Abstract:
BACKGROUND:Primary care physicians struggle to treat chronic noncancer pain while limiting opioid misuse, abuse, and diversion. The objective of this study was to understand how primary care physicians perceive their decisions to prescribe opioids in the context of chronic noncancer pain management. This question is important because interventions, such as decision support tools, must be designed based on a detailed understanding of how clinicians use information to make care decisions. METHODS:We conducted in-depth qualitative interviews with family medicine and general internal medicine physicians until reaching saturation in emergent themes. We used a funneling approach to ask a series of questions about physicians' general decision making challenges and use of information when considering chronic opioids. We then used an iterative, open-coding approach to identify and characterize themes in the data. RESULTS:We interviewed fifteen physicians with diverse clinical experiences, demographics, and practice affiliations. Physicians said that general decision making challenges in providing pain management included weighing risks and benefits of opioid therapies and time and resource constraints. Also, some physicians described their active avoidance of chronic pain treatment due to concerns about opioid risks. In their decision making, physicians described the importance of objective and consistent information, the importance of identifying "red flags" related to risks of opioids, the importance of information about physical function as an outcome, and the importance of information that engenders trust in patients. CONCLUSIONS:This study identified and described primary care physicians' struggles to deliver high quality care as they seek and make decisions based on an array of incomplete, conflicting, and often untrusted patient information. Decision support systems, education, and other interventions that address these challenges may alleviate primary care physicians' struggles and improve outcomes for patients with chronic pain and other challenging conditions.
journal_name
BMC Fam Practjournal_title
BMC family practiceauthors
Harle CA,Bauer SE,Hoang HQ,Cook RL,Hurley RW,Fillingim RBdoi
10.1186/s12875-015-0264-3subject
Has Abstractpub_date
2015-04-14 00:00:00pages
48issn
1471-2296pii
10.1186/s12875-015-0264-3journal_volume
16pub_type
杂志文章abstract:BACKGROUND:The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This st...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-13-71
更新日期:2012-07-25 00:00:00
abstract:BACKGROUND:The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if t...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-8-8
更新日期:2007-03-08 00:00:00
abstract::Multimorbidity is a growing issue and poses a major challenge to health care systems around the world. Multimorbidity is related to ageing but many studies have now shown that it is also socially patterned, being more common and occurring at an earlier age in areas of high socioeconomic deprivation. There is lack of r...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0344-4
更新日期:2015-10-14 00:00:00
abstract:BACKGROUND:Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to asse...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0299-5
更新日期:2015-07-22 00:00:00
abstract:BACKGROUND:An open, constructive safety culture is key in healthcare since it is seen as a main condition for patient safety. Studies have examined culture improvement strategies in hospitals. In primary care, however, not much is known about effective strategies to improve the safety culture yet. The purpose of this s...
journal_title:BMC family practice
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1186/1471-2296-14-127
更新日期:2013-08-29 00:00:00
abstract:BACKGROUND:Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we describe variation in prescr...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0224-y
更新日期:2015-01-29 00:00:00
abstract:BACKGROUND:It has for years been discussed whether practice staff should be involved in patient care in general practice to a higher extent. The research concerning task delegation within general practice is generally increasing, but the literature focusing on its influence on general practitioners' and their staff's j...
journal_title:BMC family practice
pub_type: 杂志文章,评审
doi:10.1186/s12875-016-0565-1
更新日期:2016-11-30 00:00:00
abstract:BACKGROUND:Scientific evidence for the frequency of monitoring of type 2 diabetes patients is lacking. If three-monthly control in general practice could be reduced to six-monthly control in some patients, this would on the one hand reduce the use of medical services including involvement of practice nurses, and thus r...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-11-35
更新日期:2010-05-11 00:00:00
abstract:BACKGROUND:Acceptance to a family practice is key to access and continuity of care. While Canadian patients increasingly report not being able to acquire acceptance to a family practice, little is known about the association between requiring opioids and acceptance. We aim to determine the proportion of family physicia...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1027-3
更新日期:2019-10-23 00:00:00
abstract:BACKGROUND:Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the Europea...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-170
更新日期:2013-11-14 00:00:00
abstract:BACKGROUND:Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture, molecular test or a rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the stud...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01129-6
更新日期:2020-03-26 00:00:00
abstract:BACKGROUND:Overweight, obesity and hypertension can be prevented through improvements in lifestyle including nutrition and physical activity. General practitioners (GPs) in Australia have access to over 90% of the population in the course of a year and therefore, the general practice setting may be ideal to assist pati...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-11-8
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Hypertension prevalence is high in China, while patients' levels of hypertension awareness, treatment and control are low. General practitioners' knowledge and training relating to hypertension prevention may be an important related factor. We aimed to investigate general practitioners' knowledge of hyperten...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-16
更新日期:2013-01-28 00:00:00
abstract:BACKGROUND:A variety of psychological interventions to treat depressive disorders have been developed and are used in primary care. In a systematic review, we compared the effectiveness of psychological treatments grouped by theoretical background, intensity of contact with the health care professional, and delivery mo...
