Studies
Effects of a Distance Learning Program on Physicians’ Opioid- and Benzodiazepine-Prescribing Skills
Author: Midmer D, Kahan M, Marlow B
Intervention Type: Distribution of Educational Materials to Professionals, Educational Meetings for Professionals, Local Consensus Process for Professionals
Disease State: Not specific to any chronic disease
Research Objective
To determine the effectiveness of a series of email case discussions in improving physicians’ attitudes and clinical performance in the prescribing of opioids and benzodiazepines
Methods
Design: Randomized controlled trial that was 4-6 months in duration
Study sample: Family physicians; Community-dwelling adults
Intervention:
All physicians received a 3 hour interactive presentation and a comprehensive syllabus on opioid and benzodiazepine prescribing, presenting current evidence-based guidelines given by a physician investigator
Group 1 – Intervention: Email case discussion group: each physician was assigned 2 to 3 cases (20 cases in total assigned) over a 10-week period that contained a common management problem adapted for community physicians. Group participation was encouraged allowing everyone an opportunity to use the management strategies presented in the initial workshop and the responses were circulated to all members of the group. The facilitator then responded to the cases and to the participants’ responses.
Group 2 – Control: Usual care
Medication Prescribing and Use Outcome(s)
- Physicians’ knowledge for prescribing opioids and benzodiazepines in managing patients with chronic nonmalignant pain
Other Outcomes
- Physicians’ perceived competence in successfully managing patients with chronic nonmalignant pain
- Use of clinical techniques to identify and manage opioid-dependent patients
Key Results
- There were no significant differences between groups on the pre-test and post-test survey responses for any domains tested
- Both groups expressed more optimism on patient outcomes on the post-test survey than the pre-test survey
- During the telephone consultations, the intervention group asked significantly more questions (odds ratio 1.27, p=0.06), and offered more advice than the control group (odds ratio 1.33, p=0.01)
Key Implementation Issues
- Men in the intervention group performed better than men in the control group (p=0.05), but a similar trend did not reach statistical significance in women.
- Validity of simulated telephone consultations in measuring physician performance is not clear as it is easier for physicians to communicate with peers than patients.
- Continuing Medical Education events should focus on specific clinical behaviours.
Citation(s)
Effects of a Distance Learning Program on Physicians’ Opioid- and Benzodiazepine-Prescribing Skills. Midmer, D., Kahan, M., Marlow, B. The Journal of Continuing Education in the Health Professions, 2006, Vol. 26, No. 4, 294-301.