Opioid vs Nonopioid Prescribers: Variations in Care for a Standardized Acute Back Pain Case

Hanley, Kathleen; Zabar, Sondra; Altshuler, Lisa; Lee, Hillary; Ross, J. Cosbie; Rivera, Nicomedes; Marvilli, Christian; Gillespie, Colleen

doi:10.1080/08897077.2017.1319894

Cited by 12 publications

(3 citation statements)

References 15 publications

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“…This allows for data collection free from the bias associated with knowing that one is being observed ( Zabar, Kachur, Kalet, & Hanley, 2013 ). Our medical education program has been using USPs to assess residents since 2009 ( Hanley et al, 2017 ). By delivering a standardized case of a smoking patient into the healthcare system where residents provide ambulatory care, we sought to systematically describe: (1) how residents approach smoking cessation counseling with a new patient, including how they document the efforts; (2) whether differences in approach or treatment recommendations are associated with core general clinical skills demonstrated in the visit (including counseling, communication, and documentation); and (3) the impact of residents' smoking cessation counseling on USP ratings of patient activation.…”

Section: Introductionmentioning

confidence: 99%

Igniting activation: Using unannounced standardized patients to measure patient activation in smoking cessation

Wilhite¹,

Velcani²,

Watsula-Morley³

et al. 2019

Addictive Behaviors Reports

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Introduction Despite a decline, smoking rates have remained high, especially in communities with lower income, education, and limited insurance options. Evidence shows that physician-initiated counseling on smoking cessation is effective and saves lives, and that specific skills are needed to appropriately lead this type of patient-physician communication. Residency is a critical moment for future physicians and may be the optimal time to learn, practice, and refine this skillset. Unannounced Standardized Patients (USPs) have been found to be effective, incognito evaluators of resident practices. Methods This study introduced rigorously trained actors (USPs) into two urban, safety-net clinics to assess resident ability to engage, activate, and counsel a pre-contemplative smoker. A complementary chart review assessed appropriate documentation in the patient's electronic health record (EHR) and its relationship to counseling style and prescribing practices. Results Resident scores (% well done) on patient education and engagement were low (33% and 23%, respectively). Residents who coupled cessation advice with an open discussion style activated their patients more than those who solely advised cessation across all comparable measures. On EHR documentation, residents who accurately documented smoking history were more likely to directly advise their patient to quit smoking when compared to residents who did not document (t(97) = 2.828, p = .006, Cohen's D = 0.56). Conclusions Results highlight the need to reinforce training in patient-centered approaches including motivational interviewing, counseling, and shared decision-making. Future research should focus on the effects of smokers in pre-contemplation on physician counseling style and examine the relationship between medical training and provider communication to guide interventions.

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Section: Introductionmentioning

confidence: 99%

Igniting activation: Using unannounced standardized patients to measure patient activation in smoking cessation

Wilhite¹,

Velcani²,

Watsula-Morley³

et al. 2019

Addictive Behaviors Reports

Self Cite

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“…7,8 In 2 studies of patients, both of which focused on selected samples of adults with musculoskeletal conditions, those who received prescription opioids were more satisfied with their health care than those receiving no prescription opioids after adjusting for potential confounders. 9,10 However, a third patient study found that the patients of primary care clinicians with relatively high rates of opioid prescribing were no more satisfied with their pain management than patients of providers with lower rates of prescribing. 11 One study of adult outpatients visiting a single primary care office found that, after adjusting for potential confounders, clinician denial of requests for pain medication was associated with worse patient satisfaction compared with fulfillment of pain medication requests.…”

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confidence: 99%

Satisfaction with Health Care Among Prescription Opioid Recipients

2020

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Background: Prior studies examining the association of opioid prescriptions with satisfaction with care involved limited, selected samples with mixed findings. We examined this issue, of relevance to reducing discretionary opioid prescribing, in a US representative sample. Methods: We performed an observational study of adults (N ‫؍‬ 69,985) enrolled in the 2005 to 2015 US Medical Expenditure Panel Surveys. We examined the association of high (top quartile) satisfaction with receipt of 0, 1 to 5, or >6 opioid prescriptions per year. The base model adjusted for demographics and year; the full model added adjustment for health status (12-item Short Form Survey). A sensitivity analysis further adjusted for outpatient visits. Results: In the base model, respondents who received 1 to 5 or >6 opioid prescriptions were each less likely to have high satisfaction than those who received no opioid prescriptions (adjusted odds ratios [AORs] [95% CIs] 0.83 [0.79-0.88] and 0.70 [0.63-0.79], respectively). After adding health status adjustment, compared with respondents receiving no opioid prescriptions, those receiving 1 to 5 were similarly likely and those reporting >6 were more likely to have high satisfaction (AORs [95% CIs] 1.00 [0.94-1.06] and 1.44 [1.27-1.63], respectively). The findings were not substantively affected by further adjustment for outpatient visits. Discussion: In a US national sample, individuals who received >6 opioid prescriptions in a year were more likely to have top quartile satisfaction than those receiving fewer or no opioid prescriptions after accounting for health status. Whether the high satisfaction among such individuals was driven by the prescriptions themselves or by other personal characteristics requires study, as do the effects of deprescribing.

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“…A learning healthcare system is defined as one in which there are cycles of assessment (problem definition), implementing solutions and determining the effectiveness of those solutions. USPs can play a critical role in fully realising the benefits of a learning healthcare system by ensuring that those aspects of the patient–physician interaction and team interactions that are critical to patient safety are assessed in a meaningful way and routinely fed back to all the individuals responsible for clinical system improvement 23. When done with respect and subtlety, data from USPs become core to conducting a root cause analysis when a clinical process needs to be improved.…”

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confidence: 99%

In the room where it happens: do physicians need feedback on their real-world communication skills?

et al. 2019

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Opioid vs Nonopioid Prescribers: Variations in Care for a Standardized Acute Back Pain Case

Cited by 12 publications

References 15 publications

Igniting activation: Using unannounced standardized patients to measure patient activation in smoking cessation

Igniting activation: Using unannounced standardized patients to measure patient activation in smoking cessation

Satisfaction with Health Care Among Prescription Opioid Recipients

In the room where it happens: do physicians need feedback on their real-world communication skills?

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