Decision support for chronic pain care: How do primary care physicians decide when to prescribe opioids? A qualitative study

Chris Harle, Sarah E. Bauer, Huong Q. Hoang, Robert L. Cook, Robert W. Hurley, Roger B. Fillingim

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Primary care physicians struggle to treat chronic noncancer pain while limiting opioid misuse, abuse, and diversion. The objective of this study was to understand how primary care physicians perceive their decisions to prescribe opioids in the context of chronic noncancer pain management. This question is important because interventions, such as decision support tools, must be designed based on a detailed understanding of how clinicians use information to make care decisions. Methods: We conducted in-depth qualitative interviews with family medicine and general internal medicine physicians until reaching saturation in emergent themes. We used a funneling approach to ask a series of questions about physicians' general decision making challenges and use of information when considering chronic opioids. We then used an iterative, open-coding approach to identify and characterize themes in the data. Results: We interviewed fifteen physicians with diverse clinical experiences, demographics, and practice affiliations. Physicians said that general decision making challenges in providing pain management included weighing risks and benefits of opioid therapies and time and resource constraints. Also, some physicians described their active avoidance of chronic pain treatment due to concerns about opioid risks. In their decision making, physicians described the importance of objective and consistent information, the importance of identifying "red flags" related to risks of opioids, the importance of information about physical function as an outcome, and the importance of information that engenders trust in patients. Conclusions: This study identified and described primary care physicians' struggles to deliver high quality care as they seek and make decisions based on an array of incomplete, conflicting, and often untrusted patient information. Decision support systems, education, and other interventions that address these challenges may alleviate primary care physicians' struggles and improve outcomes for patients with chronic pain and other challenging conditions.

Original languageEnglish (US)
Article number48
JournalBMC Family Practice
Volume16
Issue number1
DOIs
StatePublished - Apr 14 2015
Externally publishedYes

Fingerprint

Primary Care Physicians
Chronic Pain
Opioid Analgesics
Physicians
Decision Making
Pain Management
Quality of Health Care
Internal Medicine
Medicine
Demography
Interviews
Education
Therapeutics

Keywords

  • Chronic pain
  • Clinical decision support
  • Decision making
  • Health care quality
  • Information needs
  • Opioids
  • Primary care

ASJC Scopus subject areas

  • Family Practice

Cite this

Decision support for chronic pain care : How do primary care physicians decide when to prescribe opioids? A qualitative study. / Harle, Chris; Bauer, Sarah E.; Hoang, Huong Q.; Cook, Robert L.; Hurley, Robert W.; Fillingim, Roger B.

In: BMC Family Practice, Vol. 16, No. 1, 48, 14.04.2015.

Research output: Contribution to journalArticle

Harle, Chris ; Bauer, Sarah E. ; Hoang, Huong Q. ; Cook, Robert L. ; Hurley, Robert W. ; Fillingim, Roger B. / Decision support for chronic pain care : How do primary care physicians decide when to prescribe opioids? A qualitative study. In: BMC Family Practice. 2015 ; Vol. 16, No. 1.
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abstract = "Background: Primary care physicians struggle to treat chronic noncancer pain while limiting opioid misuse, abuse, and diversion. The objective of this study was to understand how primary care physicians perceive their decisions to prescribe opioids in the context of chronic noncancer pain management. This question is important because interventions, such as decision support tools, must be designed based on a detailed understanding of how clinicians use information to make care decisions. Methods: We conducted in-depth qualitative interviews with family medicine and general internal medicine physicians until reaching saturation in emergent themes. We used a funneling approach to ask a series of questions about physicians' general decision making challenges and use of information when considering chronic opioids. We then used an iterative, open-coding approach to identify and characterize themes in the data. Results: We interviewed fifteen physicians with diverse clinical experiences, demographics, and practice affiliations. Physicians said that general decision making challenges in providing pain management included weighing risks and benefits of opioid therapies and time and resource constraints. Also, some physicians described their active avoidance of chronic pain treatment due to concerns about opioid risks. In their decision making, physicians described the importance of objective and consistent information, the importance of identifying {"}red flags{"} related to risks of opioids, the importance of information about physical function as an outcome, and the importance of information that engenders trust in patients. Conclusions: This study identified and described primary care physicians' struggles to deliver high quality care as they seek and make decisions based on an array of incomplete, conflicting, and often untrusted patient information. Decision support systems, education, and other interventions that address these challenges may alleviate primary care physicians' struggles and improve outcomes for patients with chronic pain and other challenging conditions.",
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