Opioid Prescribing: Can the Art Become More Science?

Alford, Daniel P.

doi:10.1007/s11606-013-2493-2

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…Our findings are consistent with prior research that showed no association between receipt of opioids and patient care experience among surgical inpatients 17,18,26 . Overall, our findings do not support concerns from policymakers and legislators 12,13 that influenced the CMS decision to remove HCAHPS measures of patient experience with pain care from the hospital reimbursement formula in 2018.…”

Section: Discussionsupporting

confidence: 82%

“…Patient experience with pain care is a significant predictor of overall patient care experiences, 7,8 and clinicians report increased pressure to fulfill patient requests for immediate pain relief 9‐11 . Moreover, policymakers, legislators, and clinicians have expressed concern that clinicians may order opioids to meet these requests for immediate pain relief and to improve HCAHPS scores 12,13 . Indeed, to reduce the financial incentive to prescribe opioids inappropriately, CMS temporarily removed questions related to patient experiences with pain care from hospital reimbursement formulas in 2018 14…”

Section: Introductionmentioning

confidence: 99%

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Receipt of opioids and patient care experiences among nonsurgical hospitalized adults

Mazurenko

Blackburn

Kara

et al. 2020

Health Services Research

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Providing patient-centered care, defined as care that is respectful of and responsive to individual patient preferences, needs, and values, is a priority of the US health care system. 1,2 Thus, hospitals are required to publicly report patient-centered assessments, including results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient care experience surveys. 3 In addition to public reporting, hospital performance on HCAHPS surveys is used to calculate value-based incentive payments in the Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (VBP) program. 3 Consequently,

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Receipt of opioids and patient care experiences among nonsurgical hospitalized adults

Mazurenko

Blackburn

Kara

et al. 2020

Health Services Research

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“…An interactive discussion was facilitated regarding specific roles for each MHCP to achieve a range of behavioural targets, including increased physical activity levels and increased supportive connections. The second session focused on consolidating pain management skills using role plays such as working with a person who is convinced they require a higher medication dose, as they perceive the opioids are no longer working (Alford 2013;Ballantyne et al 2012). The clinicians observed the therapeutic communication style used by the trainers and discussed and analysed role plays as time permitted (Jensen et al 2010;Swinglehurst et al 2012).…”

Section: Interventionmentioning

confidence: 99%

Training primary care providers in opioid deprescribing and chronic pain management based on local guidance: a pre–post study of attitude change

White

Hayes

Boyes

et al. 2019

HEPJ

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Background. Local chronic non-cancer pain guidance recommends that general practitioners should consider opioid deprescribing and referral to multidisciplinary healthcare providers for behaviourally based treatments. We designed a training package called AIMM (Assess, Inform, Manage and Monitor) to reinforce this stewardship.Aim. To identify whether participation in AIMM training effectively aligned clinicians’ attitudes with local guidance for treating chronic non-cancer pain.Design and setting. In 2014–15, the AIMM training was tested using a pre–post-test non-randomised design at two sites in NSW, Australia. The primary outcome measure was an 11-item, study-specific, pain attitude questionnaire (PAQ).Method. Step one of AIMM training involved online completion of the PAQ and review of a specialist pain website. Step two involved attendance at two face-to-face, two-hour interactive workshops led by pain experts who addressed opioid deprescribing and switching to broader care. A repeat PAQ survey was completed at the conclusion of the second workshop.Results. Nineteen participants attended the workshops, including general practitioners (n = 7), nurses (n = 5), exercise physiologists (n = 2), a dietitian (n = 1), community pharmacists (n = 2) and psychologists (n = 2). Significant shifts in six attitudes occurred, including prescribing less pain medication, greater emphasis on social reconnection, increasing planned activity and adopting anti-inflammatory nutrition (p < .05). Responses to the item regarding expectations of a positive recovery was not aligned with local guidance and no significant attitudinal change was found. Four other attitudes were aligned with local guidance at baseline and did not change during the study.Conclusions. Online information and face-to-face training can achieve a change in healthcare provider attitudes towards non-pharmacological treatment of chronic non-cancer pain. Further work is needed to assess whether attitudinal changes are maintained and translate into behavioural change.

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“…10,11 Nevertheless, meeting patient preferences in pain care may raise significant patient safety and long-term health concerns, especially when patients request opioid medications. 9,12,13 In an attempt to be patient-centered, hospitals and clinicians may feel pressure to concede to patient requests for opioids or to prescribe higher doses of opioids. This situation has occurred because of a rise in patient consumerism, 14 the Joint Commission's report on pain as the "fifth vital sign" with a goal of "pain-free" patients, 15 and Centers for Medicare & Medicaid Services' (CMS) use of patient satisfaction scores in hospital and clinician reimbursement.…”

Section: Introductionmentioning

confidence: 99%

Balancing Patient-Centered and Safe Pain Care for Nonsurgical Inpatients: Clinical and Managerial Perspectives

Mazurenko¹,

Andraka‐Christou²,

Kara³

et al. 2019

The Joint Commission Journal on Quality and Patient Safety

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Background: Hospitals and clinicians aim to deliver care that is safe. Simultaneously, they are ensuring that care is patient-centered, meaning that it is respectful of patients' values, preferences, and experiences. However, little is known about delivering care in cases where these goals may not align. For example, hospitals and clinicians are facing the daunting challenge of balancing safe and patient-centered pain care for nonsurgical patients, due to lack of comprehensive care guidelines and complexity of this patient population. Methods: To gather clinical and managerial perspectives on the importance, feasibility, and strategies used to balance patient-centered care (PCC) and safe pain care for nonsurgical inpatients, we conducted in-depth, semi-structured interviews with hospitalists (n=10), registered nurses (n=10), and health care managers (n=10) from one healthcare system in the Midwestern United States. We systematically examined transcribed interviews and identified major themes using a thematic analysis approach. Results: Participants acknowledged the importance of balancing PCC and safe pain care. They envisioned this balance as a continuum, with certain patients for whom it is easier (e.g., opioidnaïve patient with a fracture), versus more difficult (e.g., patient with opioid use disorder). Participants also reported several strategies they use to balance PCC and safe pain care, including

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Opioid Prescribing: Can the Art Become More Science?

Cited by 4 publications

References 10 publications

Receipt of opioids and patient care experiences among nonsurgical hospitalized adults

Receipt of opioids and patient care experiences among nonsurgical hospitalized adults

Training primary care providers in opioid deprescribing and chronic pain management based on local guidance: a pre–post study of attitude change

Balancing Patient-Centered and Safe Pain Care for Nonsurgical Inpatients: Clinical and Managerial Perspectives

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