Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy

[drusso]

Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy: A Qualitative Study

AbstractObjective. Given the changing political and social climate around opioids, we examined how clinicians in the outpatient setting made decisions about man

academic.oup.com

Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy: A Qualitative Study
Michelle S Keller, PhD, MPH, Alma Jusufagic, MPH, Teryl K Nuckols, MD, MSHS, Jack Needleman, PhD, MarySue Heilemann, PhD, RN, FAAN
Pain Medicine, pnaa045, Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy: A Qualitative Study
Published:

18 March 2020

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Abstract
Objective
Given the changing political and social climate around opioids, we examined how clinicians in the outpatient setting made decisions about managing opioid prescriptions for new patients already on long-term opioid therapy.

Methods
We conducted in-depth interviews with 32 clinicians in Southern California who prescribed opioid medications in the outpatient setting for chronic pain. The study design, interview guides, and coding for this qualitative study were guided by constructivist grounded theory methodology.

Results
We identified three approaches to assuming a new patient’s opioid prescriptions. Staunch Opposers, mostly clinicians with specialized training in pain medicine, were averse to continuing opioid prescriptions for new patients and often screened outpatients seeking opioids. Cautious and Conflicted Prescribers were wary about prescribing opioids but were willing to refill prescriptions if they perceived the patient as trustworthy and the medication fell within their comfort zone. Clinicians in the first two groups felt resentful about other clinicians “dumping” patients on opioids on them. Rapport Builders, mostly primary care physicians, were the most willing to assume opioid prescriptions and were strategic in their approach to transitioning patients to safer doses.

Conclusions
Clinicians with the most training in pain management were the least willing to assume responsibility for opioid prescriptions for patients already on long-term opioid therapy. In contrast, primary care clinicians were the most willing to assume this responsibility. However, primary care clinicians face barriers to providing high-quality care for patients with complex pain conditions, such as short visit times and less specialized training.
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Issue Section:
Original Research Article

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[lobelsteve]

Wow, no MD/DO as authors. But they are spot on.
When we get consults for these legacy trainwreck patients, we know better to just continue on a useless path.
Our responsibility is to let the referring MD/DO why we are not going to take that route.

 

[Ferrismonk]

There's an MD in there if you look closely.

 

[Ferrismonk]

As I keep telling people, if the person with the most training and experience treating pain doesn't think the dose of opiates is appropriate, maybe it's the PCP that's doing something wrong, not the specialist.

 

[geauxg8rs]

As I keep telling people, if the person with the most training and experience treating pain doesn't think the dose of opiates is appropriate, maybe it's the PCP that's doing something wrong, not the specialist.

“But you’re pain management, my pCP said you would take over. He said it was against the law for him to write my meds anymore. He said you could do it. “ ‍♂️

 

[deleted480308]

“But you’re pain management, my pCP said you would take over. He said it was against the law for him to write my meds anymore. He said you could do it. “ ‍♂

“They lied”

 

[Ferrismonk]

Here's my template:

Patient states that he/she was referred to my clinic for continuation of prior opiate therapy. Patient also states that he/she was told that "because of the new laws" his/her prior provider is no longer able to continue writing for opiate pain medication. I reviewed current laws and guidelines regarding the prescribing of opiate pain medication in detail with the patient this visit.

Of course, by this I mean that I tell them how we all follow the same laws and their PCP lied.

 

[Ferrismonk]

Is there any chance someone could post the pdf? I'm not an AAPM member

 

[craigkes]

“But you’re pain management, my pCP said you would take over. He said it was against the law for him to write my meds anymore. He said you could do it. “ ‍♂

Exactly. I flat out tell folks that all the time. Tell that that is flat out not true. "My job is to guide your primary care in what is best for you in terms of management while keeping you out of harm". Usually follow up as needed.

 

[DOctorJay]

Is there any chance someone could post the pdf? I'm not an AAPM member