Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain

Allison A. Macerollo, MD; Donald O. Mack, MD; Rupal Oza, MD, MPH; Ian M. Bennett, MD, PhD; Lorraine S. Wallace, PhD

doi:10.5055/jom.2014.0213

Authors

Allison A. Macerollo, MD
Donald O. Mack, MD
Rupal Oza, MD, MPH
Ian M. Bennett, MD, PhD
Lorraine S. Wallace, PhD

DOI:

https://doi.org/10.5055/jom.2014.0213

Keywords:

family medicine, opioid analgesic, prescribing, primary care

Abstract

Objective: To examine academic family medicine physicians' current practices, experiences, beliefs, level of concern about negative outcomes, and confidence and comfort when prescribing opioid analgesics for chronic nonmalignant pain management.

Design: Electronic cross-sectional survey.

Participants: This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians.

Main outcome measures: Respondents completed survey items addressing their 1) sociodemographic and practice characteristics, 2) current opioid prescribing practices, 3) experiences and beliefs toward prescribing opioid analgesics for chronic nonmalignant pain management, 4) level of concern about negative opioid-related outcomes, and 5) confidence and comfort when prescribing opioid analgesics.

Results: The majority of the sample (n = 491) were male (57.8 percent) with 84.1 percent identifying themselves as non-Hispanic white. Nearly all respondents (91.0 percent) reported currently prescribing opioids to patients with chronic nonmalignant pain. Most respondents reported being confident (88.4 percent) and comfortable (76.2 percent) in their prescribing for patients with chronic nonmalignant pain. Family physicians who were comfortable in their opioid prescribing skills were more likely to report satisfaction in prescribing opioids to patients with chronic pain (ρ = 0.494, p < 0.001), while those who were confident in their opioid prescribing skills were more likely to identify pain management as high priority (ρ = -0.287, p < 0.001).

Conclusions: Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription.

Author Biographies

Allison A. Macerollo, MD

Assistant Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

Donald O. Mack, MD

Assistant Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

Rupal Oza, MD, MPH

Assistant Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

Ian M. Bennett, MD, PhD

Associate Professor, Department of Family Medicine and Community Health, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.

Lorraine S. Wallace, PhD

Associate Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

References

Gureje O: Persistent pain and well-being: A World Health Organization study in primary care. JAMA. 1998; 280: 147-151.

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.

Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006; 21: 652-655.

Barry DT, Irwin KS, Jones ES, et al.: Opioids, chronic pain, and addiction in primary care. J Pain. 2010; 11: 1442-1450.

Laverence RR, Williams RL, Potter M, et al.: Chronic non-cancer pain: A siren for primary care—A report from the PRImary care MultiEthnic Network (PRIME Net). Am J Board Fam Med. 2011; 24: 551-561.

Spitz A, Moore AA, Papaleontiou M, et al.: Primary care providers’ perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study. BMC Geriatr. 2011; 11: 35.

McCarberg BH: Pain management in primary care: Strategies to mitigate opioid misuse, abuse, and diversion. Postgrad Med. 2011; 123: 119-130.

Strassels SA: Economic burden of prescription opioid misuse and abuse. J Manag Care Pharm. 2009; 15: 556-562.

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.

Dobscha SK, Corson K, Flores JA, et al.: Veterans affairs primary care clinicians’ attitudes toward chronic pain and correlates of opioids prescribing rates. Pain Med. 2008; 9: 564-571.

Mainous AG, Seehusen D, Shokar N: CAFM educational research alliance (CERA) 2011 residency director survey: Background and methods. Fam Med. 2012; 44: 691-693.

Clark LG, Upshur CC: Family medicine physicians' views of how to improve chronic pain management. J Am Board Fam Med. 2007; 20: 479-482.

Gannon M, Qaseem A, Snow V, et al.: Pain management and the primary care encounter. J Prim Care Community Health. 2011; 2: 37-44.