The impact of continuing medical education on opioid prescribing practices.

OBJECTIVE

Clinician adherence to clinical guidelines after engaging in continuing medical education (CME) is often limited to self-report. We sought to determine the impact of a CME course addressing safer opioid prescribing on clinician opioid-related prescribing practices for patients prescribed opioids for pain.

DESIGN

A retrospective cohort study.

SETTING

Single health system, Northeast United States.

SUBJECTS: Clinician prescribers of opioids (Medical Doctor/Doctor of Osteopathy, Doctor of Podiatric Medicine, Nurse Practitioner, Physician Assistant) who did and did not complete a CME program.

METHODS

Practice adherence to the Food and Drug Administration Opioid Analgesia Risk Evaluation and Management Strategies (REMS) Education Blueprint was assessed by comparing electronic health record data from clinicians who participated in a CME course (REMS-OA+) with data from matched clinicians who did not (REMS-OA-). We compared prescribing practices, including opioid dose and patient-level outcomes, including visit type, naloxone prescription, and urine drug testing, before and after CME participation. A difference-in-differences (DiD) approach estimated the absolute change in prescribing practices and patient-level outcomes.

RESULTS

A total of 49 clinicians completed a portion of the REMS-OA CME and prescribed opioids during the study period. After adjustment, the absolute DiD for prescribing practices and patient-level outcomes was not significantly different between REMS-OA+ prescribers and REMS-OA- prescribers. The only significant difference was that REMS-OA+ prescribers completed more in-person visits compared with telemedicine visits than REMS-OA- prescribers.

CONCLUSIONS

We did not detect significant differences in clinician adherence to clinical guidance between the REMS-OA CME groups. Improved adherence to guidelines for opioid prescribing likely requires both CME and additional interventions.