Safe and Competent Opioid Prescribing Education: Increasing Dissemination with a Train-The-Trainer Program

Abstract

Background: Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing education based on an FDA curricular Blueprint. This paper describes the Safe and Competent Opioid Prescribing Education ( SCOPE of Pain) train-the-trainer program and its impact on (1) disseminating the SCOPE of Pain curriculum and (2) knowledge, confidence, attitudes, and performance of the participants of trainer-led compared with expert-led meetings. Methods: SCOPE of Pain is a 3-hour ER/LA opioid REMS education. In addition to expert-led live statewide meetings, a 2-hour train-the-trainer (TTT) workshop was developed to increase dissemination nationally. The trainers were expected to conduct SCOPE of Pain meetings at their institutions. Participants of both the trainer-led and expert-led SCOPE of Pain programs were surveyed immediately post and 2 months post meetings to assess improvements in knowledge, confidence, attitudes, and self-reported safe opioid prescribing practices. Results: During 9 months (May 2013 to February 2014), 89 trainers were trained during 9 TTT workshops in 9 states. Over 24 months (May 2013 to April 2015), 33% of the trainers conducted at least 1 SCOPE of Pain training, with a total of 79 meetings that educated 1419 participants. The average number of meetings of those who conducted at least 1 meeting was 2.8 (range: 1–19). The participants of the trainer-led programs were significantly more likely to be practicing in rural settings than those who participated in the expert-led meetings (39% vs. 26%, P < .001). At 2 months post training, there were no significant differences in improvements in participant knowledge, confidence, attitudes, and performance between expert-led and trainer-led meetings. Conclusions: The SCOPE of Pain TTT program holds promise as an effective dissemination strategy to increase guideline-based safe opioid prescribing knowledge, confidence, attitudes, and self-reported practices.

Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury

“…Other strategies described in the literature include brief one-on-one physician education, 311,312 development and dissemination of guidelines and policies, 313,314 and Risk Evaluation and Mitigation Strategy. 315 Public health detailing is an approach based on the pharmaceutical sales strategy, by which messages are pushed using brief one-on-one educational visits during the normal workflow. Staten Island saw a reduction in high-dose prescribing and stabilizing of days' supply after implementing this strategy.…”

“…318 The SCOPE of Pain program has also implemented a “train the trainer” approach, which facilitates wide dissemination of information. 315 Physicians are advised to be aware of potential conflicts of interest when attending pharmaceutical company–funded sessions. 319…”

Changes in consumption of opioid analgesics in Israel 2009 to 2016: An update focusing on oxycodone and fentanyl formulations

“…The REMS program has potential to improve the safety of using opioids for the treatment of chronic pain . The Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program was also implemented within the REMS framework . It was demonstrated that using this program has resulted in improvements in knowledge, attitudes, confidence, as well as in safer opioid prescribing practices.…”

“…31 The Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program was also implemented within the REMS framework. 31,32 It was demonstrated that using this program has resulted in improvements in knowledge, attitudes, confidence, as well as in safer opioid prescribing practices. This program contributed greatly to stopping or even reversing the trend of increasing rates of opioid abuse, addiction, overdose, and death observed prior to implementation of the REMS.…”

Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education

“…Current online and in‐person educational sessions address the medical knowledge that physicians need and want when it comes to prescribing opioids. For example, one of the more effective educational strategies for modifying physician prescribing is the “academic detailing” using a “train‐the trainer” system . The effectiveness of detailing, modeled on “drug detailing” visits to physicians by pharmaceutical representatives, is largely due to its face‐to‐face delivery of an individualized educational session with up‐to‐date information on best practices in opioid prescribing.…”