Highlights
- •Barriers to opioid guideline implementation include physician beliefs and attitudes.
- •Time pressure may lead to underuse of recommended opioid management practices.
- •Patients describe prevention of opioid-related harm as a physician responsibility.
Abstract
Prior studies have demonstrated poor physician adherence to opioid management guidelines
in primary care. The objectives of this qualitative study were to understand physicians'
and patients' perspectives on recommended opioid management practices and to identify
potential barriers to and facilitators of guideline-concordant opioid management in
primary care. Individual semistructured interviews were conducted with 14 primary
care physicians and 26 of their patients receiving long-term opioid therapy. Data
were analyzed using a qualitative immersion/crystallization approach. We identified
3 major barriers to and 1 facilitator of use of recommended opioid management practices.
Major barriers were inadequate time and resources available; relying on general impressions
of risk for opioid misuse; and viewing opioid monitoring as a “law enforcement” activity.
The third barrier was most apparent for physicians in the context of drug testing
and for patients in the context of opioid agreements. Beliefs about the need to protect
patients from opioid-related harm emerged as a major facilitator, especially among
patients. We hypothesize that future interventions to improve opioid management in
primary care will be more effective if they address identified barriers and use a
patient-centered framework, in which prevention of opioid-related harm to patients
is emphasized as the primary goal.
Perspective
This article describes primary care perspectives on guideline-recommended opioid management
practices. Barriers identified in this study may contribute to underuse of recommended
opioid management practices. Consideration of barriers and facilitators to guideline-concordant
care could improve effectiveness of future interventions aimed at improving opioid
management in primary care.
Key words
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Article info
Publication history
Published online: August 29, 2014
Accepted:
August 23,
2014
Received in revised form:
August 18,
2014
Received:
March 20,
2014
Footnotes
This work was supported by the U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Career Development Awards to E.E.K. (CDA 07-215) and M.S.M. (CDA 10-034).
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.
The authors report no financial conflicts of interest.
Identification
Copyright
Published by Elsevier Inc.
