Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

BMC Geriatrics

Research Article

Barbara J Turner¹  Aerin Spitz²  Maria Papaleontiou³  Evelyn Granieri⁴  M Carrington Reid⁵  Alison A Moore⁶ 

[1] Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA;Department of Internal Medicine, Virginia Mason Medical Center, Seattle, WA, USA;Division of Endocrinology, University of Michigan School of Medicine, Ann Arbor, MI, USA;Division of Geriatric Medicine and Aging, Columbia University, New York, NY, USA;Division of Geriatrics and Gerontology, Weill Cornell Medical College, New YorkNY, USA;Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA;

关键词: Focus Group;    Chronic Pain;    Primary Care Provider;    Nurse Practitioner;    Community Health Center;   

DOI  :  10.1186/1471-2318-11-35

 received in 2011-02-03, accepted in 2011-07-14,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.MethodsSix focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.ResultsMost participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.ConclusionsProviders perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.

【 授权许可】

Unknown   
© Spitz et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.