The hospitalist perspective on opioid prescribing: A qualitative analysis

Abstract

Background Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. Objective We aimed to understand physicians’ attitudes, beliefs and practices towards opioid prescribing during hospitalization and discharge. Design In-depth, semi-structured interviews Setting Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. Participants Hospitalists (N=25) Measurements We systematically analyzed transcribed interviews and identified emerging themes using a team-based mixed inductive and deductive approach. Results Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction when managing acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events which altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. Conclusions Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed.

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

“…In line with recent literature, 27,28 we found that our participants reported difficulties balancing PCC and safety for patients with chronic pain, patients on long-term opioid therapy, and patients with an OUD, often labeled as difficult. Labeling a patient as difficult is likely inconsistent with providing PCC and in fact may suggest an interest in avoiding care that fully considers patients' individual values, goals, or preferences.…”

“…Our findings are in line with recent literature that shows clinicians use guidelines and state policies to facilitate communication about opioids. 27,28,35 Recent studies 24,34 also highlight clinician concerns over increased regulation of opioid prescribing that may hinder their ability to provide PCC, especially in the area of pain care. On the other hand, such clinician attitudes may be viewed as an attempt to deflect the responsibility for prescribing decisions to something other themselves.…”

Family Physician Perceptions of Their Role in Managing the Opioid Crisis

“…The emotional burden of opioid prescribing and challenging patient conversations are felt across physician specialties. 22,28,29 Opioid prescribing represents a significant proportion of specialist prescribing, with 56% of newly initiated opioid treatments attributed to non-primary care specialties. 30 Although prescriptions are often initiated elsewhere in the system, the prevailing sentiment is that the care of these patients is "dumped" on FPs.…”

Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners

“…A qualitative approach was considered best suited to exploring GP experiences, beliefs and attitudes and their relationship to clinical decision-making 48. A pragmatic integrative approach (ie, both deductive and inductive49) was taken to balance the need for an exploratory approach warranted by the paucity of previous research on problematic use of opioids in the cancer context with the opportunity to build on findings from a large number of studies in the non-cancer pain context 30 31 33 50–62…”