How Do Clinicians of Different Specialties Perceive and Use Opioid Risk Mitigation Strategies? A Qualitative Study
Bibliographic Data
| ID | 21645482 |
|---|---|
| Authors | Michelle S Keller (0000-0002-8157-7586, Cedars-Sinai Medical Center, corresponding author), Alma Jusufagic (University of California, Los Angeles), Teryl K Nuckols (0000-0002-0416-1595, Cedars-Sinai Medical Center), Jacob Needleman (0000-0002-2875-0589, Cedars-Sinai Medical Center), Jack Needleman (Cedars-Sinai Medical Center), Marysue V Heilemann (0000-0001-5490-6076, University of California, Los Angeles) |
| Year | 2021 |
| Volume | 56 |
| Issue | 9 |
| Pages | 1352-1362 |
| Publication date | 2021-07-29 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Substance Use & Misuse (JOURNAL) |
| Journal identifiers | ISSN: 1082-6084 • E-ISSN: 1532-2491 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/10826084.2021.1926514 |
| PMID | 34027814 |
| OpenAlex | W3165532611 |
| Language | EN |
| Citations received | 1 |
| References cited | 40 |
Background In response to the opioid crisis, states and health systems are encouraging clinicians to use risk mitigation strategies aimed at assessing a patient’s risk for opioid misuse or abuse: opioid agreements, prescription drug monitoring programs (PDMPs), and urine drug tests (UDT). Objective: The objective of this qualitative study was to understand how clinicians perceived and used risk mitigation strategies for opioid abuse/misuse and identify barriers to implementation. Methods: We interviewed clinicians who prescribe opioid medications in the outpatient setting from 2016-2018 and analyzed the data using Constructivist Grounded Theory methodology. Results: We interviewed 21 primary care clinicians and 12 specialists. Nearly all clinicians reported using the PDMP. Some clinicians (adopters) found the opioid agreement and UDTs to be valuable, but most (non-adopters) did not. Adopters found the agreements and UDTs helpful in treating patients equitably, setting limits, and having objective evidence of misuse; protocols and workflows facilitated the use of the strategies. Non-adopters perceived the strategies as awkward, disruptive to the clinician-patient relationship, and introducing a power differential; they also cited lack of time and resources as barriers to use. Conclusions: Our study demonstrates that clinicians in certain settings have found effective ways to implement and use the PDMP, opioid agreements, and UDT but that other clinicians are less comfortable with their use. Administrators and policymakers should ensure that the strategies are designed in a way that strengthens the clinician-patient relationship while maximizing safety for patients and that clinicians are adequately trained and supported when introducing the strategies
Business · Early adopter · Family medicine · Medical emergency · Medical prescription · Opioid · Opioid use disorder · Prescription Drug Misuse · Psychiatry · Qualitative research · Medicine · Nursing · Opioid Use Disorder Treatment · Prenatal Substance Exposure Effects · Substance Abuse Treatment and Outcomes
The Coding Manual for Qualitative Researchers
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Sampling for qualitative research
Is Nonconsensual Tapering of High-Dose Opioid Therapy Justifiable
Sampling in Interview-Based Qualitative Research
Socioeconomic status, fundamental cause theory, and prescription opioid use behaviors
| Unique citing works | 1 |
|---|---|
| Citations per year | 0,33 |
| Citation span | 2023 - 2023 (1) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 1 |