Abstract
A weekly tele-mentoring program was implemented in Ontario to help address the growing opioid crisis through teaching and mentoring family physicians on the management of chronic pain and opioid prescribing. This study assessed opioid prescribing behaviours among family physicians who attended the tele-mentoring program compared to two groups of Ontario family physicians who did not attend the program. We conducted a retrospective cohort study with two control groups: a matched cohort, and a random sample of 3000 family physicians in Ontario. Each physician was followed from one year before the program, which is the index date, and one year after. We examined the number and proportion of patients on any opioid, on high dose opioids, and the average daily morphine equivalent doses prescribed to each patient. We included 24 physicians who participated in the program (2760 patients), 96 matched physicians (11,117 patients) and 3000 random family doctors (374,174 patients). We found that, at baseline, the tele-mentoring group had similar number of patients on any opioid, but more patients on high dose opioids than both control groups. There was no change in the number of patients on any opioid before and after the index date, but there was a significant reduction in high-dose opioid prescriptions in the extension for community healthcare outcomes (ECHO) group, compared to a non-significant increase in the matched cohort, and a non-significant reduction in the Ontario group during the same comparable periods. Participation in the program was associated with a greater reduction in high-dose opioid prescribing.
Highlights
Chronic pain is estimated to affect 19% of Canadians, more than half of whom report that their pain has persisted for more than 10 years [1]
High rates of opioid prescribing by physicians have been implicated in the first phase of the opioid crisis [4]
Our group demonstrated that participation in extension for community healthcare outcomes (ECHO) led to a significant increase in chronic pain self-efficacy and knowledge, these were self-reported results, and there is a need for objective measures of skills and competence [10]
Summary
Chronic pain is estimated to affect 19% of Canadians, more than half of whom report that their pain has persisted for more than 10 years [1]. In Canada, most patients with chronic pain are managed by family physicians, family physicians receive little training in managing this complex condition [2,3]. North America has been facing an opioid crisis that started around 1999. High rates of opioid prescribing by physicians have been implicated in the first phase of the opioid crisis [4].
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