Sources of distress in primary care opioid management and the role of a controlled substance review group: A qualitative study

Elizabeth Hulen, Somnath (Som) Saha, Benjamin Morasco, Claire Zeigler, Katherine Mackey, Samuel Edwards

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Objective. The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers. Setting. A Veterans Health Administration primary care clinic in Portland, Oregon. Participants: 12 members of primary care clinic staff representing multiple disciplines with recent participation in the Controlled Substance Review Group. Methods. Six semistructured interviews with primary care providers, one focus group discussion with six Nurse Care Managers, and 28 structured observations of CSRG meetings were conducted. In an iterative process using applied thematic analysis, a trained qualitative researcher reviewed textual data for themes. Results. Four broad domains with associated themes emerged from the analysis: 1) challenges of pain management'objective pain measures, changing guidelines, lack of coordinated approach; 2) patient attachment to opioids'threats, entitlement, abandonment; 3) provider frustration'confrontation in clinic visits, lack of mental health engagement, complex social situation; and 4) role of the Controlled Substance Review Group'communication techniques, supporting mental health engagement, structured backing. Conclusions. Primary care providers experience stress associated with opioid prescribing, including the provision of appropriate pain management using opioid analgesics and difficult patient-provider communication. The Controlled Substance Review Group functions to support providers through assistance with decision-making and shared responsibility for decision outcomes.

Original languageEnglish (US)
Pages (from-to)1570-1577
Number of pages8
JournalPain Medicine (United States)
Volume19
Issue number8
DOIs
StatePublished - Jan 1 2018

Fingerprint

Controlled Substances
Opioid Analgesics
Primary Health Care
Pain Management
Mental Health
Communication
Veterans Health
United States Department of Veterans Affairs
Frustration
Ambulatory Care
Focus Groups
Decision Making
Referral and Consultation
Nurses
Research Personnel
Guidelines
Interviews
Pain

Keywords

  • Chronic Pain
  • Clinical Decision Support
  • Opioids
  • Patient-Provider Communication
  • Primary Care
  • Qualitative Research

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Sources of distress in primary care opioid management and the role of a controlled substance review group : A qualitative study. / Hulen, Elizabeth; Saha, Somnath (Som); Morasco, Benjamin; Zeigler, Claire; Mackey, Katherine; Edwards, Samuel.

In: Pain Medicine (United States), Vol. 19, No. 8, 01.01.2018, p. 1570-1577.

Research output: Contribution to journalReview article

@article{7e64fa7a2bac4e11ade7e8f9bfa11510,
title = "Sources of distress in primary care opioid management and the role of a controlled substance review group: A qualitative study",
abstract = "Objective. The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers. Setting. A Veterans Health Administration primary care clinic in Portland, Oregon. Participants: 12 members of primary care clinic staff representing multiple disciplines with recent participation in the Controlled Substance Review Group. Methods. Six semistructured interviews with primary care providers, one focus group discussion with six Nurse Care Managers, and 28 structured observations of CSRG meetings were conducted. In an iterative process using applied thematic analysis, a trained qualitative researcher reviewed textual data for themes. Results. Four broad domains with associated themes emerged from the analysis: 1) challenges of pain management'objective pain measures, changing guidelines, lack of coordinated approach; 2) patient attachment to opioids'threats, entitlement, abandonment; 3) provider frustration'confrontation in clinic visits, lack of mental health engagement, complex social situation; and 4) role of the Controlled Substance Review Group'communication techniques, supporting mental health engagement, structured backing. Conclusions. Primary care providers experience stress associated with opioid prescribing, including the provision of appropriate pain management using opioid analgesics and difficult patient-provider communication. The Controlled Substance Review Group functions to support providers through assistance with decision-making and shared responsibility for decision outcomes.",
keywords = "Chronic Pain, Clinical Decision Support, Opioids, Patient-Provider Communication, Primary Care, Qualitative Research",
author = "Elizabeth Hulen and Saha, {Somnath (Som)} and Benjamin Morasco and Claire Zeigler and Katherine Mackey and Samuel Edwards",
year = "2018",
month = "1",
day = "1",
doi = "10.1093/pm/pnx259",
language = "English (US)",
volume = "19",
pages = "1570--1577",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Sources of distress in primary care opioid management and the role of a controlled substance review group

T2 - A qualitative study

AU - Hulen, Elizabeth

AU - Saha, Somnath (Som)

AU - Morasco, Benjamin

AU - Zeigler, Claire

AU - Mackey, Katherine

AU - Edwards, Samuel

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective. The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers. Setting. A Veterans Health Administration primary care clinic in Portland, Oregon. Participants: 12 members of primary care clinic staff representing multiple disciplines with recent participation in the Controlled Substance Review Group. Methods. Six semistructured interviews with primary care providers, one focus group discussion with six Nurse Care Managers, and 28 structured observations of CSRG meetings were conducted. In an iterative process using applied thematic analysis, a trained qualitative researcher reviewed textual data for themes. Results. Four broad domains with associated themes emerged from the analysis: 1) challenges of pain management'objective pain measures, changing guidelines, lack of coordinated approach; 2) patient attachment to opioids'threats, entitlement, abandonment; 3) provider frustration'confrontation in clinic visits, lack of mental health engagement, complex social situation; and 4) role of the Controlled Substance Review Group'communication techniques, supporting mental health engagement, structured backing. Conclusions. Primary care providers experience stress associated with opioid prescribing, including the provision of appropriate pain management using opioid analgesics and difficult patient-provider communication. The Controlled Substance Review Group functions to support providers through assistance with decision-making and shared responsibility for decision outcomes.

AB - Objective. The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers. Setting. A Veterans Health Administration primary care clinic in Portland, Oregon. Participants: 12 members of primary care clinic staff representing multiple disciplines with recent participation in the Controlled Substance Review Group. Methods. Six semistructured interviews with primary care providers, one focus group discussion with six Nurse Care Managers, and 28 structured observations of CSRG meetings were conducted. In an iterative process using applied thematic analysis, a trained qualitative researcher reviewed textual data for themes. Results. Four broad domains with associated themes emerged from the analysis: 1) challenges of pain management'objective pain measures, changing guidelines, lack of coordinated approach; 2) patient attachment to opioids'threats, entitlement, abandonment; 3) provider frustration'confrontation in clinic visits, lack of mental health engagement, complex social situation; and 4) role of the Controlled Substance Review Group'communication techniques, supporting mental health engagement, structured backing. Conclusions. Primary care providers experience stress associated with opioid prescribing, including the provision of appropriate pain management using opioid analgesics and difficult patient-provider communication. The Controlled Substance Review Group functions to support providers through assistance with decision-making and shared responsibility for decision outcomes.

KW - Chronic Pain

KW - Clinical Decision Support

KW - Opioids

KW - Patient-Provider Communication

KW - Primary Care

KW - Qualitative Research

UR - http://www.scopus.com/inward/record.url?scp=85055485510&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055485510&partnerID=8YFLogxK

U2 - 10.1093/pm/pnx259

DO - 10.1093/pm/pnx259

M3 - Review article

C2 - 29099982

AN - SCOPUS:85055485510

VL - 19

SP - 1570

EP - 1577

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - 8

ER -