Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study.
Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study.
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DOI：
10.1186/s12875-015-0264-3
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发表时间：
2015-04-14
影响因子：
2.9
通讯作者：
Fillingim RB
中科院分区：
文献类型：
--
作者：
Harle CA;Bauer SE;Hoang HQ;Cook RL;Hurley RW;Fillingim RB
初级保健医生努力治疗慢性非癌症疼痛，同时限制阿片类药物滥用，滥用和转移。本研究的目的是了解初级保健医生如何看待他们在慢性非癌症疼痛管理背景下处方阿片类药物的决定。这个问题很重要，因为干预措施，如决策支持工具，必须基于对临床医生如何使用信息来做出护理决策的详细了解而设计。我们对家庭医学和普通内科医生进行了深入的定性访谈，直到在紧急主题中达到饱和。我们使用有趣的方法来询问一系列关于医生在考虑慢性阿片类药物时的一般决策挑战和信息使用的问题。然后，我们使用迭代的开放编码方法来识别和描述数据中的主题。我们采访了15位具有不同临床经验、人口统计学特征和执业背景的医生。医生说，提供疼痛管理的一般决策挑战包括权衡阿片类药物治疗的风险和益处以及时间和资源限制。此外，一些医生描述了他们由于担心阿片类药物风险而主动避免慢性疼痛治疗。在他们的决策过程中，医生描述了客观和一致信息的重要性，识别与阿片类药物风险相关的“红旗”的重要性，有关身体功能的信息作为结果的重要性，以及在患者中产生信任的信息的重要性。这项研究确定并描述了初级保健医生在寻求并根据一系列不完整、相互冲突且通常不可信的患者信息做出决策时提供高质量护理的努力。解决这些挑战的决策支持系统、教育和其他干预措施可能会减轻初级保健医生的挣扎，并改善慢性疼痛和其他挑战性疾病患者的预后。
Primary 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. We 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. We 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. This 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.
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DOI：
10.1016/j.jpain.2008.10.008
发表时间：
2009-02
期刊：
The journal of pain
影响因子：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
影响因子：
4.2
作者：
Kavukcu, Ethem;Akdeniz, Melahat;Oner, Mehmet
通讯作者：
Oner, Mehmet
影响因子：
5.7
作者：
Abbo, Elmer D.;Zhang, Qi;Huang, Elbert S.
通讯作者：
Huang, Elbert S.
影响因子：
5.7
作者：
Merrill, J;Rhodes, LA;Bradley, KA
通讯作者：
Bradley, KA
影响因子：
5.4
作者：
Burgess, Diana Jill;Crowley-Matoka, Megan;van Ryn, Michelle
通讯作者：
van Ryn, Michelle