1. VCU Chronic Nonmalignant Pain Management: An Online Curriculum Leanne M. Yanni, MD Creator & Editor VCU Medical Center November 16 th, 2007

2. Background Managing Pain is challenging Managing Pain is challenging –Spans professions and specialties –Variation in chronic pain syndromes –Limited evidence-based guidelines –Limited provider training –Provider fears of legal ramifications Upshur et al 2006; Chen et al 2006; Adams et al 2001

3. IM Resident Chart Review Inconsistent documentation of pain assessment and past history Inconsistent documentation of pain assessment and past history Underutilization of a multi-modal approach to treatment Underutilization of a multi-modal approach to treatment Underutilization of important clinical practice tools Underutilization of important clinical practice tools –Assist in recognizing and/or averting misuse Yanni et al 2006 (abstract)

4. IM Resident Attitudes Over half reported their experience negatively impacted their view of primary care Over half reported their experience negatively impacted their view of primary care Nearly all residents were less confident in their ability to treat pain than other conditions Nearly all residents were less confident in their ability to treat pain than other conditions –Over half rated preparation as fair or poor No resident found treatment of pain rewarding No resident found treatment of pain rewarding Weaver et al 2005 (abstract); Chen et al 2007

5. System Interventions to standardize opioid prescribing and monitoring Pain clinic in the Internal Medicine resident practice Development of pain curriculum

6. Curriculum Aims Improve knowledge of chronic nonmalignant pain Improve knowledge of chronic nonmalignant pain Improve attitudes towards managing patients with chronic nonmalignant pain Improve attitudes towards managing patients with chronic nonmalignant pain Offer ongoing access to practice resources Offer ongoing access to practice resources –Ease practice challenges

7. The Process Assembled interdisciplinary team of writers Assembled interdisciplinary team of writers Developed outline and objectives Developed outline and objectives Wrote content and developed resources Wrote content and developed resources Partnered with VCU SOM to design web module Partnered with VCU SOM to design web module Recruited national reviewers Recruited national reviewers Initiated educational studies in medical students and residents Initiated educational studies in medical students and residents

8. Completion to Date

9. Course Evaluation Questions Having completed the curriculum will you access any of the resources? Having completed the curriculum will you access any of the resources? Is the assessment and treatment of patients with CNMP more important to you as a result of using this curriculum? Is the assessment and treatment of patients with CNMP more important to you as a result of using this curriculum? As a result of the curriculum, will you make any changes in your behavior or practice? As a result of the curriculum, will you make any changes in your behavior or practice? Would you recommend this curriculum to your colleagues? Would you recommend this curriculum to your colleagues?

10. % Yes to Evaluation Questions StudentsN=161ResidentsN=278PhysiciansN=14 Resources8983100 Importance928461 Changes757469 Recommend9690100

11. Reviewer Data If so, what changes? If so, what changes? –“Change medication agreement, use urine drug screening.” –“Change contract and procedure for follow-up.” –“Use template. Specific appointments for pain.” –“Create standardized office visit forms, different urine screening policy and procedures, update my own lecture.” –“Many…”

12. Resident Data If so, what changes? If so, what changes? –“I will not assume that everyone is ‘drug seeking.’ ” –“Increased utilization of multimodal approach to chronic pain.” –“More frequent office visits for patients with pain, more thorough evaluation prior to starting meds…” –“Careful prescribing habits regarding complete documentation.”

13. Current Applications VCU GME programs VCU GME programs VCU SOM undergraduate curriculum VCU SOM undergraduate curriculum GME and undergraduate medical schools outside of Virginia GME and undergraduate medical schools outside of Virginia VCU School of Pharmacy VCU School of Pharmacy Virginia Providers Virginia Providers –Supported by DHP

14. Aims of Partnership with DHP Provide accessible resources for pain education Provide accessible resources for pain education Create a Virginia-specific module to outline responsibilities and legalities Create a Virginia-specific module to outline responsibilities and legalities Highlight Virginia specific resources Highlight Virginia specific resources –Virginia’s Prescription Monitoring Program (PMP)

15. The Curriculum Access through DHP www.dhp.virginia.gov Access through DHP www.dhp.virginia.gov www.dhp.virginia.gov Create LMS account Create LMS account Register for course activity Register for course activity –Use valid license number –Access code: “Virginia Pain” Review Navigation Instructions Review Navigation Instructions

42. Future Directions Analyze data from educational studies Analyze data from educational studies Evaluate usefulness for Virginia Providers Evaluate usefulness for Virginia Providers Extend use in training programs Extend use in training programs –All professions and specialties Partner with other organizations on a regional or national level for pain education Partner with other organizations on a regional or national level for pain education

43. The Curriculum Team: Design John Priestley, MA John Priestley, MA –Instructional design, web design & development Joel Browning Joel Browning –Learning Management System, web programming & administration Chris Stephens Chris Stephens –Web programming and administration Jeanne Schlesinger, Med Jeanne Schlesinger, Med –Project management, instructional design, and photography

44. The Curriculum Team: Content Leanne Yanni, MD Leanne Yanni, MD –Creator, Editor, & Content Contributor –lyanni@mcvh-vcu.edu lyanni@mcvh-vcu.edu Betty Anne Johnson, MD, PhD Betty Anne Johnson, MD, PhD Laura Morgan, PharmD Laura Morgan, PharmD Mike Weaver, MD Mike Weaver, MD Sarah Beth Harrington, MD Sarah Beth Harrington, MD Christine Huynh, MD Christine Huynh, MD Carl Wolf, PhD Carl Wolf, PhD

45. VCU Chronic Nonmalignant Pain Management www.dhp.virginia.gov License Number Access code: “Virginia Pain”