Faculty Bibliography

BACKGROUND/UNASSIGNED:Intrathecal drug delivery systems (IDDS) are effective tools for the management of chronic non-cancer pain, cancer-associated pain, and spasticity. Given the overall risks of opioid medications, it is imperative that IDDS opioid-infusion patients receive education regarding the risks versus benefits of their intrathecal opioid medications and that controlled substance agreements (CSAs) are utilized to both educate patients and hold them accountable for keeping IDDS programming visits, refill appointments, or other IDDS maintenance appointments. METHODS/UNASSIGNED:A retrospective electronic medical record (EMR) review study was conducted at an interventional pain management practice, quantifying the number of non-cancer chronic pain IDDS opioid therapy patients with signed CSAs. An educational intervention was conducted to increase staff awareness regarding compliance with CSAs and the location of proper CSA documentation within the EMR. Follow-up EMR review and provider knowledge assessment surveys were deployed to assess the success of the intervention. RESULTS/UNASSIGNED:Staff knowledge of CSAs increased from 14.3% (3/21) to 45.5% (10/22) following CSA education while their ability to locate CSAs within the EMR also increased from 38.1% (8/21) to 40.9% (9/22). Post-education intervention, rates of CSA documentation improved from 4.5% to 74.5%. Lastly, there was a 39.5% reduction in rescheduled IDDS appointments within the patient population studied. CONCLUSION/UNASSIGNED:The results of this study suggest potentially profound impacts that a simple education intervention can have on staff knowledge and compliance with CSA documentation for patients receiving IDDS opioid therapy for chronic non-cancer pain. Furthermore, implementation of CSAs for this patient population may be associated with a decrease in the number of missed, no-show, or rescheduled IDDS maintenance appointments, which have important patient safety implications. Further research is warranted to investigate the impact of CSA compliance on adverse patient outcomes and the potential cost-savings practices with required CSAs.

INTRODUCTION/UNASSIGNED:Based on recent data, the pain fellowship match is decreasing in competitiveness. The most recent 2023-2024 match cycle had the most unfilled positions and the highest match rate in the last five years. Although there has been some speculation about potential factors contributing to these trends, our study aimed to gather insight from pain fellowship program directors (PDs) nationwide to provide valuable perspectives on recent match trends. METHODS/UNASSIGNED:We created an anonymous online survey, with questions regarding potential factors contributing to match trends over the last five years. Our survey was emailed to 115 program directors (PDs), and one follow-up Email was sent three weeks later to maximize responses. RESULTS/UNASSIGNED:Surveys were completed by 25.2% (29/115) of PDs. Over the past five years, 82.8% of PDs (24/29) reported a decrease in applications to their program. For residency specialty of pain fellowship applicants, 100% of PDs (29/29) reported a decline in anesthesiology applicants. Most PDs reported an increase in applicants from PM&R (62.1%, 18/29), Neurology (69.0%, 20/29), and Emergency Medicine (93.1%, 27/29). For potential contributors to these trends, increasing compensation in primary residency specialty was the most significant perceived contributor, with a weighted average of 4.89/5. Decreasing pain reimbursement was the second strongest contributor, with a weighted average of 4.31/5. CONCLUSION/UNASSIGNED:Increasing compensation in primary residency specialty and declining pain reimbursements were the two most significant perceived contributors to the recent decline in interest in pain fellowship to resident trainees. Pain medicine is now attracting a more diverse applicant pool with a decrease in anesthesiology applicants and an increase in PM&R, Internal Medicine, Neurology, Emergency Medicine, and Psychiatry applicants. Future pain fellows' increased variety of training backgrounds may present an opportunity to critically assess the current pain medicine curriculum to suit the needs of a more diverse cohort.