Interview with Dr. Lisa Miller
Dr. Lisa Miller, PharmD, is Executive Director of Healthcare Education and Liaison Programs for Purdue Pharma L.P., where she leads the Medical Education and Medical Liaison Departments. In this role, Dr. Miller is responsible for educational initiatives addressing proper pain management and risk minimization. The Medical Liaison department addresses education, managed care and payer concerns, as well as alliance outreach on a regional and state basis. With more than fourteen years experience working in health systems and ten years in the area of pain and symptom management, Dr. Miller was Pharmacy Manager for the Hospice of the Florida Suncoast and a clinical oncology pharmacist prior to joining Purdue Pharma in 2001.
Q: HFA’s upcoming teleconference will focus on “Pain Management: Bridging the Gap Between Knowledge and Practice.” As a health care professional and an educator, what gaps would you identify?
A: Pain patients do not fit into a mold. There is no one standard treatment that is effective or appropriate for all patients.
Gap 1: Assessment
Health care professionals must become comfortable and proficient at doing a complete pain assessment (including physical, psychological, functional, spiritual, cultural and environment factors). Only after such an assessment is done can a unique treatment plan be developed for a given patient. Those working in hospice and palliative care settings have demonstrated leadership in this area by taking the time to provide thorough assessments and communicating their findings to others on the health care team. These settings are also ideal to ascertain the quality outcomes as a result of the selected treatment plan and as they relate to the patient’s quality of life.
Gap 2: Reassessment
A second need that is often overlooked is that of reassessment--the continual monitoring of the patient’s condition and pain management regimen. Continuing the dialog, responding to changes, and keeping pain management as a priority are effective ways to improve patient comfort and satisfaction with their care.
Gap 3: Individualized treatment
While pain management has come a long way with collaborative treatment guidelines and educational resources to assist health care professionals, it is important to remember that the guidelines are just that, guides to assist health care providers in employing the most appropriate therapeutic options for an individual patient. Each patient needs an individualized treatment plan that takes into account the physical, psychosocial, functional, spiritual, cultural, and environmental needs. Cookie cutter medicine is not the right treatment for patients with pain.
Q: In developing Purdue’s Medical Education programs, what requests or concerns do you hear most frequently from professionals?
A: The overarching request is to make sure that education is applicable and practical for today’s health care professional. Whether requests are for case-based learning, interactive formats, or opportunities to “meet the professors”, they all employ the principles of adult learning. Health care professionals want information that they can take directly from the education setting to the clinical health care setting. Education should continue to occur in those health care settings as we reflect, listen and learn from our patients. We are also seeing a growing trend in e-learning and the use of web-based tools.
Topics that seem to be the most useful are those that build skills such as pain assessment, reassessment, treatment planning, appropriate medication selection, dosing, administration, and adjustments, how to manage transitions in care; and even how to improve communication and documentation skills.
Q: What progress have you seen in pain management education in recent years?
A: Efforts in recent years by pain management advocates have created more awareness of the disparities that exist in pain care. With these problems revealed, it allows more emphasis to be placed on how to best address these concerns.
For hospice and palliative care, addressing the pain needs of patients with non-cancer diagnoses has evolved. The unique challenges of advanced cardiac and pulmonary disease, osteoarthritis and other conditions are being addressed.
Patient access to pain care and treatment is also an area that has received attention. As health care professionals collaborate on the best approaches on patient care, referrals to pain or palliative care specialists and the challenges of dealing with reimbursement, formularies, and health care systems, they teach one another how to thrive and survive in an ever changing health care environment.
In education, another area that we continue to work on is applicability. The sheer volume of lectures, monographs, and other written information can be overwhelming; finding ways of providing information that is tangible and applicable to practice is critical. Professionals like to know what is working for others and how a particular tool, medication, or document is being utilized with favorable results. By asking others and providing reports of “best practices” or “clinical pearls”, health care professionals are able to discern what may benefit their patients, colleagues, and practice.
Health care education is changing with evolving standards and guidelines. An important step is to conduct research on how teaching styles, content, and learning can have the positive impact of improving pain management for patients and job satisfaction for professionals. Addressing educational needs and evaluating educational outcomes are two ways to support and encourage success in patient care.
NOTE: The Healthcare Professionals section of www.partnersagainstpain.com includes a comprehensive Medical Education Resource Catalog, which includes both accredited and non-accredited course offerings for a range of professionals, as well as other resources in pain management.
