scholarly journals Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing

2020 ◽  
Vol 70 (697) ◽  
pp. e589-e597 ◽  
Author(s):  
Christopher D Saffore ◽  
Sarette T Tilton ◽  
Stephanie Y Crawford ◽  
Michael A Fischer ◽  
Todd A Lee ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Qualitative Analysis ◽  
Health System ◽  
Primary Care Providers ◽  
Academic Detailing ◽  
Care Providers ◽  
Opioid Prescribing ◽  
Field Notes ◽  
Safe Opioid Prescribing

Background Understanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse, misuse, and overdose in the US. Educational outreach strategies, such as academic detailing (AD), provide a forum for identification of barriers to, and strategies to facilitate, safe opioid prescribing in primary care.AimTo identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD.Design and settingQualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area.MethodThe AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis, field notes were analysed to identify recurring themes related to opioid prescribing barriers.ResultsDetailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices.ConclusionBarriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.

Reduction in Schedule II opioid prescribing by primary care providers, orthopedic and general surgeons, and pain management specialists following the implementation of a State House Bill and an Institutional Controlled Substance Task Force

2021 ◽  
Vol 17 (2) ◽  
pp. 155-167
Author(s):  
Lisa B. E. Shields, MD ◽  
Timothy A. Johnson, BS ◽  
Michael W. Daniels, MS ◽  
Alisha Bell, MSN, RN, CPN ◽  
Diane M. Siemens, PharmD ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Primary Care Providers ◽  
The United States ◽  
Prescription Opioid ◽  
Evidence Based ◽  
Care Providers ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
General Surgeons

Objective: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists.Design: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. Results: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity 90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. Conclusions: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient’s pain without initiating or exacerbating a potentially lethal opioid addiction.

scholarly journals Do primary care providers who prescribe more opioids have higher patient panel satisfaction scores?

2018 ◽  
Vol 6 ◽  
pp. 205031211878254 ◽  
Author(s):  
Frederick North ◽  
Sarah J Crane ◽  
Jon O Ebbert ◽  
Sidna M Tulledge-Scheitel
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Patient Complexity ◽  
Satisfaction Measures

Objectives: Opioid prescribing in the United States has tripled since 1999. At the same time, there has been increasing attention to patient satisfaction. It has been suggested that providers concerned about patient satisfaction may be more likely to treat pain with opioids. We examined primary care providers’ opioid prescribing practices to determine if higher provider opioid prescribing was associated with higher patient satisfaction. Methods: For 77 primary care providers, we compared each provider’s opioid prescription count and amount prescribed to each provider’s patient panel satisfaction measures. Satisfaction measures were obtained from surveys following office visits and consisted of Likert-type scale answers concerning satisfaction for pain management and other provider satisfaction domains. Satisfaction surveys were generated independent of patient complaint of pain and had the aim of overall assessment of patient satisfaction with the provider and the healthcare system. We assessed the correlation between opioid prescribing and patient panel pain management satisfaction using linear regression models with and without adjustment for patient complexity. Results: We observed no statistically significant correlation between patient panel satisfaction with their provider and the quantity of opioids that the provider prescribed (R2 = 0.006; p = 0.52). There was also no correlation between patient panel satisfaction and the number of opioid prescriptions written by their provider (R2 = 0.005; p = 0.54). Additional multivariate analysis after adjusting for patient complexity also demonstrated no correlation of pain management satisfaction with opioids prescribed. Although the quantity of opioid prescriptions was not correlated with pain management satisfaction, several other patient satisfaction measures correlated significantly with pain management satisfaction. Conclusion: Primary care providers with a greater rate of opioid prescribing did not have higher patient panel satisfaction scores for pain management. In primary care, providers who want to improve patient satisfaction should focus on other components of patient care besides opioid-based pain management.

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

Tools, Time, Training, and Team—Military Primary Care Providers’ Perspectives on Improving Chronic Pain Assessment and Management

2021 ◽  
Author(s):  
Asha Mathew ◽  
Honor McQuinn ◽  
Diane M Flynn ◽  
Jeffrey C Ransom ◽  
Ardith Z Doorenbos
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Assessment ◽  
Insurance Coverage ◽  
Primary Care Providers ◽  
Stepped Care ◽  
Chronic Pain Management ◽  
Care Providers ◽  
Pain Care

ABSTRACT Introduction Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. Materials and Methods Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. Results Four categories captured providers’ challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. Conclusions Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.

