Grants and Contracts Details
Description
The overarching goal of this project is to enhance our understanding of the opioid prescribing
and dispensing decision-making processes of primary care providers (physicians, physician
assistants, and nurse practitioners) and pharmacists. Since 1980, use of chronic opioid therapy
(COT) for chronic non-cancer pain (CNCP) has increased dramatically. Increases in use of COT
for CNCP have been paralleled by increased rates of prescription opioid use disorders (abuse
and dependence) and opioid overdose deaths. Prescription opioid use disorders are the fastest
growing form of drug abuse, and prescription opioids are the most common cause of accidental
drug overdose in the United States (an “epidemic,” per the Centers for Disease Control and
Prevention). The central dilemma facing clinicians who prescribe opioids for CNCP is how to
best balance the benefits of pain relief with the risks of opioid misuse. Primary care providers
and pharmacists who prescribe and dispense opioids with the objective of relieving pain play a
central, albeit unintentional, role in this epidemic. Training, policies, and interventions are
urgently needed to improve pain management and decrease opioid abuse, diversion, and
deaths. To succeed, these programs need to be predicated on a thorough understanding of
primary care providers’ and pharmacists’ decision-making processes when they prescribe and
dispense opioids. Unfortunately these decision-making processes are poorly understood. To fill
this knowledge gap, we propose to use face-to-face qualitative semistructured interviews to
investigate primary care provider and pharmacist decision-making processes regarding COT for
CNCP. Qualitative methods are ideal for this study because prior evidence is insufficient to
construct conceptual models or hypotheses about how to improve clinical decision making
about opioids. We have assembled a multidisciplinary team of physicians, health services
researchers, a pharmacist, and qualitative methods experts with content expertise in chronic
pain, addictions, and psychiatry, to analyze the detailed qualitative data about primary care
provider and pharmacist decision making. Results will be used to construct a full conceptual
model of primary care providers’ and pharmacists’ prescribing and dispensing behaviors
regarding COT for CNCP. This model will enable diverse stakeholders to address this complex
problem in an informed manner, generating testable hypotheses on specific approaches to
addressing the prescription opioid epidemic via training, quality improvement infrastructure,
clinical decisions support, and public and clinical policy.
Status | Finished |
---|---|
Effective start/end date | 5/15/14 → 4/30/18 |
Funding
- Research Triangle Institute: $183,972.00
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