VCU Chronic VCU Chronic Nonmalignant Nonmalignant

Pain ManagementPain Management: : An Online CurriculumAn Online Curriculum

Leanne M. Yanni, MDLeanne M. Yanni, MDCreator & EditorCreator & Editor

VCU Medical CenterVCU Medical CenterNovember 16November 16thth, 2007, 2007

BackgroundBackground

Managing Pain is challengingManaging Pain is challenging– Spans professions and specialtiesSpans professions and specialties– Variation in chronic pain syndromesVariation in chronic pain syndromes– Limited evidence-based guidelinesLimited evidence-based guidelines– Limited provider trainingLimited provider training– Provider fears of legal ramificationsProvider fears of legal ramifications

Upshur et al 2006; Chen et al 2006; Adams et al 2001

IM Resident Chart ReviewIM Resident Chart Review

Inconsistent documentation of pain Inconsistent documentation of pain assessment and past historyassessment and past history

Underutilization of a multi-modal Underutilization of a multi-modal approach to treatmentapproach to treatment

Underutilization of important clinical Underutilization of important clinical practice toolspractice tools– Assist in recognizing and/or averting Assist in recognizing and/or averting

misusemisuseYanni et al 2006 (abstract)

IM Resident AttitudesIM Resident Attitudes

Over half reported their experience Over half reported their experience negatively impacted their view of negatively impacted their view of primary careprimary care

Nearly all residents were less Nearly all residents were less confident in their ability to treat pain confident in their ability to treat pain than other conditionsthan other conditions– Over half rated preparation as fair or Over half rated preparation as fair or

poorpoor No resident found treatment of pain No resident found treatment of pain

rewardingrewardingWeaver et al 2005 (abstract); Chen et al 2007

System Interventions to standardize opioid prescribing and monitoring

Pain clinic in the Internal Medicine resident practice

Development of pain curriculum

Curriculum AimsCurriculum Aims

Improve knowledge of chronic Improve knowledge of chronic nonmalignant painnonmalignant pain

Improve attitudes towards managing Improve attitudes towards managing patients with chronic nonmalignant patients with chronic nonmalignant painpain

Offer ongoing access to practice Offer ongoing access to practice resourcesresources– Ease practice challengesEase practice challenges

The ProcessThe Process

Assembled interdisciplinary team of Assembled interdisciplinary team of writerswriters

Developed outline and objectivesDeveloped outline and objectives Wrote content and developed resourcesWrote content and developed resources Partnered with VCU SOM to design web Partnered with VCU SOM to design web

module module Recruited national reviewersRecruited national reviewers Initiated educational studies in medical Initiated educational studies in medical

students and residentsstudents and residents

Completion to DateCompletion to Date

0

50

100

150

200

250

300

Other MedicalStudents

Residents Physicians

Course Evaluation Course Evaluation QuestionsQuestions

Having completed the curriculum will you Having completed the curriculum will you access any of the access any of the resourcesresources??

Is the assessment and treatment of Is the assessment and treatment of patients with CNMP patients with CNMP more important to youmore important to you as a result of using this curriculum?as a result of using this curriculum?

As a result of the curriculum, will you As a result of the curriculum, will you make any make any changeschanges in your behavior or in your behavior or practice?practice?

Would you Would you recommendrecommend this curriculum to this curriculum to your colleagues?your colleagues?

% Yes to Evaluation % Yes to Evaluation QuestionsQuestions

StudentsStudents

N=161N=161ResidentsResidents

N=278N=278PhysiciansPhysicians

N=14N=14

ResourcesResources 8989 8383 100100

ImportanceImportance 9292 8484 6161

Changes Changes 7575 7474 6969

RecommendRecommend 9696 9090 100100

Reviewer DataReviewer Data

If so, what changes?If so, what changes?– ““Change medication agreement, use urine Change medication agreement, use urine

drug screening.”drug screening.”– ““Change contract and procedure for follow-Change contract and procedure for follow-

up.”up.”– ““Use template. Specific appointments for Use template. Specific appointments for

pain.”pain.”– ““Create standardized office visit forms, Create standardized office visit forms,

different urine screening policy and different urine screening policy and procedures, update my own lecture.”procedures, update my own lecture.”

