{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:36:05Z","timestamp":1781192165160,"version":"3.54.1"},"reference-count":21,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2017,7,1]],"date-time":"2017-07-01T00:00:00Z","timestamp":1498867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Abuse"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Opioid analgesics are effective and appropriate therapy for many types of acute pain. Epidemiologic evidence supports a direct relationship between increased opioid prescribing and increases in opioid use disorders and overdoses. Objective: To tailor our residency curriculum, we designed and fielded an unannounced standardized patient (USP) case involving a patient with acute back pain who is requesting Vicodin (5\/325\u00a0mg). We describe residents\u2019 case management and examine whether their management decisions, including opioid prescribing, were related to their core clinical skills.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Results are based on 50 (USP) visits with residents in 2 urban primary care clinics. Highly trained USPs portrayed a patient with acute lower back pain who was taking leftover Vicodin with effective pain relief but was running out. We describe how residents managed this case, using both USP report and chart review data, and compare summary clinical skills scores between those who prescribed Vicodin and those who did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 50 residents, 18 prescribed Vicodin (10\u201360 pills). Among those who did not prescribe (32\/50), most (50%) prescribed ibuprofen. Eighty-three percent of the prescribers and 72% of nonprescribers ordered physical therapy (nonsignificant). Of the 18 prescribers, 13 documented checking the prescription monitoring database. Prescribers had significantly better communication scores than nonprescribers (relationship development: 80% vs. 58% well done, P = .029; patient education: 59% vs. 31% well done, P = .018). Assessment summary scores were also higher (60% vs. 46%) but not significantly ( P = .060). Patient satisfaction and activation scores were higher in the prescribers than nonprescribers (71% vs. 39%, P = .004 and 48% vs. 26%, P = .034, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most Vicodin prescribers did not follow prescribing guidelines, and they demonstrated better communication and assessment skills than the nonprescribers. Results suggest the need to guide residents in using a systematic approach to prescribing opioids safely and to develop an acceptable alternative pain management plan when they decide against prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1080\/08897077.2017.1319894","type":"journal-article","created":{"date-parts":[[2017,6,6]],"date-time":"2017-06-06T15:53:04Z","timestamp":1496764384000},"page":"324-329","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Opioid vs Nonopioid Prescribers: Variations in Care for a Standardized Acute Back Pain Case"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1764-0667","authenticated-orcid":false,"given":"Kathleen","family":"Hanley","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA"},{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sondra","family":"Zabar","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA"},{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Altshuler","sequence":"additional","affiliation":[{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Lee","sequence":"additional","affiliation":[{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Ross","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA"},{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicomedes","family":"Rivera","sequence":"additional","affiliation":[{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Marvilli","sequence":"additional","affiliation":[{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA"},{"name":"Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA"},{"name":"Institute for Innovations in Medical Education, NYU School of Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,7,1]]},"reference":[{"key":"bibr1-08897077.2017.1319894","unstructured":"Substance Abuse and Mental Health Services Administration. Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008. The TEDS Report. July 15, 2010. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2010."},{"key":"bibr2-08897077.2017.1319894","unstructured":"Centers for Disease Control and Preventation. Injury Prevention & Control: Opioid Overdose. 2016; http:\/\/www.cdc.gov\/drugoverdose\/index.html. Published 2016. Accessed July 27, 2016."},{"key":"bibr3-08897077.2017.1319894","unstructured":"Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers and other drugs among women\u2014United States, 1999\u20132010. MMWR. Morb Mortal Wkly Rep. 2013;62:537\u2013542."},{"key":"bibr4-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2011.06.100232"},{"key":"bibr5-08897077.2017.1319894","author":"Goodnough A","year":"2017","journal-title":"New York Times Health"},{"key":"bibr6-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.0544"},{"key":"bibr7-08897077.2017.1319894","unstructured":"Lanza AJ. Senate Bill S7637. June 8, 2012."},{"key":"bibr8-08897077.2017.1319894","unstructured":"Health N. New York City Emergency Department Discharge Opioid Prescribing Guidelines. https:\/\/www1.nyc.gov\/assets\/doh\/downloads\/pdf\/basas\/opioid-prescribing-guidelines.pdf. Published 2013. Accessed May 10, 2017."},{"key":"bibr9-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0826-3"},{"key":"bibr10-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.16.1995"},{"key":"bibr11-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00510.x"},{"key":"bibr12-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1080\/10401330701542495"},{"key":"bibr13-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.13.1715"},{"key":"bibr14-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000920"},{"key":"bibr15-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2011.06.006"},{"key":"bibr16-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2002.10837.x"},{"key":"bibr17-08897077.2017.1319894","first-page":"52","volume":"17","author":"Alford DP","year":"2016","journal-title":"Pain Med."},{"key":"bibr18-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2016.05.009"},{"key":"bibr19-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2367"},{"key":"bibr20-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.03.019"},{"key":"bibr21-08897077.2017.1319894","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.06.030"}],"container-title":["Substance Abuse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1080\/08897077.2017.1319894","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1080\/08897077.2017.1319894","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1080\/08897077.2017.1319894","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T08:48:37Z","timestamp":1777625317000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1080\/08897077.2017.1319894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1080\/08897077.2017.1319894"],"URL":"https:\/\/doi.org\/10.1080\/08897077.2017.1319894","relation":{},"ISSN":["0889-7077","1547-0164"],"issn-type":[{"value":"0889-7077","type":"print"},{"value":"1547-0164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]}}}