Proposal for Supporting Academic Detailing on Safe Pain Medication Use for Utah Providers

Focus is on Provider Education Nearly ½ of deaths had valid Rx Half of these involved methadone Large number also on benzodiazepines Patients and families often didn’t recognize developing problem

Challenges Reduce deaths but preserve indicated Rx Engage time-pressured providers Displace current practices and mental models Requires mindful approach Overcome skepticism Confounding issues (mental health, addiction, diversion)

Approach Interactive face-to-face learning Support materials Practice redesign Performance feedback Enhanced by –Using existing relationships –Reputable sources if information –Demonstrating respect for targeted providers

Intervention Methods Detail Balance effectiveness with cost efficiency 10 rural and 20 Wasatch front groups –Educational presentation –Tools and support materials –Practice redesign –Performance feedback Large audience CME (6-10 meetings) Partner with Intermountain and U. of U. Clinics Articles

Recruitment Use regularly scheduled meetings Customized mail, , and telephone invitations Instructions to look at DOPL Controlled Substances Database ahead of time.

Materials to provide attendees Comparison data Guidelines Toolbox –Patient education forms –Referral options for addicts, mentally ill, inadequate pain response –Information for HealthInsight assistance –Access to peer experts

Areas of primary focus Screening patients for risk vs. benefit from long- acting narcotics Understanding special issues with methadone Avoiding benzodiazepines in combination with opioids Use of sleep studies when appropriate Avoiding long-acting opioids for acute pain Educating patients and families regarding risks and signs of toxicity

Areas of secondary focus Dealing with drug-seeking patients Dealing with diversion Preferred approaches to non-malignant pain

Supplemental education strategies Intermountain University of Utah clinics UMIA Physician meetings Articles

Measurement and evaluation PPMEP steering committee –Patient outcomes HealthInsight –Process measures Number, percent reached by specialty Provider evaluations of sessions Follow-up calls to track process changes

Summary Over next 12 months: 10 rural small group meetings 20 Wasatch front small group meetings Integrate with Intermountain, U. of Utah, UMIA Several statewide CME meetings Articles in UMA Bulletin