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Source: Wikimedia Commons and Christine Dela Cerna

Pain Med Non-Compliance Rate 70%; Rothman Partners With Capital Health; More Arthroscopy Practice Required

Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, June 23rd, 2017

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70% of Patients Confused and Non-Compliant With Their Pain Med Regimen?

New research from a Level-I trauma center finds that not only do an exorbitant number of patients misunderstand their pain medication regimen, but many alter that regimen.

The new study, “Patient Comprehension and Compliance Survey to Assess Postoperative Pain Regimens in the Orthopaedic Trauma Population,” was published in the June 2017 edition of the Journal of Orthopaedic Traumatology.

Ajith Malige, M.D. an orthopedic surgery resident at St. Luke’s University Health Network in Bethlehem, Pennsylvania, and co-author on the study, told OTW, “The effectiveness of opioids as pain reducing medications has made them an integral part of post-operative pain regimen plans, but the many harmful side effects of these medications makes patient compliance and physician monitoring crucial.”

“Based on the clinical experiences of our attending physicians, there seems to be an increased demand and dependence on opioid medications in their patients. In line with the new FDA guidelines for opioid prescription, we believe it is important to check patient understanding and use of these potentially dangerous medications to ensure better patient care.”

The authors wrote, “A total of 171 patients between the ages of 18-89 years underwent surgical fixation of fractures involving the pelvis, long bones, or periarticular regions of the knee, ankle, elbow, and wrist…. Of that group, 147 patients completed the survey.”

“Seventy percent (n=114) of patients could not accurately reproduce their pain medication regimen, regardless of age, employment status, income level, education level, time between surgery and follow-up, and whether pain interfered with activities of daily living.”

“Patients (61.2%; n=90), regardless of the six aforementioned demographic factors, also admitted to modifying their pain medication regimen with non-prescribed medications, with 55.8% (n=82) of patients adding over-the-counter medications to surgeon-prescribed narcotic medications.”

Dr. Malige commented to OTW, “While there were no specific demographic factors that could be correlated with patient miscomprehension and non-compliance, the overall high rate of miscomprehension and non-compliance to opioid medications as well as the patient-driven addition of over-the-counter pain relievers (e.g., ibuprofen, acetaminophen) to their post-operative pain regimen plans points to the need for further close monitoring. Both increased patient education about these medications and open lines of communication between patient and physician about all medications taken can possibly help in reversing this trend and keeping our patients safe.”

Rothman Institute Partners With Capital Health

“Trenton Orthopaedics at Rothman Institute” Never heard of it? That is because the doors are just on the verge of opening.

Rothman Institute has announced a partnership with New Jersey-based Capital Health (comprised of two hospitals, among other facilities) that will bring the full line of Rothman services closer to more patients.

Alexander R. Vaccaro, M.D., Ph.D., M.B.A., president of Rothman Institute, told OTW, “Our plans are to make Rothman services available throughout the East Coast and beyond. Part of this is to be available to patients in the Trenton, New Jersey area. Rothman Institute surgeons and physicians will now have privileges at Capital Health facilities including: Regional Medical Center – Trenton and Capital Health Medical Center – Hopewell. We began talks with Capital Health in December 2016 and just two weeks ago signed the final paperwork.”

“Joining Capital Health is a great move for us. We appreciate their finely-tuned management structure and are confident that their physicians and ours share the same healthcare philosophy.”

“Capital Health is proud to partner with the world-renowned Rothman Institute in bringing truly world-class orthopedic care conveniently to the residents of Mercer and Bucks counties and beyond,” said Al Maghazehe, Ph.D., F.A.C.H.E., president and CEO of Capital Health, in the May 31, 2017 news release. “Our unique partnership represents another step forward for Capital Health as we further develop the depth and breadth of our clinical programs for the benefit of our neighbors.”

“The decision to partner with Capital Health was a natural one with their geographic reach and accessibility in Central New Jersey and Eastern Pennsylvania,” said Mike West, CEO of Rothman Institute. “They have the same commitment to excellence as our organization and have an outstanding reputation in the Trenton marketplace and its extended suburbs. We anticipate a successful transition and partnership now and long into the future.”

Arthroscopy: Increase Cases to Achieve Competency?

A cross-sectional study from England has found that the number of cases needed to achieve competency in shoulder arthroscopy may need to be increased. “Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectional Study Highlighting the Impact of Working Time Directives,” was published in the June 2017 edition of Arthroscopy.

Robert M. Middleton, B.M.B.Ch., M.A. (Cantab), M.R.C.S., is a research fellow at Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford in England. Dr. Middleton, co-author on the study, told OTW, “The introduction of working time directives has resulted in new challenges for surgical training programs.”

“The reductions in training opportunities, their impact, and how to address them, have been a focus of our research group in Oxford for some time. This study aimed to investigate the dexterity performance at two shoulder arthroscopy tasks by surgeons with varying degrees of previous experience. We wanted to gain some estimates of how many such procedures need to be performed by trainees before they reach high levels of performance. Our aim was to provide some useful information for those responsible for planning and organizing training programs.”

The authors wrote, “…A total of 45 participants of varying experience performed 2 validated tasks: a simple diagnostic task and a more complex Bankart labral repair task. All participants provided logbook numbers for previously performed arthroscopies. Performance was assessed with the Global Rating Scale and motion analysis….”

Dr. Middleton commented to OTW, “The involvement of statistical expertise using receiver operating curves allowed us to estimate the number of shoulder arthroscopies required to reach a given performance level.”

“As expected, with decreasing levels of experience, performance on both arthroscopic tasks were reduced, suggesting a ‘minimum number of procedures performed’ is a sensible requirement in training programs. However, our results suggest numbers that are higher than some national programs require and so this study provides useful data to those responsible for training programs.”

“Whilst competency based training programs are now the mainstay, minimum operating numbers also play an important role, but ideally should be evidence based. If working time directives are not optional then surgical programs need to optimize training opportunities, explore the use of simulation platforms or to consider lengthening training. For those trainees expecting to include arthroscopy as part of their practice, the acquisition of complex, specialist skills are likely to only be achieved from extra fellowship training.”

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