Postdoctoral Fellow, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois. ORCID: https://orcid.org/0000-0003-2792-7140.
Professor, Department of Health Outcomes and Biomedical Informatics, Chief Research Information Officer, University of Florida Health, Gainesville, Florida.
J Opioid Manag. 2021 Nov-Dec;17(6):499-509. doi: 10.5055/jom.2021.0684.
The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.
We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.
Opioid prescribing policies influenced clinicians' treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).
Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.
2016 年疾病控制与预防中心（CDC）发布的阿片类药物治疗慢性疼痛指南旨在帮助初级保健临床医生安全有效地为慢性非癌痛患者开具阿片类药物。各个州、支付方和医疗系统都发布了类似的政策，对慢性疼痛患者的阿片类药物处方规定了各种限制。专家认为，医疗机构和临床医生可能对联邦指南和随后的阿片类药物处方政策存在误解，导致疼痛管理不足。本研究旨在了解初级保健临床医生如何将阿片类药物处方政策纳入他们的治疗决策以及与慢性疼痛患者的沟通中。
我们对来自美国中西部三个医疗系统的 20 名临床医生的 64 次独特的初级保健就诊和 87 次就诊后访谈的数据进行了二次定性分析。使用多步骤过程和主题分析，我们系统地分析了涉及阿片类药物处方政策的数据摘录。
阿片类药物处方政策影响了临床医生对大多数慢性疼痛患者的治疗决策，包括不开始开具阿片类药物（主题 1）、总体上开具较少的阿片类药物（主题 1）以及开始逐渐减少和停止阿片类药物（主题 2）。在为慢性疼痛患者就诊时，直接援引了阿片类药物处方政策中描述的临床预防措施（主题 3）。
阿片类药物处方政策对慢性疼痛患者的临床医生治疗决策有多重影响。我们的研究结果可能为未来的研究提供信息，以探索在满足个体化疼痛治疗需求的同时，协调来自各种阿片类药物处方政策的处方压力的机制。
