Veterans Affairs Primary Care Clinicians’ Attitudes toward Chronic Pain and Correlates of Opioid Prescribing Rates

Authors

  • Steven K. Dobscha MD,

    Corresponding author
    1. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon;
    2. Department of Psychiatry, Oregon Health and Science University, Portland, Oregon;
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  • Kathryn Corson PhD,

    1. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon;
    2. Department of Psychiatry, Oregon Health and Science University, Portland, Oregon;
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  • Jennifer A. Flores MA,

    1. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon;
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  • Erin C. Tansill BS,

    1. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon;
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  • Martha S. Gerrity MD, MPH

    1. Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon;
    2. Department of Medicine, Oregon Health and Science University, Portland, Oregon;
    3. Division of Hospital and Specialty Medicine, Portland VA Medical Center, Portland, Oregon, USA
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Steven K. Dobscha, MD, Portland VA Medical Center, PO Box 1034 (R&D-66), Portland, OR 97207, USA. Tel: 503-220-8262 × 156444; Fax: 503-273-5060; E-mail: steven.dobscha@va.gov.

ABSTRACT

Objectives.  The primary objective of this study was to identify veterans affairs (VA) primary care clinicians’ attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates.

Design.  Cross-sectional study of clinician survey and pharmacy data.

Participants.  Forty-five VA clinicians from five primary care clinics of one VA medical center.

Measures.  Survey of pain-related attitudes and behaviors, satisfaction with treatment resources, and job satisfaction; percentage of patients in clinicians’ panels prescribed opioids (PCPO).

Results.  Seventy-one percent of clinicians felt moderately or strongly confident in their ability to treat chronic pain, and 77% moderately or strongly agreed that skilled pain management is a high priority. However, 73% moderately or strongly agreed that patients with chronic pain are a major source of frustration and 38% reported moderate or greater dissatisfaction with their ability to provide optimal pain treatment. Fifty-two percent moderately or strongly agreed that their management is influenced by previous experiences with patients addicted to drugs. The mean PCPO was 16.5% (SD = 6.7). In bivariate comparisons, clinician panel size, job and resource satisfaction, and professional training were associated with opioid prescribing rates.

Conclusion.  High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.

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