emphasizes the greatest need is limited.
Materials and Methods: We interviewed six primary care providers about their concerns and challenges in prescribing opioids and treating pain and addiction as well as their needs and preferences regarding continuing medical education (CME) courses on pain and addiction.
Results: The PCPs greatest concern when prescribing opioids to patients was the potential for addiction. Their greatest challenges were: 1) diversion, 2) co-occurring psychiatric disorder, and 3) inability of non-opioid treatments to relieve pain. Some participants felt that additional training would help address these challenges. For treating pain in already-addicted patients, they requested information on: 1) discerning drug-seeking behavior due to addiction vs. undertreated pain, 2) identifying relapse into addiction, 3) urine drug testing, 4) informed consent and treatment agreements, 5) how to take an addiction history, and 6) referral resources and clinical tools to help clinicians identify, interview, and manage addicted patients. Participants expressed the most interest in back pain, fibromyalgia, neuropathy, and osteoarthritis. Their greatest interest for practical skills training was in screening for addiction or interviewing pain patients.
Conclusions: PCPs identify a need for education on the risk of addiction in patients with pain. Meeting that need will require a comprehensive resource addressing multiple skills deficits and tools to help the provider find appropriate resources.
This research is funded by NIDA/NIH contract #HHSN271200800012C
References
- CASA. Under the counter: The diversion and abuse of controlled prescription drugs in the U.S. The National Center on Addiction and Substance Abuse at Columbia University. 2005.
- Lin JJ, Alfandre D, Moore C. Physician attitudes toward opioid prescribing for patients with persistent noncancer pain. Clinical Journal of Pain. 2007;23(9):799-803.
- Merrill JO, Rhodes LA, Deyo RA, Marlatt A, Bradley KA. Mutual mistrust in the medical care of drug users. Journal of General Internal Medicine. 2002;17:327-333.
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
