Abstract
Background: The objective of this qualitative study is to better understand primary care clinician decision making for managing chronic pain. Specifically, we focus on the factors that influence changes to existing chronic pain management plans. Limitations in guidelines and training leave clinicians to use their own judgment and experience in managing the complexities associated with treating patients with chronic pain. This study provides insight into those judgments based on clinicians’ first-person accounts. Insights gleaned from this study could inspire innovations aimed at supporting primary care clinicians (PCCs) in managing chronic pain. Methods: We conducted 89 interviews with PCCs to obtain their first-person perspective of the factors that influenced changes in treatment plans for their patients. Interview transcripts were analyzed thematically by a multidisciplinary team of clinicians, cognitive scientists, and public health researchers. Results: Seven themes emerged through our analysis of factors that influenced a change in chronic pain management: 1) change in patient condition; 2) outcomes related to treatment; 3) nonadherent patient behavior; 4) insurance constraints; 5) change in guidelines, laws, or policies; 6) approaches to new patients; and 7) specialist recommendations. Conclusions: Our analysis sheds light on the factors that lead PCCs to change treatment plans for patients with chronic pain. An understanding of these factors can inform the types of innovations needed to support PCCs in providing chronic pain care. We highlight key insights from our analysis and offer ideas for potential practice innovations.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 42-50 |
| Number of pages | 9 |
| Journal | Journal of the American Board of Family Medicine |
| Volume | 33 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 2020 |
Funding
Funding: This project was supported by Grant R01HS023306 from the Agency for Healthcare Research and Quality, Designing User-Centered Decision Support Tools for Primary Care Pain Management. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. This project was supported by Grant R01HS023306 from the Agency for Healthcare Research and Quality, Designing User-Centered Decision Support Tools for Primary Care Pain Management. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Conflict of interest: CAH is a principal investigator on past and current research grants from the Agency for Healthcare Research and Quality (AHRQ) and Pfizer, Inc. related to chronic pain care. RC receives funding from the National Institutes of Health (NIH) and the Florida Department of Health. RWH receives funding from AHRQ, NIH, Medtronic (educational grant to Wake Forest University School of Medicine), Medtronic (consultancy), and the Robert Wood Johnson Foundation (research funding as a Clinical Scholar). BTAC serves as a coinvestigator on an NIH Conflict of interest: CAH is a principal investigator on past and current research grants from the Agency for Healthcare Research and Quality (AHRQ) and Pfizer, Inc. related to chronic pain care. RC receives funding from the National Institutes of Health (NIH) and the Florida Department of Health. RWH receives funding from AHRQ, NIH, Medtronic (educational grant to Wake Forest University School of Medicine), Medtronic (consultancy), and the Robert Wood Johnson Foundation (research funding as a Clinical Scholar). BTAC serves as a coinvestigator on an NIH
Keywords
- Chronic Pain
- Clinical Decision Making
- Opioids
- Pain Management
- Primary Health Care
- Qualitative Research
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Family Practice
