Improving First-Year Family Medicine Residents' Confidence in Safe Opioid Prescribing Through a Multiactivity Educational Program.

BACKGROUND AND OBJECTIVE: It is documented that some of the opioids prescribed to manage chronic pain are diverted and used for nonmedical purposes. We investigated whether a skill-based, chronic pain management (CPM) educational program could improve first-year family medicine residents' comfort, knowledge, and concerns in assessing and managing patients who use opioids for chronic noncancer pain. METHODS: A total of 72 first-year residents (four cohorts of 18) participated in a 3-month CPM training intervention that consisted of didactic lectures, objective structured clinical examination (OSCE) activities, and post-OSCE debriefing with faculty, one being a behavioral health specialist, between 2017 and 2020. We used a single-sample, pre/post design. At three points in time (baseline, 3-months, and 6-months postintervention), participants completed a set of measures assessing comfort, knowledge, and concern. We used repeated measures analyses to assess changes in outcome measures. RESULTS: Participants reported improvements compared with baseline at both follow-up time points. At 6 months postintervention, the participants had significantly better scores on measures of comfort (F[1, 71]=65.22; P<.001), knowledge (F[1, 71]=22.38, P<.001), and concern (F[1, 71]=37.89, P<.001) in prescribing opioids for chronic noncancer pain. CONCLUSION: A multiactivity CPM educational program for first-year residents was associated with improvement in perceived sense of comfort, knowledge, and concerns in assessing and managing patients who use opioids for chronic noncancer pain. CPM training interventions may be an effective tool to educate first-year residents to implement best practices for pain management with the goal of reducing the chances of inappropriately prescribing controlled substances or denying analgesia.

Administration and Prescription of Opioids in Emergency Departments: A Retrospective Study.

INTRODUCTION: Opioid overdose caused 47,600 deaths in 2017 in the United States. Emergency departments (EDs) are one source of opioids that could be abused or diverted for non-medical use. Bills to reduce opioid use in EDs have been passed in multiple states; however, Kansas does not have a bill regulating opioid administration. This study sought to identify characteristics that influence opioid administration and prescription at EDs in Wichita, Kansas. METHODS: This was a retrospective chart review analyzing patient encounters from EDs of three hospitals in Wichita, Kansas during May 2018. Information collected from charts included demographic and insurance information, as well as pain evaluation, diagnosis, disposition, provider education, and provider documentation of efforts to limit opioid abuse. RESULTS: Of the 1,444 encounters included in the analysis, providers administered opioids in the ED during 17.4% of visits and prescribed opioids for outpatient treatment for 10.6% of ED patient encounters. Subjective pain rating and provider credentials were associated significantly with opioid prescription. CONCLUSION: The prevalence of opioid administration and prescription in participating emergency departments is roughly equivalent to current best-practice data from hospitals utilizing strong opioid-reduction protocols.

Rhinitis.

Rhinitis is caused by a variety of allergic and nonallergic mechanisms. Mild disease can usually be managed with avoidance measures alone. Allergen removal can also improve the severity of allergic rhinitis and can reduce the need for medications. Allergic rhinitis is represented by sneezing, nasal congestion, nasal pruritus, and rhinorrhea. Oral antihistamines should be used to treat patients with mild or occasional seasonal allergic rhinitis. Because of the variance in causes of nonallergic rhinitis, treatments also vary. Irrigation and debridement are the standard treatment of atrophic rhinitis. For gustatory rhinitis, pretreatment with ipratropium bromide can be used.