Close Up on Pathways to Safer Opioid Use: A Provider’s Perspective

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Prescription opioid-related deaths are considered to be one of the leading preventable public health problems in the United States. To help the health care community address this critical issue, the Office of Disease Prevention and Health Promotion (ODPHP) developed the Pathways to Safer Opioid Use training.

This online, interactive training is based on the opioid-related recommendations in the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan). It teaches strategies for the safer use of opioids to manage chronic pain — and is designed to help health care providers and students prevent opioid-related adverse drug events (ADEs).

Users who take the training can role-play 4 different characters in live-action videos: a patient, nurse, pharmacist, or primary care physician. By allowing users opportunities to participate in team decision-making in a number of multidisciplinary health care scenarios, the training teaches core competencies of safer opioid prescribing.

Because providers play such an important role in safely prescribing opioids, we sat down with Dr. Kristin Anderson, a provider in a nursing facility and Medical Director for Community Health and Prevention and Post-Acute Care in Missoula, Montana, to discuss her experience taking the Pathways training. Read on to find out what we learned from Dr. Anderson.

Dr. Kristin Anderson, Nursing facility provider and Medical Director for Community Health and Prevention and Post-Acute Care in Missoula, Montana

What role do health care providers play in preventing opioid-related ADEs?

Dr. Anderson: Health care providers are on the front lines of preventing opioid-related ADEs, so our role really can’t be overemphasized. There are so many opportunities in our day-to-day practice to recognize a patient who needs intervention. But sometimes, a patient at risk for an ADE isn’t on our radar — and that’s where screening tools come into play. Screenings — for example, the CAGE questionnaire for alcohol abuse — are important tools we can use to see if a patient might be at risk for opioid addiction problems. Providers are in the unique position to screen patients before prescribing opioids — and ultimately help prevent an ADE.

What were your impressions of the Pathways to Safer Opioid Use training?

Dr. Anderson: The training really highlighted the human aspect of the patient-provider interaction by playing out real-life scenarios that providers deal with every day. Sometimes, we get busy or overwhelmed — it can be difficult for us to identify which patients might need more time to discuss and evaluate their need for an opioid. The training really validates the challenges we face.

I found the format of the training helpful, too. Because you can make decisions as a particular character, you’re able to see how different interventions can impact a patient. Of course, the right intervention can help, but the opposite’s also true: the wrong intervention can end up causing a host of problems for the patient. I appreciated that I could play out both scenarios in the training.

How was the training relevant to your work? Will you make any changes based on what you learned from it?

Dr. Anderson: The Pathways training really underscored how important it is not to assume that my patients always understand what I’m saying. What they hear when they’re stressed — as many of us are during doctor’s appointments — may not be the most important message I’m trying to communicate. That’s where communication strategies like the teach-back method come into play — you ask the patient to repeat instructions for a prescription back to you to check for understanding.

The training also reminded me how important it is to do the teach-back method with the patient’s caregiver or advocate, as well. Because many of my patients are older adults, they may not be responsible for their own medication. Often it’s a friend, a neighbor, or a home health care aid. Involving a patient’s support system in these crucial conversations about their prescriptions from the start can help prevent an ADE down the line.

Finally, the training reinforces just how important it is to reframe patients’ expectations about resolving their pain. In many cases, pain simply can’t be completely resolved, and our goal shifts to helping the patient function — rather than providing total pain relief. The training communicated that reality very effectively.

Any final thoughts?

Dr. Anderson: Making sure that opioids are prescribed safely is something we need to deal with on multiple levels — on the macro, systems-based level, and also on the micro level in the care we provide every day. That day-to-day level is where providers have the most important opportunity to intervene, and the Pathways training reminds us just how many options are available to help us make a difference.

Want to take the training yourself? Register now — and keep in mind that free CPE or CME credit is available! You can also learn about the current evaluation of the Pathways training.

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