Starrels Joanna L, Wu Bryan, Peyser Deena, Fox Aaron D, Batchelder Abigail, Barg Frances K, Arnsten Julia H, Cunningham Chinazo O
Assistant Professor of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Candidate, MD/MPH Program at Oregon Health & Sciences University, Portland, Oregon.
J Opioid Manag. 2014 Mar-Apr;10(2):95-102. doi: 10.5055/jom.2014.0198.
To understand primary care providers (PCPs)' experiences, beliefs, and attitudes about using opioid treatment agreements (OTAs) for patients with chronic pain.
Qualitative research study.
Twenty-eight internists and family medicine physicians at two health centers.
Semistructured telephone interviews, informed by the Integrative Model of Behavioral Prediction. Themes were analyzed using a Grounded Theory approach, and similarities and differences in themes were examined among OTA adopters, nonadopters, and selective adopters.
Participants were 64 percent female and 68 percent white, and practiced for a mean of 9.5 years. Adoption of OTAs varied: seven were adopters, five were nonadopters, and 16 were selective adopters. OTA adoption reflected PCPs' beliefs and attitudes in the following three thematic categories: 1) perceived effect of OTA use on the therapeutic alliance, 2) beliefs about the utility of OTAs for patients or providers, and 3) perception of patients' risk for opioid misuse. PCPs commonly believed that OTAs were useful for physician self-protection, but few believed that they prevent opioid misuse. Selective adopters expressed ambivalent beliefs and made decisions about OTA use for individual patients based on both observed data and a subjective sense of each patient's risk for misuse.
Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices.
了解基层医疗服务提供者（PCP）对于使用阿片类药物治疗协议（OTA）治疗慢性疼痛患者的经验、信念和态度。
定性研究。
两个健康中心的28名内科医生和家庭医学医生。
采用基于行为预测整合模型的半结构化电话访谈。使用扎根理论方法分析主题，并在OTA采用者、非采用者和选择性采用者之间检查主题的异同。
参与者中64%为女性，68%为白人，平均从业9.5年。OTA的采用情况各不相同：7人是采用者，5人是非采用者，16人是选择性采用者。OTA的采用反映了PCP在以下三个主题类别中的信念和态度：1）对使用OTA对治疗联盟的感知影响；2）对OTA对患者或提供者效用的信念；3）对患者阿片类药物滥用风险的认知。PCP普遍认为OTA对医生自我保护有用，但很少有人认为它们能预防阿片类药物滥用。选择性采用者表达了矛盾的信念，并根据观察到的数据以及对每个患者滥用风险的主观感受，对个别患者使用OTA做出决策。
PCP使用OTA的情况存在很大差异，反映了PCP信念和态度的不同。迫切需要开展研究以了解使用OTA对提供者、患者和治疗联盟的影响，从而指导最佳实践。
