Factors That Influence Changes to Existing Chronic Pain Management Plans. J Am Board Fam Med 2020;33(1):42-50
Date
01/08/2020Pubmed ID
31907245Pubmed Central ID
PMC7301400DOI
10.3122/jabfm.2020.01.190284Scopus ID
2-s2.0-85077546759 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
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.
Author List
Diiulio J, Militello LG, Andraka-Christou BT, Cook RL, Hurley RW, Downs SM, Anders S, Mamlin BW, Danielson EC, Harle CAAuthor
Robert W. Hurley MD, PhD Adjunct Professor of Anesthesiology and CTSI in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Analgesics, OpioidChronic Pain
Clinical Decision-Making
Female
Humans
Male
Medication Adherence
Pain Management
Practice Guidelines as Topic
Practice Patterns, Physicians'
Primary Health Care
Qualitative Research
