How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

Effect of e-Health Literacy on COVID-19 Infection-Preventive Behaviors of Undergraduate Students Majoring in Healthcare

This study examined and verified the level of e-health literacy (e-HL) and infection preventive behaviors related to COVID-19 among undergraduate students majoring in healthcare. An online survey was conducted with 274 university students majoring in nursing, clinical pathology, and occupational therapy in South Korea. The e-HL consisted of functional, communicational, and critical literacy, and preventive behaviors were based on the Prevention Guideline on Droplet Infection. The mean score for e-HL was 3.62, with nursing students obtaining the highest scores. The overall e-HL score and the scores on its three sub-dimensions were related to infection-preventive behaviors. Moreover, e-HL affected infection-preventive behaviors (p < 0.001). Findings from this study highlight the necessity of education for improving the e-HL of undergraduate students majoring in healthcare to strengthen infection-preventive behaviors and protect patients from infectious diseases.

Envisioning a strategic framework to streamline building operation, sustainability and users’ disease control

Purpose This study aims to present a strategic framework aiming to streamline building operation and sustainability issues. To make available a further contribution to respond to Coronavirus Disease 2019 (COVID-19), an operational prevention guideline relying on the level of spread risk has also been developed, primarily intended for users when accessing and circulating within common spaces of buildings in general. Design/methodology/approach The research approach involved the development of a whole theory, essentially based on a qualitative design, by means of tree schematic representations and explanatory frames. It presents part of a model already developed (called SIAPME), although, in general, besides integrating the underlying aspects of the individual experience of daily life, it is based on insights and impressions taken from the literature review. Findings With an identity of its own, this study offers an overview of an alternative set of well-founded and integrated strategies to improve working processes in a number of fields of the building operation function. A structured vision has thus, been provided with interest in certain key topics of the present time, such as energy management, comfort and sustainability. Still, in this context, based on a frame of knowledge gathered to date, a current, innovative and simple guidance has also been designed to help prevent the contagion of COVID-19. Research limitations/implications The draft of procedures is part of an ambitious goal to serve as a well-founded strategic basis for the eventual development of an advanced software solution. As it is mainly limited to qualitative analysis, from which themes and generalisations have been arranged, this research may need more empirical evidence and additional work will be necessary to overcome any gaps that may be found. Practical implications An overall assessment of this study seems to corroborate the idea that a significant impact on the developments in building operation can occur if stakeholders seek a more integrated way of management, based on cross-referencing of current issues. At a time when great uncertainties remain and knowledge advances are in full swing, the designed framework aims to be an added input towards already existing research. Furthermore, it can be seen as a valuable contribution to improving related software applications. Originality/value The originality lies in trying to better understand how and in which aspects the general day-to-day management of building operation can be handled more effectively, sustainable and framed, following a reasoned scientific line, in addition of trying to figure out greater capacity to deal with users’ contagions, especially in the existing context of the pandemic.

Determinants of Fall Prevention Guideline Implementation in the Home- and Community-Based Service Setting

Background and Objectives Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations. Research Design and Methods Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study. Results We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff. Discussion and Implications Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.

Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrospective Clinical Data Analysis

Background There are significant medical risks of long-term opioid therapy (LTOT) for chronic pain. Consequently, there is a need to identify effective interventions for the reduction of high-dose full-agonist opioid medication use. Methods The current study details a retrospective review of 240 patients with chronic pain and LTOT presenting for treatment at a specialty opioid refill clinic. Patients first were initiated on an outpatient taper or, if taper was not tolerated, transitioned to buprenorphine. This study analyzes potential predictors of successful tapering, successful buprenorphine transition, or failure to complete either intervention and the effects of this clinical approach on pain intensity scores. Results One hundred seven patients (44.6%) successfully tapered their opioid medications under the Centers for Disease Control and Prevention guideline target dose (90 mg morphine-equianalgesic dosage), 45 patients (18.8%) were successfully transitioned to buprenorphine, and 88 patients (36.6%) dropped out of treatment: 11 patients during taper, eight during buprenorphine transition, and 69 before initiating either treatment. Conclusions. Higher initial doses of opioids predicted a higher likelihood of requiring buprenorphine transition, and a co-occurring benzodiazepine or z-drug prescription predicted a greater likelihood of dropout from both interventions. Patterns of change in pain intensity according to treatment were mixed: among successfully tapered patients, 52.8% reported greater pain and 23.6% reported reduced pain, whereas 41.8% reported increased pain intensity and 48.8% reported decreased pain after buprenorphine transition. Further research is needed on predictors of treatment retention and dropout, as well as factors that may mitigate elevated pain scores after reduction of opioid dosing.