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Acute pain treatment by physicians and dentists: Results from a WREN/PEARL collaborative survey. Mark Remiker, MA: Peggy O'Halloran, MPH: Michael Grasmick, PhD; Frederick Curro, MD; Paul Smith, MD. - PowerPoint PPT Presentation
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. . . for our health
Mark Remiker, MA: Peggy O'Halloran, MPH: Michael Grasmick, PhD; Frederick Curro, MD; Paul Smith, MD
Wisconsin Research and Education Network and the University of Wisconsin Department of Family Medicine
Acute pain treatment by physicians and dentists: Results from a WREN/PEARL collaborative
survey
WREN
• Wisconsin Research and Education Network
• Founded in 1987
• 130 Clinics
• 20 Healthcare organizations
• 37 communities
PEARL
• Practitioners Engaged in Applied Research and Learning
• NIH-sponsored network of private-practice dentists
• Launched in 2005 at NYU College of Dentistry
• Over 200 Practitioner-Investigators in 32 states
• 16 studies are ongoing or completed, with almost 6,000 subjects enrolled
Background & Significance
• common both in dentistry and primary care
• very little literature on prevalence in primary care
• physician attitudes poorly described in literature
• no literature to support the anecdotal link of attitudes to prescriptions given and adequacy of pain relief
Acute Pain:
Collaborative Aim
Describe the attitudes and practices related to the treatment of acute pain and any differences between primary care clinicians and dentists through electronic survey.
- Descriptive analysis
- Hypothesis generation
Survey Group
• Members– Simple online registration– Respond to at least 80%– Responses inform WAFP board how you feel about the
issue in question
• Surveys– Address issues important to primary care– 12 or less a year– Take approximately 5 minutes
Methods: the sample
Table 1: Sample demographics
WRENDoctors
PEARLDentists
Both
N 79 145 224
Age (SD) 47.4 (9.8) 50.25 (10.03) 49.3 (10.04)
Years Practicing (SD)
17.3 (10.1) 20.96 (9.6) 19.48 (9.8)
Sex (M/F) 37/31 103/42 140/73
Method: Survey 2 (general attitudes)
- How often do you use the following treatment options for acute orofacial pain?
– Education– Medication– Referrals
- Drugs commonly prescribed? – NSAIDS– Opioids– Muscle relaxants
- Attitudes toward prescribing opioids
Methods: Survey 1 (Scenarios)
Scenario 1 (TRAUMA)A 25 year old male with no known medication allergies slipped on the
ice while carrying a package and fell hitting his face on the curb about 12 hours ago. He did not lose consciousness, but he has facial bruises, swelling and broke off part of an incisor. He put the ice on the injury when he got home last night because of the pain. He took Ibuprofen 600mg every 6 hours and it “helps some,” but he woke up twice last night because of the pain. He has an angular fracture with no pulpal exposure and approximately 1/3 of the incisal edge is gone. You do not suspect any bone fractures.
– Scenario 1: TRAUMA– Prescription: Ibuprofen 600 mg/6 hours– Effective: SOME
Methods: Survey 1 (Scenarios)
Scenario 2 (SINUSITUS)A 23 year old woman with no known medication allergies presents with
right maxillary tooth pain, a two week history of gradual improving upper respiratory symptoms, but worsening facial pressure and pain for the past 10 days. She took some Claritin D 24 hours which did not help much. You make a clinical diagnosis of right maxillary sinusitis.
– Scenario 2: SINUSITUS– Prescription: Ibuprofen 600 mg/6 hours– Effective: NO
Methods: Survey 1 (Scenarios)
Scenario 3 (ABSCESS)A 43 year old female with no known medication allergies has had a right
lower mandibular pain intermittently for 2 weeks. She has developed swelling and increasing pain the last 3 days inadequately controlled with acetaminophen 500 mg every 4 hours. She woke up 4 times last night and is in obvious distress. You make a diagnosis of tooth abscess.
– Scenario 3: ABSCESS– Prescription: acetaminophen 50 mg/4 hours– Effective: NO
Methods: Survey 1 (Scenarios)
Post-scenario questions– Any non-medication treatments?
– Would you recommend a medication?• Name• Dose• Instructions• Prescription?
– Medication 2?
Preliminary Results
Correlation Matrix
Age Years Practicing
Trauma Sinusitis Abscess Total
Age x
Years Practicing
0.89* x
Trauma 0.01 -0.04 x
Sinusitis -0.01 0.001 0.21* x
Abscess -0.07 -0.07 0.33* 0.05 x
Total 0.00 -0.02 0.72* 0.67* 0.61* x
* = p < 0.000
Preliminary Results
Med Recommendation: Trauma
Doctor Dentist Total
No 13 34 47
Yes 65 108 173
Total 78 142 220
Pearson Chi2 = 1.59p = 0.21
Scenario 1: Trauma
First Med Recommendation
Acetaminophen NSAID Opioids Antibiotic Other0
10
20
30
40
50
60
DentistDoctor
– Scenario 1: TRAUMA– Prescription: Ibuprofen 600 mg/6 hours– Effective: SOME
Preliminary Results
Med Recommendation: Sinusitis
Doctor Dentist Total
No 4 51 55
Yes 72 87 159
Total 76 138 214
Pearson chi2 = 25.78p < 0.00
Scenario 2: Sinusitis
First Med Recommendation
Acetaminophen NSAID Opioids Antibiotic Other0
10
20
30
40
50
60
70
80
90
DentistDoctor
– Scenario 2: SINUSITUS– Prescription: Ibuprofen 600 mg/6 hours– Effective: NO
Preliminary Results
Med Recommendation: Abscess
Doctor Dentist Total
No 2 4 6
Yes 73 135 208
Total 75 139 214
Pearson chi2 = 0.008p = 0.93
Scenario 3: Abscess
First Med Recommendation
Acetaminophen NSAID Opioids Antibiotic Other0
10
20
30
40
50
60
70
80
90
DentistDoctor
– Scenario 3: ABSCESS– Prescription: acetaminophen 50 mg/4 hours– Effective: NO
Preliminary Results
Prescribing opioids across scenarios
No Yes Total
Doctor 41 35 76
Dentist 103 36 139
Total 144 71 215
Pearson chi2 = 9.028p = 0.003
Summary of preliminary findings
• Individuals who prescribe more for one ailment are likely to prescribe more for others.
• Dentists less likely than doctors to prescribe for sinus infection
• Dentists more likely than doctors to avoid prescribing opioids
Limitations
- Sample size - Sex ratio- Exploratory analyses- Attitudes only, not behaviors- Analyses do not speak to a effectiveness
Future Directions
1. Analyze the rest of survey 1 and the entire 2nd survey
2. What methods are most effective?
3. What are the patients attitudes?
Thank you
- Questions? Comments? Did anyone generate any Hypotheses?
- WREN/PEARL survey takers- PEARL group: Van P. Thompson, Don Vena,
Frederick Naftolin, Matthew Buchholz- WREN group: Hannah Louks- National Institute of Health