Background & Aims
Opioid prescribing guidelines have been available in Canada since 2010 (1). The majority of opioids prescribed in Canada are prescribed by family physicians who have little time to learn and implement guidelines. This study recruited prescribers and learners to evaluate participants’ knowledge in opioid prescribing for chronic non-cancer pain according to the most recent 2017 version of the Canadian Opioid Guideline. The Online Opioid Self-Assessment Program (SAP) is a 3-hour CME accredited course that was developed using the recommendations in the 2017 Canadian Opioid Guideline (2). Questions in the Online Opioid SAP included case-based, multiple choice, true/false and free text and were developed to match every recommendation in the Canadian Opioid Guideline. Pre and post test scores of participants completing the Online Opioid SAP were evaluated to determine whether there was an improvement in knowledge after participation in the program.
Methods
A prospective evaluation using a pre post-test design with an accredited Online Opioid SAP (3) from October 1, 2019 to March 31, 2021 and included Canadian family physicians, specialists, nurse practitioners, medical students, residents, fellows, and other health professionals. A total of 651 participants consented to participate in this study. Five assessment areas were tested that include general knowledge, titration of opioids, optimization of non-opioid treatments, tapering/switching/rotating opioids, and prevention of opioid use disorder and overdose. The program was promoted through targeted emails to university program directors, physician email databases, and shared through personal networks and social media platforms. Participants were required to complete a baseline pre-test, the 3-hour Online Opioid SAP and a post-test following completion of the program. Data collected from this study was analyzed using pre and post analysis using statistical program ‘R’ version 3.4.1.
Results
From October 1, 2019-March 31, 2021, 651 participants completed the Online Opioid SAP and consented to take part in this study. The professions of the participants were general practitioner (N= 152, 23.3%), resident (N=131, 20.1%), undergraduate medical student (N=95, 15%), nurse practitioner (N=94, 14%), physician-specialist(N=56, 9%), nurse practitioner student (N=48, 7%), pharmacist (N=39,6%) and fellow (N=21, 3%). The pre-and post-test showed a statistically significant increase (35%, p-value<0.0000) in the total score. Cohen's d (effect size) is 1.7, considered a large effect size, indicating a substantial change from the pre-test. The results indicated a statistically significant increase in all six assessment areas from pre to post-test, with the highest change found in the assessment area "Tapering opioids safely and effectively to the lowest possible dose" (mean change=55%, df=189, p-value<0.0000).
Conclusions
This study shows a significant improvement in participants knowledge from baseline scores to the post-test after completing the program. While the post-test was completed by participants immediately after the Online Opioid SAP, the long term retention of knowledge of participants in this study is unknown. However, retention of knowledge was tested in our Online Opioid SAP 2015 pilot study with a post test 6 months after completion of the SAP showing statistically significant improvements in scores (4). Medical education related to opioids for non-cancer chronic pain is needed. Cost-free, remote access to the online program has made it possible for prescribers and learners to learn about safer opioid prescribing without the barrier of location and cost, allowing greater accessibility for opioid prescribing education for prescribers.
References
1. Kahan M, Mailis-Gagnon A, Wilson L, Srivastava A; National Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population. Can Fam Physician. 2011;57(11):1257-66.
2. Busse JW, Craigie S, Juurlink DN, Buckley N, Wang L, Couban RJ, Agoritsas T, Akl EA, Carrasco-Labra A, Cooper L, Cull C, da Costa BR, Frank JW, Grant G, Iorio A, Persaud N, Stern S, Tugwell P, Vandvik PO, Guyatt GH. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017: 189(18): E659-666.
3. University Health Network. Online Opioid Self-Assessment Program. [Internet]. Toronto: 2021 [cited 2024 Jan 31]. Available from: https://opioidassessment.ca/
4. Leece P, Shantharam Y, Hassam S, Buchman DZ, Hamilton M, Persaud N, Kahan M, Spithoff S, Srivastava A, Sproule BA, Carlin L, Furlan AD. Improving opioid guideline adherence: evaluation of a multifaceted, theory-informed pilot intervention for family physicians. BMJ Open. 2020 Jan 26;10(1):e032167.
Presenting Author
Yalnee Shantharam
Poster Authors
Yalnee Shantharam
MSc
University Health Network
Lead Author
Metasebia Assefa
BSc.
Toronto Rehabilitation Institute-University Health Network
Lead Author
Quinn Cassucio-Treen
BSc.
Toronto Rehabilitation Institute-University Health Network
Lead Author
Ralph Fabico
BSc.
Toronto Rehabilitation Institute-University Health Network
Lead Author
John Flannery
MD
Toronto Rehabilitation Institute-University Health Network
Lead Author
Andrea Furlan
IWH
Lead Author
Topics
- Treatment/Management: Pharmacology: Opioid