journal_title:BMC family practice
pub_type: 杂志文章,meta分析,评审
doi:10.1186/s12875-015-0314-x
更新日期:2015-08-19 00:00:00
abstract:BACKGROUND:There is wide variation in the quality of care provided by primary care practices to individuals with chronic illnesses. Individual doctor attitudes and interest have been demonstrated to influence patient outcomes in some instances. Given the trend towards larger practices and part-time working, continuity ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-6-9
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:The prevalence of childhood obesity is rising and the UK Government have stated a commitment to addressing obesity in general. One method has been to include indicators relating to obesity within the GP pay-for-performance Quality and Outcomes Framework (QOF) contract. This study aimed to explore general pra...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-8-50
更新日期:2007-09-03 00:00:00
abstract:BACKGROUND:Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-015-0285-y
更新日期:2015-07-04 00:00:00
abstract:BACKGROUND:Depression is prevalent in people with type 2 diabetes and affects both glycemic control and overall quality of life. The aim of this trial was to evaluate the effect of the antidepressant paroxetine on metabolic control, quality of life and mental well-being in mildly depressed women with type 2 diabetes. ...
journal_title:BMC family practice
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1186/1471-2296-4-7
更新日期:2003-05-14 00:00:00
abstract:BACKGROUND:Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. METHODS:Internet based survey of 3081 primary care physicians, recruited via ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0529-5
更新日期:2016-09-08 00:00:00
abstract:BACKGROUND:People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an ...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-019-1042-4
更新日期:2019-11-08 00:00:00
abstract:BACKGROUND:Cluster randomized controlled trials are often used in research in primary care but creates challenges regarding biases and confounders. We recently presented a study on low back pain from primary care in Norway with equal effects in the intervention and the control group. In order to understand the specific...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12875-018-0759-9
更新日期:2018-05-22 00:00:00
abstract:BACKGROUND:There are a substantial number of instruments for primary-care clinicians to assess physical-activity (PA). However, there are few studies that have explored the views of clinicians regarding comparative acceptability and ease of use. A better understanding of how clinicians perceive instruments could help o...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0536-6
更新日期:2016-09-22 00:00:00
abstract:BACKGROUND:General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call ('K Doc'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy im...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-016-0484-1
更新日期:2016-07-21 00:00:00
abstract:BACKGROUND:General practitioners (GPs) and patients find it difficult to talk about risk of future disease, especially when patients have asymptomatic conditions, and treatment options are unlikely to cause immediate perceptible improvements in well-being. Further studies in risk communication training are needed. AIM...
journal_title:BMC family practice
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2296-11-70
更新日期:2010-09-22 00:00:00
abstract:BACKGROUND:Ultrasound imaging is utilized in Swiss primary care; however, little is known regarding the extent to which it is performed. With this study, we aim to (1) provide an overview of ultrasound use by general practitioners (GPs), and (2) determine the clinical indications of ultrasound in Swiss general practice...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-020-01209-7
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety me...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/s12875-018-0793-7
更新日期:2018-06-30 00:00:00
abstract:BACKGROUND:There is compelling evidence that there is substantial undetected vision loss amongst older people. Early recognition of undetected vision loss and timely referral for treatment might be possible within general practice, but methods of identifying those with unrecognised vision loss and persuading them to ta...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-14-99
更新日期:2013-07-16 00:00:00
abstract:BACKGROUND:The work of general practitioners (GPs) is increasingly being looked at from the perspective of the strategies and factors shaping it. This reflects the importance given to primary care services in health care system reform. However, the literature provides little insight into the medical decision-making pro...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-9-12
更新日期:2008-02-19 00:00:00
abstract:BACKGROUND:There are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregiver's situation has not been the subject of much evaluation. The aim of thi...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-12-19
更新日期:2011-04-15 00:00:00
abstract:BACKGROUND:Internationally, guidelines for depression recommend a stepped care approach, implying that antidepressant medication should not be offered as a first step treatment to patients with sub-threshold or mild depression. In the Netherlands, antidepressant prescribing rates in general practice as a first treatmen...
journal_title:BMC family practice
pub_type: 杂志文章
doi:10.1186/1471-2296-15-35
更新日期:2014-02-19 00:00:00