Family Physician Perceptions of Their Role in Managing the Opioid Crisis

Abstract

PURPOSE We examined the perspectives of family physicians (FPs) on opioid prescribing and management of chronic pain to better understand the barriers to safer prescribing in primary care and differences in perspectives that may be potential drivers of practice variation. METHODS We used an exploratory qualitative study design. Semistructured interviews were conducted in June and July 2017 with 22 FPs in Ontario and coded inductively. Thematic analysis was used to identify themes, and a framework analysis explored the influence of physician demographics on prescribing experience. RESULTS Three key themes emerged: the discrepancy between FPs' training and current practice, the tension between the FP's role and patient and system expectations, and the influence of length of time in practice and strength of therapeutic relationships on perspectives on opioid prescribing. There was an overarching sentiment among participants that FPs are unsupported in their efforts to manage chronic pain. More years in practice (≥15 years) seems to influence practice patterns by increasing trust in therapeutic relationships and decreasing reliance on emergent guidelines (vs clinical experience). CONCLUSION Number of years in practice influences FPs' response to emergent evidence, requiring initiatives to include strategies tailored to individual beliefs. Initiatives must move beyond dissemination and education to equip FPs with the skills they need to navigate emotionally charged conversations. External pressures and misaligned system and patient expectations place FPs at the center of a challenging situation, which may result in a higher risk of burnout compared with that of their specialist colleagues.

Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study

“…20,21 The findings from non-Canadian studies that corroborated our own included barriers to safe and effective prescribing for CNCP caused by the complexity of chronic pain management, addictions risks inherent to POAs, lack of training in CNCP management, delicate physician-patient relationships and systemic factors such as waitlists. [22][23][24] Desveaux et al 14,15 also documented these barriers in their two 2019 Ontario studies.…”

“…In Canada, only two such studies have been conducted, both in Ontario and both by the same research team. 14,15 Three other Canadian qualitative studies have examined opioid prescribing from the perspective of Ontario pain specialists 19 or with a focus on non-physician providers in long-term care settings. 20,21 The findings from non-Canadian studies that corroborated our own included barriers to safe and effective prescribing for CNCP caused by the complexity of chronic pain management, addictions risks inherent to POAs, lack of training in CNCP management, delicate physician-patient relationships and systemic factors such as waitlists.…”

“…The participants in our study also did not observe, as Krebs et al 25 had, that monitoring of patients' POA treatment with urine screening and treatment agreements could disrupt an effective therapeutic relationship. Participants in both 2019 Ontario qualitative studies mentioned using urine screening, but they suggested that use increased tension in the physician-patient relationship 15 or that urine screening was not useful. 14 Buchman and Ho 26 pointed out that despite the paucity of evidence for the use of POA treatment agreements, they are widely used and could undermine the therapeutic relationship between physician and patient.…”

“…6.03 details of their CNCP management practices useful for determining how to tailor policies and supports to make opioid prescribing for CNCP as safe and effective as possible in the context of continued POArelated harms. Qualitative studies internationally [10][11][12][13] and in Ontario 14,15 have identified key barriers and facilitators to safe and effective prescribing of opioid analgesics for CNCP by primary care physicians. These studies documented a great deal of complexity in the unique relationships between CNCP patients and their providers.…”

Étude qualitative sur les facteurs qui entravent et ceux qui facilitent le travail des médecins de famille devant prescrire des opioïdes contre la douleur chronique non cancéreuse

“…Comme les méde cins de famille jouent un rôle important dans la prescription d'opioïdes, l'étude de leurs pratiques en matière de traitement de la DCNC est utile pour savoir comment adapter les politiques et les services de soutien afin de rendre la prescription d'opioïdes pour le traitement de la DCNC aussi sûre et efficace que possible dans un contexte de hausse des méfaits liés aux analgésiques opioïdes sur ordonnance. Des études qualitatives internatio nales 1013 et ontariennes 14,15 ont répertorié les princi paux facteurs qui entravent et ceux qui facilitent une prescription sûre et efficace d'analgésiques opioïdes pour le traitement de la DCNC par les médecins de soins pri maires. Ces études ont révélé un haut niveau de complexité dans les relations entre les patients atteints de DCNC et leurs fournisseurs de soins.…”