BACKGROUND: Although opioids are central to acute @entity158 management, numerous studies have shown that many physicians prescribe them incorrectly, resulting in inadequate @entity158 management and side effects. We assessed whether a case-based palliative medicine curriculum could improve medical house staff opioid prescribing practices. DESIGN: Prospective chart review of consecutive pharmacy and billing records of @entity1 who received an opioid during hospitalization before and after the implementation of a curricular intervention, consisting of 10 one-hour case-based modules, including 2 @entity158 management seminars. MEASUREMENTS: Consecutive pharmacy and billing records of @entity1 who were cared for by medical residents (n = 733) and a comparison group of neurology and rehabilitative medicine @entity1 (n = 273) that received an opioid during hospitalization in 8-month periods before (1/1/97 to 4/30/97) and after (1/1/99 to 4/30/99) the implementation of the curriculum on the medical service were reviewed. Three outcomes were measured: 1) percent of opioid orders for @entity6882 ; 2) percent of opioid orders with concomminant bowel regimen; and 3) percent of opioid orders using adjuvant nonsteroidal anti-inflammatory drugs (NSAIDs). MAIN RESULTS: The percentage of @entity1 receiving @entity6882 decreased in the study group, but not in the comparison group. The percentages receiving NSAIDs and bowel medications increased in both groups. In multivariate logistic models controlling for age and race, the odds of an experimental group @entity1 receiving @entity6882 in the post-period decreased to 0.55 (95% confidence interval [95% CI], 0.32 to 0.96), while the odds of receiving a bowel medication or NSAID increased to 1.48 (95% CI, 1.07 to 2.03) and 1.53 (95% CI, 1.01 to 2.32), respectively. In the comparison group models, the odds of receiving a NSAID in the post-period increased significantly to 2.27 (95% CI, 1.10 to 4.67), but the odds of receiving a bowel medication (0.45; 95% CI, 0.74 to 2.00) or @entity6882 (0.85; 95% CI, 0.51 to 2.30) were not significantly different from baseline. CONCLUSIONS: This palliative care curriculum was associated with a sustained (>6 months) improvement in medical residents' opioid prescribing practices. Further research is needed to understand the changes that occurred and how they can be translated into improved @entity1 outcomes.

Can a XXXX management and palliative care curriculum improve the opioid prescribing practices of medical residents?

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity6882 :: ('MESH:D008614', 'Chemical') :: ['meperidine'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain']
@entity158 :: (MESH:D010146,Disease) :: ['pain']
