Training primary care providers in opioid deprescribing and chronic pain management based on local guidance: a pre–post study of attitude change

Abstract

Background. Local chronic non-cancer pain guidance recommends that general practitioners should consider opioid deprescribing and referral to multidisciplinary healthcare providers for behaviourally based treatments. We designed a training package called AIMM (Assess, Inform, Manage and Monitor) to reinforce this stewardship.Aim. To identify whether participation in AIMM training effectively aligned clinicians’ attitudes with local guidance for treating chronic non-cancer pain.Design and setting. In 2014–15, the AIMM training was tested using a pre–post-test non-randomised design at two sites in NSW, Australia. The primary outcome measure was an 11-item, study-specific, pain attitude questionnaire (PAQ).Method. Step one of AIMM training involved online completion of the PAQ and review of a specialist pain website. Step two involved attendance at two face-to-face, two-hour interactive workshops led by pain experts who addressed opioid deprescribing and switching to broader care. A repeat PAQ survey was completed at the conclusion of the second workshop.Results. Nineteen participants attended the workshops, including general practitioners (n = 7), nurses (n = 5), exercise physiologists (n = 2), a dietitian (n = 1), community pharmacists (n = 2) and psychologists (n = 2). Significant shifts in six attitudes occurred, including prescribing less pain medication, greater emphasis on social reconnection, increasing planned activity and adopting anti-inflammatory nutrition (p < .05). Responses to the item regarding expectations of a positive recovery was not aligned with local guidance and no significant attitudinal change was found. Four other attitudes were aligned with local guidance at baseline and did not change during the study.Conclusions. Online information and face-to-face training can achieve a change in healthcare provider attitudes towards non-pharmacological treatment of chronic non-cancer pain. Further work is needed to assess whether attitudinal changes are maintained and translate into behavioural change.

Evaluation of a Web-Based ADHD Awareness Training in Primary Care: Pilot Randomized Controlled Trial With Nested Interviews

“…GPs in the United Kingdom need to participate in ongoing continuing professional development (CPD) to keep up to date with medical knowledge and changes in practice. Although many training packages and programs are continually being developed to improve medical skills of GPs [ 12 - 16 ], to our knowledge, there are no current web-based programs aimed at ADHD. Some published evidence indicates that primary care training on specific topics can improve patient care [ 15 , 17 , 18 ]; clinical outcomes [ 17 ]; and GP knowledge, confidence, and attitudes [ 19 - 21 ], highlighting the potential benefit for a targeted ADHD education package.…”

Integrated Primary Healthcare Opioid Tapering Interventions: A Mixed-Methods Study of Feasibility and Acceptability in Two General Practices in New South Wales, Australia

“…Patients are assessed by their GP to ensure serious pathologies (red flags) are eliminated, their beliefs regarding ongoing pain and its meaning are explored and the messaging that pain is not a symptom of damage is reinforced. Patients are informed of current evidence and the rationale for tapering opioids in line with community guidelines [15,[19][20]. The practice nurse role is to discuss relevant behavioural change management options including team-based planned care (via Medicare-subsidised visits with a dietitian, exercise physiologist, an accredited practicing pharmacist medication review and a psychologist when indicated) plus encourage and undertake regular monitoring [18].…”