An evaluation of the performance of the Opioid Manager clinical tool in primary care: A qualitative study

Andrew Robertson, BSc, MD (Candidate); Sander L. Hitzig, PhD; Andrea D. Furlan, MD, PhD

doi:10.5055/jom.2014.0207

Authors

Andrew Robertson, BSc, MD (Candidate)
Sander L. Hitzig, PhD
Andrea D. Furlan, MD, PhD

DOI:

https://doi.org/10.5055/jom.2014.0207

Keywords:

chronic pain, opioids, primary care, qualitative methodology, interviews, family physicians

Abstract

Aims: The Opioid Manager (OM) is a point-of-care paper tool for physicians, which summarizes the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. To evaluate the efficacy of the OM, there is a need to better understand how physicians are using the OM, and how it is relevant to their practice.

Methods: Semistructured interviews were conducted with six family physicians in Ontario with clinical pain management experience. The interviews were analyzed using content analysis. The technique of “code-recode” was conducted by two analysts to verify content validity.

Results: The following main themes emerged: 1) OM as a communication tool; 2) OM as an educational tool; 3) OM as a clinical tool; 4) OM content/design; 5) OM benefits; 6) who the OM is used with; 7) OM potential; and 8) challenges of pain management. Physicians' commented the OM was a useful reference for helping their clinical decision making regarding opioids, and used it to educate and communicate with their patients/colleagues. Although many felt the content/design of the OM had a number of good features, there was a need for modifications (ie, merge with other tools and create electronic version). Given the challenges associated with pain management, a number of benefits were derived from using the OM (ie, protection and building therapeutic alliance), and respondents' felt the tool had the potential to meet a number of unmet needs related to opioid management.

Conclusions: Overall, the OM was viewed positively for improving pain management practices but further work is required to refine the tool's potential.

Author Biographies

Andrew Robertson, BSc, MD (Candidate)

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Sander L. Hitzig, PhD

Faculty of Medicine, Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.

Andrea D. Furlan, MD, PhD

Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Physiatry, University of Toronto, Toronto, Ontario, Canada; Institute for Work & Health, Toronto, Ontario, Canada.

References

Gureje O, Von KM, Simon GE, et al.: Persistent pain and well-being: A World Health Organization study in primary care. JAMA. 1998; 280: 147 - 151.

Langley PC: The prevalence, correlates and treatment of pain in the European Union. Curr Med Res Opin. 2011; 27: 463 - 480.

Breivik H, Collett B, Ventafridda V, et al.: Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10: 287 - 333.

Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, et al.: Relationships among pain, anxiety, and depression in primary care. Depress Anxiety. 2008; 25: 593 - 600.

Moulin DE, Clark AJ, Speechley M, et al.: Chronic pain in Canada—Prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manag. 2002; 7: 179 - 184.

Morley-Forster PK, Clark AJ, Speechley M, et al.: Attitudes toward opioid use for chronic pain: A Canadian physician survey. Pain Res Manag. 2003; 8: 189 - 194.

Allen MJ, Asbridge MM, Macdougall PC, et al.: Self-reported practices in opioid management of chronic noncancer pain: A survey of Canadian family physicians. Pain Res Manag. 2013; 18: 177 - 184.

Currie CL, Wild TC, Schopflocher DP, et al.: Illicit and prescription drug problems among urban aboriginal adults in Canada: The role of traditional culture in protection and resilience. Soc Sci Med. 2013; 88: 1 - 9.

Wenghofer EF, Wilson L, Kahan M, et al.: Survey of Ontario primary care physicians’ experiences with opioid prescribing. Can Fam Physician. 2011; 57: 324 - 332.

Gomes T, Mamdani MM, Dhalla IA, et al.: Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011; 171: 686 - 691.

Dhalla IA, Mamdani MM, Sivilotti ML, et al.: Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ. 2009; 181: 891 - 896.

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Canada: National Opioid Use Guideline Group (NOUGG). 2010. Available at http://nationalpaincentre.mcmaster.ca/opioid/. Accessed March 20, 2014.

Davis DA, Taylor-Vaisey A: Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997; 157: 408 - 416.

Emslie C, Grimshaw J, Templeton A: Do clinical guidelines improve general practice management and referral of infertile couples? BMJ. 1993; 306: 1728 - 1731.

Furlan AD, Reardon R, Salach L: The opioid manager: A point-of-care tool to facilitate the use of the Canadian opioid guideline. J Opioid Manag. 2012; 8: 57 - 61.

Sandelowski M: Whatever happened to qualitative description? Res Nurs Health. 2000; 23: 334 - 340.

Norman C, Bender JL, Macdonald J, et al.: Questions that individuals with spinal cord injury have regarding their chronic pain: A qualitative study. Disabil Rehabil. 2010; 32: 114 - 124.

Graneheim UH, Lundman B: Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24: 105 - 112.

Creswell JW: Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 2nd ed. Thousand Oaks: Sage Publications, 2003.

Young A, Alfred KC, Davignon PP, et al.: Physician survey examining the impact of an educational tool for responsible opioid prescribing. J Opioid Manag. 2012; 8: 81 - 87.