SCOPE: Empowering Family Physicians to Manage Chronic Pain F. Stuart Leeds1 and Josephine F. Wilson 2 Departments of Family Medicine1 and Community Health 2, Boonshoft School of Medicine, Wright State University, Dayton, Ohio Introduction Results Chronic nonmalignant pain (CNMP) is one of the most common reasons for office visits to family physicians. Because there is no defined scope of practice for CNMP, family physicians are reluctant to treat these patients – and often lack the training to do so SCOPE is an evaluation and treatment protocol based on a defined scope of practice, and driven by evidence-based management principles We hypothesized that SCOPE can be taught to FM residents in one or two brief, intensive clinical sessions; and that… Once learned, SCOPE will measurably enhance a resident’s experience managing patients with chronic pain The Concentric Circles of Scope-of-Practice (MALPRACTICE) SCOPE is aimed at expanding this inner circle Outer limits defined by the specialty itself Regional/local “cultural” standards Individual Training, Skill & Prerogatives SCOPE – Scope-of-Care Oriented Pain Engagement The DESCRIBE Acronym Simplifying the Initial Evaluation of Patients with Chronic Pain SCOPE’s core is its scope-of-practice definition. Patients must: Be reliable and reasonable Be straightforward (medically and functionally) Have exhausted non-opioid alternatives SCOPE’s principles of treatment include: Preferential use of long-acting opioids Best use of opioid-sparing adjuncts “Universal precautions” – compliance testing for all Duration - must be chronic (>12 weeks) Etiology - one or more clear diagnoses to explain pain symptoms Story - narrative from onset to present Consultation – has been evaluated by appropriate specialist Red Flags? – by history, exam, labs, or PDMP Irreversible? - reversible causes of chronic pain addressed Basic– patient’s overall clinical picture and proposed regimen are not excessively complex Exhausted all reasonable non-opioid alternatives Summary of Results Brief SCOPE training resulted in statistically-significant changes in pre/post questionnaire scores. Sixteen of eighteen questions trended in the direction of improvement Seven questions achieved individual statistical significance, including the key item: “I feel comfortable managing patients with chronic non-malignant pain.” Subjective Experience and Perceived Competence improved significantly Total (overall “readiness”) scores also improved significantly Methods Conclusion SCOPE is a chronic pain management protocol built on an explicit definition of scope of practice for family physicians SCOPE can be rapidly and effectively taught to family medicine residents in an office setting Use of SCOPE results in a better physician experience with respect to chronic pain patients SCOPE, therefore, has the potential to enhance access to care for patients with CNMP Twelve family medicine residents, all levels of training, studied over three years Residents were trained to use SCOPE in two intensive clinical half-days with chronic pain patients Eighteen-item Likert scale questionnaires regarding resident attitudes, beliefs and experiences regarding CNMP patients were completed before and after SCOPE training Individual and total scores, as well as scores for the 4 question categories (Subjective Experience, Perceived Competence, Provider Beliefs, and Provider Behavior) were analyzed using paired T-tests. Reference: Leeds FS, Wilson JF (2014) A Novel Scope-of-Practice Based Paradigm for Empowering Family Physicians to Manage Chronic Nonmalignant Pain. J Family Med Community Health 1(4): 1023. PDF available, free of charge at: http://www.jscimedcentral.com/FamilyMedicine/familymedicine-1-1023.pdf