Misprescribing controlled substances: An evaluation of a professional development program

ABSTRACT

Background: Controlled prescription drug (CPD) abuse has reached epidemic proportions in the United States. Most physicians attending a 3-day continuing medical education (CME) professional development program (PDP) lack training in identifying risk and in managing patients who misuse CPDs. To address this issue, the authors conducted an evaluation of a PDP that trains physicians on proper prescribing, identifying substance abuse, utilizing screening, brief intervention, and referral to treatment (SBIRT), and implementing motivational interviewing (MI). Methods: The authors conducted a program evaluation to assess the efficacy and impact of the PDP on physicians' knowledge and prescribing behaviors. Results: Participants (N = 174) were typically middle-aged (average age of 53 years), male (89%), and physicians (82%) and other health care professionals (18%). Many physicians practice in solo primary care settings (46%). Course evaluations were completed by n = 155 (89%) participants who rated the course and presenters highly (mean 4.8/5 respectively). Physicians' knowledge scores on pre/post assessments increased significantly: pretest (M = 58.7, SD = 13.12) and posttest (M = 78.28, SD = 9.83) (t(173) = 20.06, P ≤ .0001, 95% confidence interval, CI: [−21.51, −17.65]). Almost half of the participants, n = 83/174 (48%), completed the follow-up survey, and 93% agreed/strongly agreed (A/SA) they made professional practice changes. Of participants practicing with an active DEA (Drug Enforcement Administration) registration (n = 57), most agreed/strongly agreed they implemented changes to align their practices with current guidelines (89%), used CPD more appropriately (87%), implemented office policies on prescribing (81%), identified and referred more substance abuse patients to treatment (80%), shared new information/experience from course with other 25 health professionals (93%), and felt the course positively impacted their behaviors personally and professionally (90% and 96%, respectively). Conclusions: This is the first known study evaluating a PDP in this population. Results demonstrated participant satisfaction and improvement in prescribers' knowledge and self-reported prescribing behaviors. However, further study is needed to assess actual clinical practice changes, direct impact on patient outcomes, and rates of recidivism.

KEYWORDS:

• Continuing medical education
• controlled prescription drugs
• Kirkpatrick Model
• misprescribing
• physician
• professional development program
• program evaluation
• SBIRT

Acknowledgments

The program evaluation was conducted without funding. The authors thank Diana Phillips for her contributions in data collection, formatting, and editing the paper, Erin E. Riley for her technical editing, and Wayne J. Riley, MD, MBA, MPH, MACP for his critical review and feedback of the study and manuscript. The authors thank all participants in the study for their willingness to participate, their many contributions to the course, their suggestions for improvement, and their willingness to change their personal and professional practice behaviors to improve patient care.

Author contributions

Each author contributed significantly to data analysis, interpretation of results, and writing and revising the manuscript. Dr. Dewey served as first author and was responsible for writing the institutional review board (IRB) application, the overall management of the study, survey design, evaluation development, data collection, data analysis, data interpretation, and writing the manuscript. Marine Ghulyan was responsible for assisting in survey design, data collection, data analysis, data interpretation, and writing/finalizing/editing the manuscript. William Swiggart teaches in each course and was responsible for data interpretation and writing/revising/editing the manuscript.