– ““Many…”Many…”

Resident DataResident Data

If so, what changes?If so, what changes?– ““I will not assume that everyone is ‘drug I will not assume that everyone is ‘drug

seeking.’ ”seeking.’ ”– ““Increased utilization of multimodal Increased utilization of multimodal

approach to chronic pain.” approach to chronic pain.” – ““More frequent office visits for patients More frequent office visits for patients

with pain, more thorough evaluation with pain, more thorough evaluation prior to starting meds…” prior to starting meds…”

– ““Careful prescribing habits regarding Careful prescribing habits regarding complete documentation.”complete documentation.”

Current ApplicationsCurrent Applications

VCU GME programsVCU GME programs VCU SOM VCU SOM

undergraduate undergraduate curriculumcurriculum

GME and GME and undergraduate medical undergraduate medical schools outside of schools outside of VirginiaVirginia

VCU School of VCU School of PharmacyPharmacy

Virginia ProvidersVirginia Providers– Supported by DHPSupported by DHP

Aims of Partnership with Aims of Partnership with DHPDHP

Provide accessible resources for pain Provide accessible resources for pain education education

Create a Virginia-specific module to Create a Virginia-specific module to outline responsibilities and legalitiesoutline responsibilities and legalities

Highlight Virginia specific resourcesHighlight Virginia specific resources– Virginia’s Prescription Monitoring Virginia’s Prescription Monitoring

Program (PMP)Program (PMP)

The CurriculumThe Curriculum

Access through DHPAccess through DHPwww.dhp.virginia.govwww.dhp.virginia.gov

Create LMS accountCreate LMS account Register for course activityRegister for course activity

– Use valid license numberUse valid license number– Access code: “Virginia Pain”Access code: “Virginia Pain”

Review Navigation InstructionsReview Navigation Instructions

Future DirectionsFuture Directions

Analyze data from educational studiesAnalyze data from educational studies Evaluate usefulness for Virginia Evaluate usefulness for Virginia

ProvidersProviders Extend use in training programsExtend use in training programs

– All professions and specialties All professions and specialties Partner with other organizations on a Partner with other organizations on a

regional or national level for pain regional or national level for pain educationeducation

The Curriculum Team: The Curriculum Team: DesignDesign

John Priestley, MAJohn Priestley, MA– Instructional design, web design & Instructional design, web design &

developmentdevelopment Joel BrowningJoel Browning

– Learning Management System, web Learning Management System, web programming & administrationprogramming & administration

Chris StephensChris Stephens– Web programming and administration Web programming and administration

Jeanne Schlesinger, MedJeanne Schlesinger, Med– Project management, instructional design, and Project management, instructional design, and

photography photography

The Curriculum Team: The Curriculum Team: ContentContent

Leanne Yanni, MDLeanne Yanni, MD– Creator, Editor, & Content ContributorCreator, Editor, & Content Contributor– lyanni@mcvh-vcu.edulyanni@mcvh-vcu.edu

Betty Anne Johnson, MD, PhDBetty Anne Johnson, MD, PhD Laura Morgan, PharmDLaura Morgan, PharmD Mike Weaver, MDMike Weaver, MD Sarah Beth Harrington, MDSarah Beth Harrington, MD Christine Huynh, MDChristine Huynh, MD Carl Wolf, PhDCarl Wolf, PhD

VCU Chronic VCU Chronic Nonmalignant Pain Nonmalignant Pain

ManagementManagement

www.dhp.virginia.govwww.dhp.virginia.govLicense NumberLicense Number

Access code: “Virginia Pain”Access code: “Virginia Pain”