Department of Family Medicine, University of Washington, Seattle, Washington, USA.
School of Public Health, University of Washington, Seattle, Washington, USA.
BMJ Open. 2017 Nov 12;7(11):e015083. doi: 10.1136/bmjopen-2016-015083.
The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management.
This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis.
Nine patient participants and five primary care providers were included in the study.
Living with chronic pain is disruptive to patients' lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient-provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change.
As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.
当今，美国处方类阿片（POs）的滥用现象十分猖獗。为了遏制因处方不当而导致的 POs 使用泛滥，许多州已经实施了相关立法。印第安纳州颁布了自 2013 年 12 月起生效的 PO 处方规定。这些规定改变了医疗保健提供者管理慢性疼痛的方式。本定性研究旨在评估印第安纳州阿片类药物处方立法对患者疼痛管理体验的影响。
这是一项定性研究，通过对患者和初级保健提供者的访谈来获取三角数据来源。患者是从一家综合性疼痛诊所招募的，这些患者是从联邦合格健康诊所（FQHCs）转介过来的。初级保健提供者是从同一 FQHC 招募的。该研究采用了归纳、新兴主题分析。
该研究共纳入 9 名患者参与者和 5 名初级保健提供者。
慢性疼痛严重影响了患者的生活质量，表现在多个方面。处方规定的改变扰乱了既定的疼痛管理实践。患者与提供者之间的关系，涉及权力动态和决策，与规则的改变平行发生了重大转变。
由于疼痛管理实践的改变，一些患者经历了重大挑战。需要进一步研究这种变化的程度。此外，探索在确保疼痛管理充分获取的同时规范处方的方法至关重要。
