Do Patients Know They Are on Pain Medication Agreements? Results from a Sample of High-Risk Patients on Chronic Opioid Therapy
University of Pittsburg School of Medicine, Pittsburgh, Pennsylvania, USA. Pain Medicine
(Impact Factor: 2.3).
07/2012; 13(9):1174-80. DOI: 10.1111/j.1526-4637.2012.01430.x
Objective. Pain medicine agreements are frequently recommended for use with high-risk patients on chronic opioid therapy. We assessed how consistently pain medicine agreements were used and whether patients were aware that they had signed a pain medicine agreement in a sample of HIV-infected adults prescribed chronic opioid treatment.
Design. We recruited patients from a longitudinal cohort of community-based HIV-infected adults and recruited the patients' primary care providers (PCPs). The patients completed in-person interviews and PCPs completed mail-based questionnaires about the patients' use of pain medicine agreements. Among patients prescribed chronic opioid therapy, we analyzed the prevalence of pain medicine agreement use, patient factors associated with their use, and agreement between patient and clinician reports of pain agreements.
Results. We had 84 patient–clinician dyads, representing 38 PCPs. A total of 72.8% of patients fit the diagnostic criteria for a lifetime substance use disorder. PCPs reported using pain medicine agreements with 42.9% of patients. Patients with pain medicine agreements were more likely to be smokers (91.7% vs 58.3%; P = 0.001) and had higher mean scores on the Screener and Opioid Assessment for Patients with Pain (µ = 26.0 [standard deviation, SD] = 9.7) vs µ = 19.5 [SD = 9.3]; P = 0.003). Patients reported having a pain medicine agreement with a sensitivity of 61.1% and a specificity of 64.6%.
Conclusions. In a high-risk sample, clinicians were using agreements at a low rate, but were more likely to use them with patients at highest risk of misuse. Patients exhibited low awareness of whether they signed a pain medicine agreement.
Available from: JP Estèbe
- "La situation est encore plus complexe lorsque la douleur doit être traitée pour un patient toxicomane (opium, héroïne). Malgré l'utilisation de contrats signés, le risque de mésusage reste important et le détournement de la méthadone et de la buprémorphine est important . "
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ABSTRACT: La prise en charge anesthésique des patients sous traitements morphiniques préopératoire (opioïde-tolérant) est difficile. La difficulté de prise en charge est due à la grande variabilité de réponses qui rend les facteurs peu prédictifs. Ces patients doivent être considérés comme à haut risque de douleurs postopératoires et de surconsommation de morphiniques.
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ABSTRACT: To understand primary care providers (PCPs)' experiences, beliefs, and attitudes about using opioid treatment agreements (OTAs) for patients with chronic pain.
Qualitative research study.
Twenty-eight internists and family medicine physicians at two health centers.
Semistructured telephone interviews, informed by the Integrative Model of Behavioral Prediction. Themes were analyzed using a Grounded Theory approach, and similarities and differences in themes were examined among OTA adopters, nonadopters, and selective adopters.
Participants were 64 percent female and 68 percent white, and practiced for a mean of 9.5 years. Adoption of OTAs varied: seven were adopters, five were nonadopters, and 16 were selective adopters. OTA adoption reflected PCPs' beliefs and attitudes in the following three thematic categories: 1) perceived effect of OTA use on the therapeutic alliance, 2) beliefs about the utility of OTAs for patients or providers, and 3) perception of patients' risk for opioid misuse. PCPs commonly believed that OTAs were useful for physician self-protection, but few believed that they prevent opioid misuse. Selective adopters expressed ambivalent beliefs and made decisions about OTA use for individual patients based on both observed data and a subjective sense of each patient's risk for misuse.
Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices.
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The primary objective of this study was to measure prescribing compliance with the Veterans Affairs/Department of Defense treatment guidelines for chronic non-cancer pain (CNCP) in the primary care setting. We also determined the proportion of subjects who demonstrated aberrant drug-related behaviors (ADRBs) and the patient characteristics associated with them. DesignThis is a retrospective chart review. SettingPrimary care setting in Veterans Affairs Medical Center. SubjectsAll patients with CNCP between the ages of 18 and 87 years who received opioid prescriptions for 3 or more consecutive months during a 1-year period (July 2009 to August 2010) were eligible for inclusion. A random sample of 800 patients was selected using pharmacy prescription database. Chi-square test was utilized to analyze associations between ADRB and patient characteristics. ResultsAbout half the patients in our sample had a signed opioid pain care agreement (OPCA), and at least one urine drug test (UDT) was obtained. UDT was positive for an illicit drug/unreported opioid in 19.5% of the patients, and negative for the prescribed drug in 25.2% of the sample. About 10% of the sample population had morphine equivalent dose equal to or greater than 200mg/day. ADRBs were identified in 22.9% of the patients. Younger age, psychiatric comorbidities, history of substance abuse, and high opioid dose were associated with high risk of ADRB, but the presence of OPCA lowered the risk of ADRB. Conclusion
This article studied the prescribing practices of opioids in a primary care setting and can be used to enhance provider education regarding chronic pain guidelines.
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