Doctor-Patient Trust Among Chronic Pain Patients on Chronic Opioid Therapy after Opioid Risk Reduction Initiatives: A Survey

Article Figures & Data

Table 1.

Questions Related to Trust and Management of Opiate Pain Medicines

Questions Asked Of Patients^*

I trust my doctor's judgment in managing my opiate pain medicine

I feel my doctor trusts me in how I manage my opiate pain medicine

I sometimes worry that my doctor will stop prescribing my opiate pain medicine

My doctor, pharmacist or other providers made sure I was well informed about potential problems with opiate pain medicines

↵* Response options were totally disagree, disagree, neutral, agree, and totally agree.

Table 2.

Key Components of Opioid Risk Reduction Initiatives and Selected Measures of Adherence to Risk Reduction Initiatives

Source	Intervention Clinics	Control Clinics
Washington State COT Guideline (enacted as law in March 2010)¹⁸
Check appropriateness of pain treatment	X	X
Screen for drug abuse and diversion	X	X
Group Health Opioid Risk Reduction Initiatives^18,20,50
Decrease COT dose (intervention clinic dose decreased from 74 mg MED to 46 mg MED versus control clinic decrease from 89 mg MED to 74 mg MED)	X
Online CME followed by 1-hour discussion in each intervention clinic (87% of primary care providers participated)	X
Medical staff leader advocacy	X
Designated physician to manage COT and expert consultation for physicians in each primary care clinic	X
Practice education tools (eg, patient education materials, care plan template, online calculator to estimate MED)	X
COT care plans documented in the EHR and financial incentive for completing the plans (documented care plans increased from 10% to over 80% over the course of the intervention)	X
Guideline-based monitoring visits and urine drug screening (urine drug screening increased from less than 15% in both intervention and control clinics to about 50% in the intervention clinics and less than 20% in the control clinics)	X
28-day-maximum opioid prescription and 5-day refill notice	X

COT, chronic opioid therapy; MED, morphine equvalent dose; CME, continuing medical education; EHR, electronic health record; X, component was used in these clinics.

Table 3.

Characteristics of Survey Respondents

	Intervention Clinics		Control Clinics		P value^*
	n	%	n	%	P value^*
Total	935		653
Age, y					.001
18 to 44	73	7.8	57	8.7
45 to 64	434	46.4	358	54.8
65+	428	45.8	238	36.4
Mean Age, y (SD)	63 (12)		61 (12)		.010
Female	589	63.0	420	64.3	.590
Non-Hispanic white	783	84.7	559	87.3	.147
At least some college	691	74.0	448	68.8	.025
Employment status					.008
Full time/part time	314	33.6	223	34.2
Disabled	182	19.5	170	26.0
Retired	410	43.9	245	37.5
Other	28	3.0	15	2.3
Married (or living as married)	615	65.9	438	67.2	.601
Lives in western Washington	693	74.1	358	54.8	<.001
Mental health disorders (dx in past 36 months)	623	66.6	423	64.8	.444
Alcohol use disorder (dx in past 36 months, not in remission)	50	5.3	32	4.9	.692
Nonopioid drug use disorder (dx in past 36 months)	89	9.5	34	5.2	.002
Opioid drug use disorder (dx in past 36 months)	101	10.8	76	11.6	.602
Tobacco use disorder (dx in past 36 months)	224	24.0	151	23.1	.701
Charlson comorbidity score (based on past 12 months)					.030
0	426	45.6	307	47.0
1 to 2	219	23.4	180	27.6
3+	290	31.0	166	25.4
Average COT dose (in prior quarter)					<.001
<15 mg	232	24.8	96	14.7
15 to <50 mg	432	46.2	296	45.3
50 to <120 mg	199	21.3	150	23.0
120+ mg	72	7.7	111	17.0
Mean # days of opioid use (in prior month) (SD)	29 (3)		29 (3)		.269
Mean PEG score (SD)	5.8 (2.2)		5.9 (2.1)		.708
Helpfulness of COT					.510
Not at all or a little helpful	57	6.1	43	6.6
Moderately helpful	302	32.3	193	29.6
Very or extremely helpful	576	61.6	416	63.8
Bothersomeness of COT					.283
Not at all or a little bothersome	808	86.7	547	84.2
Moderately bothersome	99	10.6	86	13.2
Very or extremely bothersome	25	2.7	17	2.6

Some data were missing for race/ethnicity (1.5%), education (0.2%), employment (0.06%), marital status (0.2%), PEG score (0.8%), perceived helpfulness (0.1%), and bothersomeness (0.4%) of COT.
Counts and percentages in this table describe the survey respondents only and are not weighted to account for nonresponse.
↵* P values are based on χ² tests (for categorical variables) or t tests (for continuous variables) for whether the distributions of the given characteristics differ between survey respondents in the intervention and control clinics.
COT, chronic opioid therapy; dx, diagnosis; PEG, pain, enjoyment, and general activity.
SD, standard deviation.

Table 4.

Distribution of Trust and Related Characteristics among Survey Responders, with Percentages Weighted to Account for Nonresponse

	Intervention Clinics		Control Clinics		χ²P value^*
	n	%^{^†}	n	%^{^†}	χ²P value^*
Total sample	935		653
Trust doctor's judgment in managing medications^{^‡}					.002
Totally disagree	15	1.9	6	0.9
Disagree	60	6.9	27	4.4
Neutral	122	13.3	59	8.4
Agree	308	33.2	218	33.9
Totally agree	426	44.7	341	52.4
Believe doctor trusts patient in managing medications^{^‡}					.002
Totally disagree	10	1.4	9	1.3
Disagree	41	4.4	13	1.9
Neutral	72	7.9	34	5.8
Agree	308	32.8	186	27.8
Totally agree	501	53.4	410	63.3
Sometimes worry doctor will stop prescribing opioids^{^‡}					.007
Totally disagree	223	23.7	196	29.8
Disagree	270	29.1	209	32.3
Neutral	163	17.9	97	16.0
Agree	175	19.1	102	15.1
Totally agree	92	10.2	42	6.7
Believe health care team made sure patient was well informed about potential problems with opioids^{^‡}					.924
Totally disagree	7	0.8	8	1.2
Disagree	15	1.6	11	1.7
Neutral	41	4.3	32	4.3
Agree	318	33.7	209	32.1
Totally agree	553	59.6	391	60.7

↵* P values are based on χ² tests of whether the distributions of responses across the 5 categories for each question differ between participants in the intervention and control clinics after weighting for nonresponse.
↵† While n's represent the raw counts, the computed percentages are based on weighting to account for nonresponse.
↵‡ The proportion with missing data for each of the four questions were 0.4%, 0.3%, 1.2%, and 0.2%, respectively.