Using SPs to Teach About Patients at Risk For Drug Abuse

Publication ID Published Volume
9907 September 16, 2014 10

Abstract

Millions of Americans suffer from chronic pain and use prescription pain medication to help alleviate their pain. Among these chronic pain sufferers, there is a growing problem of prescription drug abuse. As a result, there is an increased number of patients visiting primary care physicians for pain medication prescriptions and an increased number of patient visits to emergency departments. In addition, there are millions of Americans who use prescription drug abuse for non-medical purposes, adding substantially to this problem. Health care providers do not feel adequately trained to properly screen, monitor and safely manage these patients.

The purpose of these standardized patient cases with checklists is to provide a tool to help health care providers practice important clinical skills in screening, monitoring and treating patients with chronic pain who use prescription drugs. When using these cases learners will be able to receive feedback on evaluating patients with chronic pain, determining the patients risk for drug abuse, and the provider’s choice of management strategies. There are six cases including two screening, two low-risk and two high-risk patients for prescription drug abuse.

Cases were originally created for use as the primary assessment measure in a randomized interventional study. Study participants were clinicians or health care professional students assigned to either the intervention or control group. The purpose of the study was to see if a self-study computer based simulation educational program would help improve learners’ ability to screen and manage patients with chronic pain. Study results were mixed, possibly due to poor compliance and attrition. However, the educational value of the standardized patient cases was noted in qualitative responses from study participants. The development of these cases is the major contribution of this research endeavor.

Two SP cases were developed for each of the following categories: screening, low-risk and high-risk. One set of cases was used for the pretest, labeled as Case 1 in the table above. The other set for the posttest, labeled as Case 2 in the table above.

For the pretest, participants saw 3 patients, one in each pretest category. For the posttest, participants again saw 3 patients, one in each posttest category. Participants had a couple of minutes to read the chart and patient encounter “tasks” prior to entering the exam room. Tasks may include screening and assessing for risk of prescription drug abuse, giving patient test results and discussing next steps in pain management. Fifteen minutes were allotted for each patient encounter. After the learner completed the patient visit and left the room, each SP completed a 17 to 19 item checklist about the learner. Clinical skills that were evaluated included communication, history taking, sharing information and counseling. In addition, SPs rated the learner in overall performance on a 15-point scale from poor to outstanding.

Citation

Yelen M, Anderson L, Wright K, Fleming M. Using SPs to teach about patients at risk for drug abuse. MedEdPORTAL Publications. 2014;10:9907. http://doi.org/10.15766/mep_2374-8265.9907

Educational Objectives

By using these cases and accompanying checklists, learners will be able to receive feedback on their ability to:

  1. Evaluate patients with chronic pain who may be at risk for misusing pain medication.
  2. Determine the level of risk for misusing pain medication.
  3. Set up a treatment or monitoring plan.
  4. Refer patients who are at risk.
  5. Increase their level of awareness of different risk levels.
  6. Develop a set of questions when evaluating patients with chronic pain.
  7. Develop a framework for safe prescribing practices.

Keywords

  • Chronic Pain Management, Chronic Pain, Opioid Abuse, Drug Abuse, Prescription Drug Abuse, Substance-Related Disorders, Drug Addiction, Standardized Patient

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ISSN 2374-8265