Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review

Abstract

Purpose: Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health.

Method: In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis.

Results: Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement.

Conclusions: Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.

Figure 1

Mapping Moore and colleagues’ continuing health provider education outcome levels (left of figure) ^, to complex intervention outcome evaluation types (right of figure). Reprinted with permission from Moore DE Jr, Chappell K, Sherman L, and Vinayaga-Pavan M. A conceptual framework for planning and assessing learning in continuing education activities designed for clinicians in 1 profession and/or clinical teams. Med Teach. 2018;40:904–913.

Figure 2

PRISMA flow diagram presenting the number of records identified, screened, assessed for eligibility, and included or excluded (along with the reasons they were excluded). Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; CINAHL, Cumulative Index to Nursing and Allied Health; ERIC, Education Resources Information Centre.