The Hospitalist Perspective on Opioid Prescribing: A Qualitative Analysis

被引:20
作者
Calcaterra, Susan L. [1 ,2 ]
Drabkin, Anne D. [1 ,2 ]
Leslie, Sarah E. [3 ]
Doyle, Reina [3 ]
Koester, Stephen [4 ,5 ]
Frank, Joseph W. [2 ,6 ]
Reich, Jennifer A. [7 ]
Binswanger, Ingrid A. [1 ,2 ,8 ]
机构
[1] Denver Hlth Med Ctr, Dept Hosp Med, Denver, CO USA
[2] Univ Colorado, Sch Med, Div Gen Internal Med, Dept Med, Aurora, CO USA
[3] Denver Hlth Med Ctr, Ctr Hlth Syst Res, Denver, CO USA
[4] Univ Colorado, Dept Anthropol, Denver, CO 80202 USA
[5] Univ Colorado Denver, Dept Hlth & Behav Sci, Denver, CO USA
[6] VA Eastern Colorado Hlth Care Syst, Denver, CO USA
[7] Univ Colorado, Dept Sociol, Denver, CO 80202 USA
[8] Kaiser Permanente Colorado, Inst Hlth Res, Denver, CO USA
基金
美国国家卫生研究院;
关键词
HEALTH-CARE; PATIENT SATISFACTION; MEDICAL LITERATURE; NEGATIVITY BIAS; USERS GUIDES; PAIN; PHYSICIANS; DISCHARGE; COMMUNICATION; PREVALENCE;
D O I
10.1002/jhm.2602
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals, and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered, and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. OBJECTIVE: We aimed to understand physicians' attitudes, beliefs, and practices toward opioid prescribing during hospitalization and discharge. DESIGN: In-depth, semistructured interviews. SETTING: Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. PARTICIPANTS: Hospitalists (N = 25). MEASUREMENTS: We systematically analyzed transcribed interviews and identified emerging themes using a teambased mixed inductive and deductive approach. RESULTS: Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction whenmanaging acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events that altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. CONCLUSIONS: Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed. (C) 2016 Society of Hospital Medicine
引用
收藏
页码:536 / 542
页数:7
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