Table 2 Mapping Needs to Program Development

Prescribed opioids were identified as an important contributor to opioid related harms and family physicians were identified as the most common prescribers of opioids [35].

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The scientific planning committee included family physicians from a diversity of backgrounds (primary care, chronic pain care, addictions medicine, anesthesia, pharmacology and inner-city medicine).

The opioid epidemic was growing in scale and was linked to the practices of the majority of family physicians [36].

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The program targeted family physicians, though it was designed to also be relevant to specialist prescribers as well as other professionals involved in opioid prescribing (e.g. pharmacists). Nurse practitioners were not identified as a primary target at the time of development since they were not eligible to prescribe opioids in our jurisdiction until early 2017.

There was an inequitable distribution of harms, with greater rates of overdoses and deaths from opioids in rural and remote communities – places where there might be less access to practice supports and high quality CHPE programs [37].

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The program was to be delivered virtually and in the evenings, outside of typical practice times, to increase accessibility for rural and remote health professionals.

Chronic pain was a major learning priority for family physicians [38, 39] and there were important knowledge gaps with respect to opioid prescribing [40].

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SOP content focused on opioid prescribing but was contextualized within models of the management of chronic pain as a complex medical condition.

There was a persistent influence of the pharmaceutical industry on prescribing practices and thus a growing skepticism of opioid educational programs because of possible pharmaceutical industry involvement [20].

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Faculty for the program during the study period of interest did not have any history of involvement with opioid or other pharmaceutical manufacturers. The program received no funding from industry for either development or delivery. It was funded entirely by participant registration fees to ensure sustainability. Fees for the program for physician participants were C$450 for the webinars and $650 for the workshops. A reduced rate for non-physician and resident participants was C$150 for the webinars and C$200 for the workshops.

Existing CHPE programs in the field tended to be based on expert opinion rather than the best available evidence, for example, from systematic reviews or clinical practice guidelines.

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Foundational documents included a national clinical practice guideline [41] and tool that was developed to support the implementation of the guideline [42].

The provincial medical regulator had an active and substantial influence on opioid prescribing behaviour, which in some cases could be an even stronger driver of prescribing behaviour than certain kinds of educational interventions [43].

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Participants in the program were sometimes required or suggested to attend by their medical regulator due to the identification of possible inappropriate controlled substance prescribing; however, program administration and faculty were blinded to participants’ regulatory status.