Veterans Affairs Primary Care Clinicians' Attitudes toward Chronic Pain and Correlates of Opioid Prescribing Rates

Dobscha, Steven K.; Corson, Kathryn; Flores, Jennifer A; Tansill, Erin C.; Gerrity, Martha S.

doi:10.1111/j.1526-4637.2007.00330.x

Cited by 127 publications

(121 citation statements)

References 24 publications

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“…1,5,6,22 PCPs frequently expressed frustration and concern in their questions to specialists, a finding that is likewise reflected in the literature. 23,24 One study found that nearly three quarters of PCPs considered providing chronic pain care to be a major source of frustration. 23 In response to these concerns, specialists in our study expressed empathy for PCPs, validating their concerns and reinforcing how challenging it can be to care for patients with chronic pain especially when a solution is elusive.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 One study found that nearly three quarters of PCPs considered providing chronic pain care to be a major source of frustration. 23 In response to these concerns, specialists in our study expressed empathy for PCPs, validating their concerns and reinforcing how challenging it can be to care for patients with chronic pain especially when a solution is elusive. Specialists also reaffirmed that PCPs are benefiting patients simply by providing a comforting, supportive presence, a claim supported by recent research.…”

Section: Discussionmentioning

confidence: 99%

“…26 Opioids' potential for misuse can render opioid prescription a contentious issue among patients and providers. 23,24,27 Some patients with chronic pain describe being treated with distrust by their providers when requesting opioids, citing the perception that they are simply seeking drugs rather than analgesia. 28 This may stem from PCPs' reaction to growing concerns around opioid misuse and dependence arising in Canada and the United States, an issue further exacerbated by many PCPs' relative inexperience with treating pain symptoms or using opioids effectively.…”

Section: Discussionmentioning

confidence: 99%

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Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service

et al. 2017

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Introduction: Excessive wait times for chronic pain are associated with significant reductions in quality of life and worse health outcomes. The Champlain BASE ™ (Building Access to Specialists through eConsultation) eConsult service can improve access to specialist care for patients with chronic pain by facilitating electronic communication between primary care providers (PCPs) and specialists. We explored the content of eConsult cases sent to chronic pain specialists to identify the major themes emerging from exchanges between PCPs and specialists regarding patients with chronic pain.Methods: We conducted a thematic analysis of eConsult cases submitted to chronic pain specialists between April 1, 2011 and October 31, 2014, using a constant comparison approach.Results: PCPs submitted 128 cases to chronic pain specialists during the study period. The study team coded 48 cases before data saturation was reached. PCPs sought advice for treating patients with chronic pain arising from a range of medical problems, and who frequently struggled with issues of mental health, substance dependence, and social complexity. Specialists responded with advice on pain management and treatment, directed PCPs to published guidelines and community resources, and validated the PCPs' frustration or concerns. Specialists provided instruction on safe opioid prescribing and how to identify and manage potential cases of substance dependence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service

et al. 2017

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“…Most medical settings do not have the type of integrated care necessary to effectively treat patients with chronic pain, and primary care physicians (PCPs) are frequently relied upon for pain management [15]. Physician's beliefs and attitudes, including the perception that they have been inadequately trained to treat patients with chronic pain [16], may lead providers' to be reluctant to prescribe opiates for patients who could benefit from them. Conversely, the patients who are receiving opiates may not be prescribed in an optimally safe and effective manner, as PCPs may not be able to conduct the in-depth biopsychosocial assessment and regular follow-up needed for these patients given the limited time and competing clinical priorities in typical primary care visits.…”

Section: Researchmentioning

confidence: 99%

Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management

Midboe

Lewis

Cronkite

et al. 2011

Behav. Med. Pract. Policy Res.

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Development of clinical decision support systems (CDSs) has tended to focus on facilitating medication management. An understanding of behavioral medicine perspectives on the usefulness of a CDS for patient care can expand CDSs to improve management of chronic disease. The purpose of this study is to explore feedback from behavioral medicine providers regarding the potential for CDSs to improve decision-making, care coordination, and guideline adherence in pain management. Qualitative methods were used to analyze semi-structured interview responses from behavioral medicine stakeholders following demonstration of an existing CDS for opioid prescribing, ATHENA-OT. Participants suggested that a CDS could assist with decision-making by educating providers, providing recommendations about behavioral therapy, facilitating risk assessment, and improving referral decisions. They suggested that a CDS could improve care coordination by facilitating division of workload, improving patient education, and increasing consideration and knowledge of options in other disciplines. Clinical decision support systems are promising tools for improving behavioral medicine care for chronic pain. KEYWORDSClinical decision support systems, Chronic pain, Opiates, Behavioral medicine, Medication managementComputer-based point-of-care clinical decision support systems (CDSs) show promise for improving clinical decision-making, evidence-based guideline adherence, care coordination across providers and disciplines, as well as patient education and communication [1]. To date, development of CDSs has focused primarily on medication management and targeted physicians and nurses even though they have the potential to be used across multiple disciplines. The expansion of CDS technology to include use by collaborative teams, including individuals from psychology, social work, pharmacy, functional rehabilitation, and other specialty providers, may better address system-level barriers to delivering coordinated patientcentered care. For example, a CDS could facilitate communication across clinics or disciplines during treatment planning, patient education, and follow-up, or educate providers in one discipline about care being provided by a clinician in another discipline and its implications for broader care decisions.Chronic pain is a highly prevalent condition [2] and pain management benefits from collaborative work across disciplines. The predominant model for pain management is the biopsychosocial model, and interdisciplinary collaboration has emerged as the standard of care for complex chronic pain conditions [3]. This approach improves functional recovery [4], is more cost-effective than a modalityoriented approach [5,6], and reduces the likelihood that treatments for pain will inadvertently exacerbate co-morbid disorders or increase medical or mental health risks such as overdose, addiction, or suicide [7]. Behavioral medicine practitioners have one of the larger roles in this approach, as patients with pain frequently have comorbid psy...

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“…Although specialized multidisciplinary pain treatment is necessary and effective, particularly for more complex patients [8][9], access to these services is limited and is often not needed [7,10]. Thus, while most patients with chronic pain are treated by a primary care provider (PCP), most PCPs face organizational and administrative barriers to providing effective care [11], receive limited training in pain management [12][13], express low confidence in their ability to care for such patients [14][15][16][17], and hold reservations regarding treatment of chronic pain. Studies suggest that there is wide variability in PCPs' adherence to guidelines for pain management [18][19][20], and documentation of comprehensive pain care plans and specific treatment provided is poor [21][22].…”

Section: Introductionmentioning

confidence: 99%

Stepped care model of pain management and quality of pain care in long-term opioid therapy

et al. 2016

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Abstract-Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ) extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA) healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC) over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days) were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education). General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.

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Veterans Affairs Primary Care Clinicians' Attitudes toward Chronic Pain and Correlates of Opioid Prescribing Rates

Cited by 127 publications

References 24 publications

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service

Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management

Stepped care model of pain management and quality of pain care in long-term opioid therapy

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Veterans Affairs Primary Care Clinicians' Attitudes toward Chronic Pain and Correlates of Opioid Prescribing Rates

Cited by 127 publications

References 24 publications

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ™ eConsult Service

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ™ eConsult Service

Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management

Stepped care model of pain management and quality of pain care in long-term opioid therapy

Contact Info

Product

Resources

About

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service

Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service