Eleanor T Lewis

Publications (4)8.01 Total impact

• Article: Opioid use patterns and association with pain severity and mental health functioning in chronic pain patients.

  Michelle A Skinner, Eleanor T Lewis, Jodie A Trafton
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  ABSTRACT: The objective of this study was to explore the relationship between patterns of opioid use, pain severity, and pain-related mental health in chronic pain patients prescribed opioids. The study was designed as a one-time patient interview with structured pain and opioid use assessments. The study was set in a tertiary care medical center in the United States Department of Veterans Affairs. PATIENTS.  Study participants were primary care patients with a pain condition for greater than 6 months who received at least one prescription for an opioid in the prior 12 months. The Prescription Drug Use Questionnaire was used to assess patterns of opioid use. The Pain Outcomes Questionnaire was used to assess pain-related functioning. Symptomatic use of opioid medication (e.g., taking an opioid in response to increased pain) was more common than scheduled (i.e., taking an opioid at regular times) or strategic use of opioid medication (e.g., taking an opioid specifically to engage in activities). Symptomatic use of opioids was associated with poorer pain-related mental health, after controlling for pain duration and pain-related physical functioning. Use of opioids in a scheduled pattern was associated with better pain-related mental health. Patients rarely reported that they used opioids strategically to facilitate functional activities. The patterns in which patients use their opioid medications are associated with their psychological functioning. This is consistent with theory regarding the potential impact of reinforcing effects of opioid medication on functional outcomes. Interventions to encourage strategic or scheduled opioid use warrant investigation as methods to improve pain outcomes with opioids.
  Pain Medicine 04/2012; 13(4):507-17. · 2.35 Impact Factor
• Source

  Available from: Kelly E Ormond

  Article: Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records.

  Diana C Darcy, Eleanor T Lewis, Kelly E Ormond, David J Clark, Jodie A Trafton
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  ABSTRACT: Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results. As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use. This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications.
  BMC Health Services Research 11/2011; 11:294. · 1.66 Impact Factor
• Article: Opioid use in primary care: asking the right questions.

  Eleanor T Lewis, Jodie A Trafton
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  ABSTRACT: Pain is one of the most common reasons that patients seek treatment from health care professionals, often their primary care providers. One tool for treating pain is opioid therapy, and opioid prescriptions have increased dramatically in recent years in the United States. This article will review recent research about opioids that is most relevant to treating chronic pain in the context of a typical primary care practice. It will focus on four key practices that providers can engage in before and during the course of opioid therapy that we believe will enhance the likelihood that opioids, when used, are an effective tool for pain management: avoiding sole reliance on opioids; using adequate opioid doses to address pain; mitigating the risk of opioid misuse by patients; and fostering collaborative relationships for treating complex patients.
  Current Pain and Headache Reports 01/2011; 15(2):137-43. · 1.66 Impact Factor
• Article: Reasons for under-use of prescribed opioid medications by patients in pain.

  Eleanor T Lewis, Ann Combs, Jodie A Trafton
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  ABSTRACT: With the growth in opioid therapy for the treatment of chronic pain, health care providers have focused their attention on avoiding over-use of opioid medications, specifically to avoid addiction, dependency, and other misuse. Qualitative and quantitative reviews of medication adherence, in contrast, focus primarily on why patients under-use or do not take their medications as prescribed and find nonadherence rates of approximately 25%. To identify the prevalence of under-use of opioid medications and the reasons and implications of under-use. As part of a variety of structured assessments, subjects were asked detailed questions about how they used their opioid medication in their daily lives. One hundred ninety-one veterans who received an opioid prescription for any pain problem within the 12 months before the interview. We defined a patient who under-used his/her medication as one who took less than their prescribed dose of medication and reported that pain impaired their ability to engage in normal daily activities. Under-use of opioids (20%) was more common than over-use (9%), consistent with research on medication adherence. Patients who under-used their opioids offered the same reasons for under-use that patients report for other medications. However, while under-users reported more pain than other opioid users they filled only slightly fewer opioid prescriptions. Communication problems between patients and providers about opioids were common. Improved communication between patients and providers and shared decision-making regarding opioid prescriptions may improve pain management and minimize the problems associated with over-prescription of opioids (i.e., diversion).
  Pain Medicine 06/2010; 11(6):861-71. · 2.35 Impact Factor