What physicians need to implement safer opioid prescribing: A qualitative study

Allison Navis, MD; Mary Catherine George, PhD; Maya Scherer, MPH; Linda Weiss, PhD; Yosuke Chikamoto, PhD; Jessica Robinson-Papp, MS, MD

doi:10.5055/jom.2019.0538

Authors

Allison Navis, MD
Mary Catherine George, PhD
Maya Scherer, MPH
Linda Weiss, PhD
Yosuke Chikamoto, PhD
Jessica Robinson-Papp, MS, MD

DOI:

https://doi.org/10.5055/jom.2019.0538

Keywords:

Centers for Disease Control, opioid prescribing guidelines, qualitative study, physician perspectives

Abstract

Introduction: In response to the US opioid epidemic, the Centers for Disease Control and Prevention issued a guideline (CDCG) for prescribing opioids for chronic pain. Successful implementation of the CDCG requires identification of the information, skills, and support physicians need to carry out its recommendations. However, such data are currently lacking.

Methods: The authors performed one-on-one interviews with nine practicing physicians regarding their needs and perspectives for successful CDCG implementation, including the perceived barriers, focusing on communication strategies. Interviews were audio recorded, transcribed, and a thematic qualitative analysis was performed.

Findings: Three major themes were identified: communication, knowledge, and information technology (IT). Physicians reported that open communication with patients about opioids was difficult and burdensome, but essential; they shared their communication strategies. Knowledge gaps included patient-specific topics (eg, availability of/insurance coverage for non-opioid treatments) and more general areas (eg, opioid dosing/equivalencies, prescribing naloxone). Finally, physicians discussed the importance of innovation in IT, focusing on the electronic medical record for decision support and to allow safer opioid prescribing within the time constraints of clinical practice.

Discussion: These qualitative data document practical issues that should be considered in the development of implementation plans for safer opioid prescribing practices. Specifically, healthcare systems may need to provide opioid-relevant communication strategies and training, education on key topics such as naloxone prescribing, resources for referrals to appropriate nonpharmacologic treatments, and innovative IT solutions. Future research is needed to establish that such measures will be effective in producing better outcomes for patients on opioids for chronic pain.

Author Biographies

Allison Navis, MD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Mary Catherine George, PhD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Maya Scherer, MPH

Center for Evaluations and Applied Research, New York Academy of Medicine, New York, New York

Linda Weiss, PhD

Center for Evaluations and Applied Research, New York Academy of Medicine, New York, New York

Yosuke Chikamoto, PhD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Jessica Robinson-Papp, MS, MD

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

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