Barriers to Using Nonpharmacologic Approaches and Reducing Opioid Use in Primary Care

Published in: Pain Medicine, [Epub October 2017]. doi: 10.1093/pm/pnx220

Posted on RAND.org on December 14, 2017

by Karleen F. Giannitrapani, Sangeeta C. Ahluwalia, Matthew McCaa, Maura Pisciotta, Steven Dobscha, Karl Lorenz

Read More

Access further information on this document at Pain Medicine

This article was published outside of RAND. The full text of the article can be found at the link above.

Background

Opioid prescribing for chronic pain, including the potential for over-reliance and misuse, is a public health concern.

Objective

In the context of Veterans Administration (VA) primary care team-based pain management, we aimed to understand providers' perceptions of barriers to reducing opioid use and improving the use of nonpharmacologic pain management therapies (NPTs) for chronic pain.

Design

A semistructured interview elucidated provider experiences with assessing and managing pain. Emergent themes were mapped to known dimensions of VA primary care access.

Subjects

Informants included 60 primary care providers, registered nurses, licensed practical nurses, clerks, psychologists, and social workers at two VA Medical Centers. METHODS: Nine multidisciplinary focus groups.

Results

Provider perceptions of barriers to reducing opioids and improving use of NPTs for patients with chronic pain clustered around availability and access. Barriers to NPT access included the following subthemes: geographical (patient distance from service), financial (out-of-pocket cost to patient), temporal (treatment time delays), cultural (belief that NPTs increased provider workload, perception of insufficient training on NPTs, perceptions of patient resistance to change, confrontation avoidance, and insufficient leadership support), and digital (measure used for pain assessment, older patients hesitant to use technology, providers overwhelmed by information).

Conclusions

Decreasing reliance on opioids for chronic pain requires a commitment to local availability and provider-facing strategies that increase efficacy in prescribing NPTs. Policies and interventions for decreasing utilization of opioids and increasing use of NPTs should comprehensively consider access barriers.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.