Article Figures & Data
Figures
- Figure 1.
Effects of Office Score on perceived opioid efficacy and burden for opioid prescribing clinicians. Clinicians were assigned one point for use of each of five office systems: Pain Assessment Tool, Controlled Substance Agreement (Narcotic Contract), Refill Policy, Prescription log, and Urine Drug Screening.
Tables
- Table 1.
Characteristics of Clinicians Participating in the Survey (N = 497), Including Comparison of Those Responding to Either the Long-Version Survey or the Short Version*
Participants P Value Total Form Long Short Network SF Bay CRN 134 (27.0%) 118 (27.6%) 16 (22.9%) <.001 SERCN 24 (4.8%) 17 (4.0%) 7 (10.0%) BIGHORN 42 (8.5%) 38 (8.9%) 4 (5.7%) CaReNet 93 (18.7%) 87 (20.4%) 6 (8.6%) RIOS Net 125 (25.2%) 117 (27.4%) 8 (11.4%) SPUR-Net 79 (15.9%) 50 (11.7%) 29 (41.4%) Geographic setting Small town, ≤ 25K pop. 79 (16.8%) 74 (18.4%) 5 (7.2%) .05 Medium town, > 25K pop. 40 (8.5%) 36 (9.0%) 4 (5.8%) City 100K–500K pop. 54 (11.5%) 45 (11.2%) 9 (13.0%) Urban/Suburban > 500K pop. 134 (28.5%) 116 (28.9%) 18 (26.1%) Urban inner city > 500K pop. 164 (34.8%) 131 (32.6%) 33 (47.8%) Clinic type Community health center 200 (42.2%) 169 (41.7%) 31 (44.9%) .03 Indian health service 34 (7.2%) 34 (8.4%) 0 (0.0%) Solo practitioner 23 (4.9%) 21 (5.2%) 2 (2.9%) University practice 125 (26.4%) 101 (24.9%) 24 (34.8%) Other group practice 92 (19.4%) 80 (19.8%) 12 (17.4%) Clinician training MD 402 (85.0%) 339 (83.9%) 63 (91.3%) .75 DO 14 (3.0%) 13 (3.2%) 1 (1.4%) NP 24 (5.1%) 22 (5.4%) 2 (2.9%) PA 31 (6.6%) 28 (6.9%) 3 (4.3%) Other degree 2 (0.4%) 2 (0.5%) 0 (0.0%) Years since completed training N/A 29 (6.2%) 25 (6.2%) 4 (5.8%) .85 <5 years 77 (16.3%) 65 (16.2%) 12 (17.4%) 5 to 10 years 101 (21.4%) 83 (20.6%) 18 (26.1%) 11 to 20 years 145 (30.8%) 125 (31.1%) 20 (29.0%) >20 years 119 (25.3%) 104 (25.9%) 15 (21.7%) -
↵* Totals for some demographic characteristics do not equal 497 because of missing data.
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SF Bay CRN, San Francisco Bay Area Collaborative Research Network; SERCN, Southeast Regional Clinicians' Network; BIGHORN, Health Outcomes Research Network; CaReNet Colorado Research Network; RIOS Net, Research Involving Outpatient Setting Network; SPUR-Net, Southern Primary Care Urban Research Network; MD, doctor of medicine; DO, doctor of osteopathy; NP, nurse practioner; PA, physician assistant.
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Total Number of Respondents Total Positive Responses, n (%) 1. Many barriers exist to the treatment of CNCP, including many uncertainties in optimal management Behavioral health care not financially accessible to CNCP patients* (% yes) 426 199 (47%) Substance abuse counselor not financially accessible to CNCP patients* (% yes) 421 143 (34%) Pain specialist not financially accessible to CNCP patients* (% yes) 422 172 (41%) Complementary/alternative medicine providers (e.g., acupuncture, herbalists) not financially accessible to CNCP patients* (% yes) 421 190 (45%) Need for more CNCP continuing medical education (% agree/strongly agree) 468 204 (44%) Long-acting opioids are over-utilized for many CNCP patients in my community (% agree/strongly agree) 489 212 (43%) Long-acting opioids are under-utilized for many CNCP patients in my community (% agree/strongly agree) 489 152 (31%) 2. For many patients, CNCP is a complex biopsychosocial condition for which a multidisciplinary approach is needed Experience discomfort in managing CNCP because of: (% some/moderate/much discomfort) Patient behavioral health issues* 400 383 (96%) Lack of a defined mechanism of pain* 406 371 (91%) Lack of full work-up for cause of pain* 406 377 (93%) Observe common reasons for uncontrolled pain in CNCP patients: (% agree/strongly agree) Depression, anxiety, other mental health disorders 469 439 (94%) Alcohol or other substance use disorders 467 354 (76%) Poor coping skills for pain 469 402 (86%) Poor coping skills for other life stressors* 401 371 (93%) Use massage therapy (% ever used) 486 379 (78%) Use acupuncture (% ever used) 486 354 (73%) Find cognitive behavioral therapy helpful (% somewhat/very helpful) 490 330 (67%) Find biofeedback, meditation, or relaxation therapy helpful (% somewhat/very helpful) 491 306 (62%) 3. Prescription opioid abuse is a serious problem Report patients ever divert opioids (% yes) 489 341 (70%) Report having had patients with severe adverse event due to CNCP opioid use (unintentional life-threatening event or death, or suicide) (% yes) 489 161 (33%) Prescribing opioids limited by (% sometimes/frequently) Concern over opioid side effects* 412 329 (80%) Concern over development of dependence* 415 292 (70%) Concern over development of addiction* 415 356 (86%) Concern over malingering/secondary gain* 416 320 (77%) Prescribe long-acting opioids No 484 75 (15%) Don't initiate but continue Rx prescribed by others 484 80 (17%) Initiate and continue 484 329 (68%) 4. Significant effort is required to properly assess for efficacy, side effects, and aberrant drug related behavior related to chronic opioid treatment Report burden to self in managing CNCP (% fair/large/biggest burden) 497 400 (80%) Report burden to practice in managing CNCP (% fair/large/biggest burden) 496 436 (88%) Report being “troubled” prescribing long-acting opioids for: (% yes) Chronic neck/back pain without defined mechanism* 400 236 (59%) Chronic headaches* 400 238 (60%) Chronic pelvic pain* 400 201 (50%) Chronic abdominal pain* 400 221 (55%) Use practice systems for CNCP management: (% yes) Use controlled substance agreements 472 407 (86%) Use urine drug screens 470 307 (65%) Use CNCP monitoring tool 474 104 (22%) 5. Perceived benefits of opioids to some patients and commitment to their patients influences clinicians to continue View CNCP as important clinical problem (% agree/strongly agree) 495 471 (95%) Concerned about poor quality of life for CNCP patients due to pain* (% agree/strongly agree) 414 401 (97%) Concerned that many CNCP patients receive inadequate pain control* (% agree/strongly agree) 412 266 (65%) Concerned about uncontrolled pain due to lack of access to resources (% agree/strongly agree) 469 343 (73%) Report benefit from patient education (e.g., handouts, web links) (% yes) 493 359 (73%) Report some CNCP patients benefit from opioid treatment* (% yes) 405 316 (78%) -
↵* Question included on long-form version of survey only.
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† Number of respondents does not match total sample because of missing data.
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CNPC, chronic non-cancer pain.
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