In the treatment of chronic non-cancer pain (CNCP), the duty to provide pain relief must be balanced with duties to avoid promoting substance abuse, promote daily function, and limit medical risks of treatment. This need for balance is best met with an integrated, collaborative care model, engaging primary care providers, nurse care managers, and other care team members. We have recently developed a web- based training on the use of opioids for CNCP in primary care: COPE-Collaborative Opioid Prescribing Education. The COPE training focuses on the communication challenges between physician and patient that accompany long-term prescription opioid use. Since these challenges extend beyond physicians to other non-prescribing members of the care team, we propose to develop COPE-N, a companion web- based training for nurses, who often serve in an essential """"""""care manager"""""""" role in CNCP care. This nurse care manager role will be based on Unutzer's IMPACT model of depression care that has been tested and implemented with much success in primary care. This role will consist of: monitoring medication effects (therapeutic and side effects and abuse), promoting patient adherence to medication and other CNCP treatments, and assuring appropriate documentation. In this Phase I proposal, we propose to provide proof-of-concept for the COPE-N training including: 1) define the core responsibilities and skills needed for the nurse care-manager (NCM) in CNCP care, 2) create a case-based 6-unit training program for NCMs, 3) develop video-based interactive clinical scenarios for COPE-N, 4) determine new software requirements to maximize the feasibility and training efficacy for COPE-N, 5) develop knowledge and skill assessments to test the training efficacy of COPE- N, 6) revise COPE-N characters, scenarios, and response modes in accord with clinician/consultant input, and 7) pilot the COPE-N with 20 practitioners and evaluate feasibility, usability and training efficacy. In a future Phase II proposal, we plan to: revise the COPE-N clinical scenarios, administration, and assessments, complete development of the COPE-N performance support system, develop a suite of alternative specialty care clinical scenarios for COPE-N, develop a version of COPE-N tailored for medical assistants (COPE-MA),conduct a large randomized trial of the COPE-N training for nurses and other care managers in a wide variety of settings: primary care, pain clinics, rheumatology, orthopedic, rehabilitation medicine.
Use of prescription opioids such as Vicodin and OxyContin for chronic pain has risen rapidly in the past two decades. Prescription opioid abuse is now the fastest growing form of drug abuse. Prescription opioids are now the top cause of accidental drug overdose. New strategies for assuring quality pain care and limiting harm from opioid abuse are urgently needed.
