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

BMC Family Practice

Research Article

Robert W Hurley¹  Roger B Fillingim²  Robert L Cook³  Christopher A Harle⁴  Sarah E Bauer⁴  Huong Q Hoang⁵ 

[1] Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA;Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA;Department of Epidemiology, University of Florida, Gainesville, FL, USA;Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA;Mayo Clinic, Rochester, MN, USA;

关键词: Clinical decision support;    Information needs;    Decision making;    Chronic pain;    Opioids;    Primary care;    Health care quality;   

DOI  :  10.1186/s12875-015-0264-3

 received in 2015-01-04, accepted in 2015-03-30,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPrimary 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.MethodsWe 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.ResultsWe 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.ConclusionsThis 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.

【 授权许可】

CC BY   
© Harle et al.; licensee BioMed Central. 2015