title: Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners.
abstract: We aimed to evaluate the effect of pain education on opioid prescribing by early-career general practitioners. A brief training workshop was delivered to general practice registrars of a single regional training provider. The workshop significantly reduced "hypothetical" opioid prescribing (in response to paper-based vignettes) in an earlier evaluation. The effect of the training on "actual" prescribing was evaluated using a nonequivalent control group design nested within the Registrar Clinical Encounters in Training (ReCEnT) cohort study: 4 other regional training providers were controls. In ReCEnT, registrars record detailed data (including prescribing) during 60 consecutive consultations, on 3 occasions. Analysis was at the level of individual problem managed, with the primary outcome factor being prescription of an opioid analgesic and the secondary outcome being opioid initiation. Between 2010 and 2015, 168,528 problems were recorded by 849 registrars. Of these, 71% were recorded by registrars in the nontraining group. Eighty-two percentages were before training. Opioid analgesics were prescribed in 4382 (2.5%, 95% confidence interval [CI]: 2.40-2.63) problems, with 1665 of these (0.97%, 95% CI: 0.91-1.04) representing a new prescription. There was no relationship between the training and total prescribing after training (interaction odds ratio: 1.01; 95% CI: 0.75-1.35; P value 0.96). There was some evidence of a reduction in initial opioid prescriptions in the training group (interaction odds ratio: 0.74; 95% CI: 0.48-1.16; P value 0.19). This brief training package failed to increase overall opioid cessation. The inconsistency of these actual prescribing results with "hypothetical" prescribing behavior suggests that reducing opioid prescribing in chronic noncancer pain requires more than changing knowledge and attitudes.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, NSW, Australia.
authors.forename: Simon Mark
authors.initials: SM
authors.lastname: Holliday
authors.affiliation: Hunter Integrated Pain Service, Hunter New England Local Health District, NSW, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Hayes
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, NSW, Australia.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Dunlop
authors.affiliation: GP, Elermore Vale General Practice, Newcastle, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia.|NSW and ACT Research and Evaluation Unit, GP Synergy, Newcastle, NSW, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia.|NSW and ACT Research and Evaluation Unit, GP Synergy, Newcastle, NSW, Australia.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Henderson
authors.affiliation: Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Mieke L
authors.initials: ML
authors.lastname: van Driel
authors.affiliation: Public Health Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Holliday
authors.affiliation: CReDITSS, Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Jean I
authors.initials: JI
authors.lastname: Ball
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davey
authors.affiliation: Eastern Victoria General Practice Training, Hawthorn, VIC, Australia.|Department of General Practice, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Neil Allan
authors.initials: NA
authors.lastname: Spike
authors.affiliation: Rural Clinical School, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Lawrence Andrew
authors.initials: LA
authors.lastname: McArthur
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia.|NSW and ACT Research and Evaluation Unit, GP Synergy, Newcastle, NSW, Australia.
authors.forename: Parker John
authors.initials: PJ
authors.lastname: Magin
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001315:Australia; D059350:Chronic Pain / Q000188:drug therapy*; D002985:Clinical Protocols; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000193:education* / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D059408:Pain Management / Q000706:statistics & numerical data*; D012042:Registries
chemical_list: D000701:Analgesics, Opioid