|The following article is part of The Clinical Advisor’s coverage from the 2018 American Academy of Physician Assistants’ annual meeting in New Orleans. Our staff will be reporting live on original research, case studies, and professional outreach and advocacy news from leading PAs in many specialty areas. Check back for ongoing updates from AAPA 2018.|
NEW ORLEANS – Integration of an opioid education program into the physician assistant (PA) curriculum improves students’ confidence to provide patient education and counseling, formulate a treatment plan for patients with chronic pain, and discuss abnormal urine drug screening results, according to a study presented at the American Academy of Physician Assistants’ (AAPA) 2018 conference.
“As primary care providers often care for patients with opioid use disorders and account for approximately half of opioid pain relievers dispensed, it is essential that PA students be prepared to identify, diagnose, and treat these patients,” stated Tia M. Solh, MT (ASCP), MSPAS, PA-C, and Sheena D. Brown, PhD, MSCR, from the Mercer University College of Health Professions in Atlanta
The researchers sought to improve the PA didactic curriculum by integrating a lecture series on opioid use disorder and prescription opioid misuse followed by standardized patient examinations (SPE) and then assess the effectiveness of this program on students’ perceived confidence in their ability to evaluate this patient group.
A PA faculty member—who was experienced in psychiatric and addiction medicine treatment setting—presented a lecture series that featured discussion on patient clinical presentation, screening, diagnosis, interviewing and counseling techniques, patient education, referral, and treatment, which included medication-assisted treatment and behavioral therapy.
The session also included a review of the Centers for Disease Control and Prevention’s Guidelines for Prescribing Opioids for Chronic Pain and legal requirements for PAs to prescribe buprenorphine. Interviewing and counseling technique topics focused on assessment for baseline opioid risk, identification of aberrant medication taking behaviors, discussion of risks and benefits of opioids for chronic pain, and discussion of universal monitoring strategies, including urine drug testing and controlled substance agreements.
Standardized patients were then used to simulate patients with chronic pain, including those with chronic lower extremity pain due to a past injury, chronic low back pain, or chronic pain due to diabetic neuropathy. The students were allotted 20 minutes to complete the interview. Faculty members used a checklist-style rubric to evaluate the students and provided feedback on their adherence to the following:
- Address and interact with the patient in a nonjudgmental manner
- Display empathy
- Avoid medical jargon
- Assess for baseline opioid risk
- Discuss risks and benefits of opioids for chronic pain
- Discuss universal monitoring strategies
- Include the patient’s perspective in the treatment plan
Standardized patients also provided formative feedback to the students and shared methods on how to establish rapport. PA students were given a voluntary, anonymous 5-point Likert scale survey (strongly disagree to strongly agree) prior to and following the standardized patient examinations, assessing perceived confidence in: history taking, ability to discuss abnormal urine drug screen results, patient education and counseling, ability to formulate a treatment plan for patients with chronic pain complaints, and overall opioid use disorder treatment knowledge base.
A total of 35 PA students completed the survey. The students showed statistically significant improvements in their perceived confidence in their patient education and counseling skills (54.5%), ability to formulate a treatment plan for patients with chronic pain complaints (19.8%), discuss abnormal urine drug screen results with patients (28.4%), and their overall opioid use disorder treatment knowledge base (35%). Significant changes were not observed in the large percentage of students who felt confident in their history-taking skills before the standardized patient examinations (80% vs 94%).
“PA students perceived improved confidence in their ability to provide patient education and counseling, formulate a treatment plan for patients with chronic pain complaints, discuss abnormal urine drug screen results, and their overall opioid use disorder treatment knowledge as a result of this exercise,” stated the researchers. “This activity could easily be replicated in other PA programs. As one limitation of this study is the use of a single cohort, we will improve upon this by including additional cohorts in the future.”
AAPA 2018 continues through Wednesday, May 23. Visit https://www.aapa.org/conference/ for more information.
Solh TM, Brown SD. Addressing the opioid epidemic: integration of opioid prescribing education and medication-assisted treatment into the physician assistant curriculum. Presented at the American Academy of Physician Assistants 2018 conference; May 19-23, 2018; New Orleans. Poster 270.