Interprofessional learner perceptions of a brief educational intervention about opioid prescribing for older adults

A brief educational intervention specifically addressing opioid prescribing in older adults can be developed and delivered as part of a Geriatrics rotation, which can lead to increased knowledge and confidence in safe prescribing by the learners who received the intervention. Although older adults over the age of 65 have a lower rate of overdose death than younger individuals, the U.S. overdose death rate among this group increased by 521% from 1999 to 2019.1, 2 Older adults may be especially vulnerable to overdose due to metabolism changes, physiological effects of aging, and increased prevalence of chronic medical conditions requiring concurrent medication. Although prescriber opioid education efforts have been robust, less attention has been paid specifically to opioid use in older adults.3 The Health Resources and Services Administration (HRSA) Geriatrics Workforce Enhancement Program (GWEP) aims to improve the health of older adults through developing a skilled healthcare workforce by integrating geriatrics and primary care. One aim of the GWEP is to enhance opioid education for future healthcare professionals and in this light, we developed and implemented an educational intervention on opioid safety in older adults and examined the outcomes of this training. Interprofessional students, residents, and fellows who were enrolled in a monthly geriatric rotation from 7/1/2020 to 2/28/2022 (20 months) at a large Midwestern academic medical center participated in the study. The geriatric rotation consisted of didactic sessions in addition to the clinical experience. Each month-long rotation had up to six learners comprised of students in Medicine, Nursing, Pharmacy, and Physician Assistant Studies. Additionally, residents in the Internal Medicine and Physical Medicine and Rehabilitation programs and fellows in the Geriatrics program were included. During the rotation, learners receive 10 h of lectures, including the opioid training, and 112 clinical hours in the outpatient setting (geriatrics primary care clinic, consult focused assessment clinic, and nursing home care). The remaining lectures cover core geriatrics topics including dementia, depression, falls, and other syndromes. Content experts in geriatric medicine and addiction psychiatry performed literature reviews and used established clinical practice guidelines to develop a brief slideshow didactic focusing on the limited evidence of benefit and unique harms of chronic opioid use in older adults, ways to screen for opioid use disorder, and strategies to reduce harms of opioid use. (Supplementary Text S1). The didactic was designed to minimize duplication of material from other lectures the learners may have received on opioid prescribing by selectively focusing on geriatric aspects of opioid use. Didactic sessions were delivered via online live-streaming technology (Zoom). We asked learners to complete a post-rotation survey via an online link. (Supplementary Text S1). Learners received an initial email with a survey link within 2 months of rotation completion, followed by weekly reminders for 2 weeks. The survey assessed (1) overall evaluation of the training on a scale of 1 = Strongly Disagree to 5 = Strongly Agree; (2) perceived knowledge and confidence in medication safety and non-opioid treatment strategies both before (pre-intervention) and after the session (post-intervention) on a scale of 1 = Very Low to 5 = Very High; and (3) potential use of these strategies in their clinical practice. We also collected demographic information (age, gender, race, and ethnicity) and health professions-related information (discipline and level of training). We used descriptive statistics for demographic characteristics and overall evaluation of the rotation. We assessed pre- and post-intervention knowledge and confidence using the Wilcoxon Signed Rank Test. All analyses were performed using SPSS version 28.0.1.0. (Supplementary Text S1). A total of 97 learners participated in the rotation over 20 months. Of those, 64 (66%) completed the survey. The disciplines represented were Medicine (69%), Pharmacy (17%), Physician Assistant Studies (13%), and Nursing (1%). About 56% of participants were students and 41% were residents and fellows. Participants reported that the faculty were clear and effective in teaching the content (Mean = 4.72), that this rotation would enhance clinical practice (Mean = 4.75), and that they would also recommend the entire geriatric rotation experience to others (Mean = 4.78). The overall satisfaction with the rotation was also high (Mean = 4.81). The participants reported a 35% increase in knowledge of prescribing opioid medications safely for an older person (pre-score 2.81, post-score 3.80, p = 0.0001) with an absolute value increase of 0.99 on a 1–5 point Likert scale. The participants also reported a 32% increase in confidence for suggesting ‘non-opioid treatment options’ for older adults (pre-score 3.14, post-score 4.13, p = 0.0001) with an increase of 0.99 (Figure 1). Most participants reported that these didactic sessions will help them educate patients (91%) and provide better care (91%). About 80% reported the sessions will help them improve communication between providers and patients or their caregivers. Participants reported that these sessions will also help them educate caregivers (77%) and other providers (58%). Only 2% reported that they do not plan to make any changes in their practice in the future. Our study is the first assessment of a brief educational intervention tailored specifically for opioid prescribing in older adults. The major strength of our study is the robustness of the learners' evaluations of the training and the changes in pre- and post-intervention knowledge and confidence. A limitation is that we did not assess changes in actual prescribing behaviors and that some learners may have received education about opioids from clinic preceptors during the rotation, which were unable to account for and could have contributed to the results. We learned that a brief educational intervention could improve confidence and knowledge in medication safety and non-opioid treatment strategies in learners who had already received significant clinical training. Further study is needed to explore how the intervention influences future prescribing behaviors. We envision collaboration opportunities with other institutions, particularly to fulfill HRSA opioid training expectations. To facilitate broader use, our materials are available upon request. (Supplementary Text S1). Others could use this work in their teaching by incorporating it into a lecture course or clinical rotation for health professions students or resident trainees in a range of disciplines including Medicine, Nursing, and Pharmacy. Another potential benefit of creating and implementing this type of educational intervention is that it allows for trainees from varied backgrounds to learn from each other and learn how to work together on interprofessional clinical teams. Additionally, this brief intervention could be used as a ‘refresher’ for practicing clinicians. All authors were involved in study concept and design. Alëna A. Balasanova, Alfred L. Fisher, and Mary Jo Spurgin delivered the training. Jungyoon Kim, Hongmei Wang, and RH curated and analyzed the data. Jungyoon Kim, Alëna A. Balasanova, and Rebecca Hiebert managed the literature searches and wrote the initial drafts of the manuscript. Alëna A. Balasanova, Alfred L. Fisher, Jungyoon Kim, and Hongmei Wang contributed to manuscript revision for intellectual content. Jane Potter secured funding for the project. All authors have read and agreed to the published version of the manuscript. This research was funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $749,836.00 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. The authors declare that there is no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Text S1. Raw dataset table. Copy of geriatric rotation survey. GWEP opioid presentation slides and handouts. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.