Design Concepts to Support Management of Outpatient Consultations in the Veterans Health Administration

2016 ◽  
Vol 60 (1) ◽  
pp. 1475-1476 ◽  
Author(s):  
Laura Militello ◽  
Julie Diiulio ◽  
Alissa Russ ◽  
April Savoy ◽  
Mindy Flanagan ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Poster Session ◽  
Primary Care Providers ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Design Concepts ◽  
Present Design

This poster describes a project to improve understanding of the challenges associated with managing consultations in the Veterans Health Administration (VHA). We conducted interviews and observations with primary care providers and specialists at two VHA facilities. Using qualitative analysis, we identified cognitive requirements, challenges associated with each, and design seeds. During the poster session, we will present design concepts exploring interventions to support management of consultations.

scholarly journals Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

2009 ◽  
Vol 24 (5) ◽  
pp. 614-619 ◽  
Author(s):  
Yeuen Kim ◽  
Alice Hm Chen ◽  
Ellen Keith ◽  
Hal F. Yee ◽  
Margot B. Kushel
Keyword(s):  
Primary Care ◽  
Health System ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Providers ◽  
Electronic Referrals

scholarly journals Protocol for a Systematic Review of the Effectiveness of Provider-targeted Interventions to Improve Opioid Prescribing in Primary Care

2021 ◽  
Author(s):  
Pallavi Prathivadi ◽  
Natalie Connell ◽  
Louisa Picco ◽  
Karleen F Giannitrapani ◽  
Hong-nei Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Primary Care Providers ◽  
Cochrane Library ◽  
Narrative Synthesis ◽  
Care Providers ◽  
Strict Adherence ◽  
Targeted Interventions ◽  
Opioid Prescribing ◽  
Wide Range

Abstract Background: Improving primary care opioid prescribing is a public health priority in many western nations. Governments, policymakers and key stakeholders are intervening on multiple levels to address patient, prescriber and systems factors contributing to opioid over-prescription in primary care. Many opioid prescribing interventions specifically target primary care providers (PCPs); however, the overall effectiveness of these interventions is not known. Identifying effective components of PCP-targeted behaviour change interventions may help inform scalability and translation of prescribing interventions across countries and varying primary healthcare settings. The aim of this systematic review is to assess the effectiveness of provider-targeted interventions to improve opioid prescribing in primary care. This protocol reports the methods of the proposed narrative synthesis review that will be guided by the Theoretical Domains Framework (TDF). Methods: The study will follow Cochrane methods for conducting a narrative synthesis. Reporting is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The review will conduct searches in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library databases for studies published in the English language from 2010 onwards. Reference lists of accepted articles will be also screened for additional studies meeting inclusion. Any opioid prescribing behaviour will be measured as an outcome. Intervention components will be mapped to domains of the TDF. No geographic limits will be applied. All stages of screening and data extraction will involve a dual review with gold standard adjudication. The Cochrane Risk of Bias tool will be used to evaluate quality and risk. Discussion: This review is being conducted in strict adherence to Cochrane principles. The protocol was submitted for registration to Prospero prior to publication for transparency and to avoid duplication of research. Formal ethics approval is not required for this research. The findings of this review will inform the delivery and implementation of PCP targeted opioid prescribing interventions. Findings will be disseminated to a wide range of stakeholders involved in quality improvement, prescribing interventions, education and training; professional groups, policymakers, researchers and PCPs.Systematic review registration: Submitted to Prospero 22 December 2020; pending registration

scholarly journals Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E L Tolma ◽  
S M Aljunid ◽  
M N Amrizal ◽  
J Longenecker ◽  
A Al-Basmy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Health System ◽  
Screening Test ◽  
Primary Care Providers ◽  
Screening Tests ◽  
Care Providers ◽  
Beliefs And Practices ◽  
Crc Screening

Abstract Background Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening. Methods This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics. Results The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%). Conclusions A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening. Key messages Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.

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