Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH (Members only) FULL-TEXT		Volume 31 (4) Volume 31, Issue 4, Fall 2011 J Contin Educ Health Prof 2011; 31(4):231-240 ORIGINAL RESEARCH Identifying primary care skills and competencies in opioid risk management Emil Chiauzzi, Kimberlee J. Trudeau, Kevin Zacharoff, Kathleen Bond A b s t r a c t Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of pain. The objective of this study was to identify which skills and competencies are most critical for PCPs in order to effectively manage opioid risk in patients treated for chronic pain. Methods: We conducted 1-hour interviews with 16 nationally known experts in primary care, pain management, and addiction. Eight were trained as PCPs, and 8 were trained as specialists. Their responses were collated and then presented online to the participants for independent sorting and rating. These data were analyzed using an online concept mapping program, which offers an innovative method of summarizing and prioritizing qualitative data. Results: Based on this analysis, items were organized into 10 clusters representing the most critical categories of skills (the “best fit” for these data). The cluster that received the highest average statement rating was "How to Manage Pain Patients With Comorbid Conditions." Follow-up analyses indicated that specialists rated this cluster, and 5 others, significantly higher than the PCPs, suggesting that the specialists perceive these competencies as more important in opioid risk management. Discussion: Using a relatively small sample and cost-effective technique (ie, concept mapping), key PCP competencies can be identified for potential inclusion in continuing education and training in opioid risk management. Lessons For Practice Concept mapping is a cost-effective method that can be used to identify key skills for a CME course. According to the experts in this study, the most important skills for PCPs managing opioid risk in chronic pain patients are: (1) how to monitor opioids, and (2) how to assess for risk factors. The highest-rated cluster in this study was about the challenges of chronic pain management in patients with comorbid conditions, suggesting that this was considered the skill category of greatest importance. Specialists (eg, psychiatrists, physiatrists) rated the importance of general pain treatment skills in primary care significantly higher than did PCP experts. When designing a PCP opioid risk management curriculum, it is important to assess the perspectives of different disciplines and types of experts.
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