An institutional ethnography of chronic pain management in family medicine (COPE) study protocol

Abstract

BackgroundPatients with chronic conditions and multiple comorbidities represent a growing challenge for health care globally. Improved coordination of care is considered essential for providing more effective and cost-efficient care for these patients with complex needs. Osteoarthritis is one of the most common and debilitating chronic conditions, is the most frequent cause of chronic pain yet osteoarthritis care is often poorly-coordinated. Primary care is usually the first contact for patients requiring relief from chronic pain. Our previous work suggests discordance between the policy goals of improving patient care and the experience of osteoarthritis patients. We plan to investigate the empirical context of the primary care setting by focusing on primary physicians’ conceptualizations and performance of their work in treating complex patients with chronic pain. This will allow for an exploration of how primary health care is – or could be – integrated with other services that play an important role in health care delivery.MethodsOur study is an Institutional Ethnography of pain management in family medicine, to be carried out in three phases over 3 years from 2014/15 to 2018. Over the first year we will undertake approximately 80 key informant interviews with primary care physicians, other health care providers, policymakers and clinical experts. In the second year we will focus on mobilizing our networks from year one to assist in the collection of key texts which shape the current context of care. These texts will be analyzed by the research team. In the final year of the study we will focus on synthesizing our findings in order to map the social relations informing care. As is standard and optimal in qualitative research, analysis will be concurrent with data collection.DiscussionOur study will allow us to identify how the work of coordinating care across multiple settings is accomplished, in practice as well as discursively and textually. Ultimately, we will identify links between everyday experience of care for patients with chronic pain, and broader discourses related to health care system inefficiencies, integration and patient-centred care. An expected outcome of this study will be the development of new, or augmentation of existing, models of care, that are based in the local realities of primary care practice.

From Opiophobia to Overprescribing: A Critical Scoping Review of Medical Education Training for Chronic Pain

“…As part of a larger ethnographic study of Chronic Pain Management in Family Medicine (COPE) [ 12 ] funded by the Canadian Institutes for Health Research, we set out to describe the current literature on chronic pain management training in undergraduate and postgraduate medical education. Going beyond typical scoping review methodologies that “map” the literature and identify gaps [ 13 , 14 ], we took a critical approach to scoping the literature, using a historical lens and bringing in theoretical concepts to arrive at a more contextual understanding of the body of literature we explored.…”

Ethnography in health professions education: Slowing down and thinking deeply

“…This interpretation of triangulation adopts the view that a single truth (or close to it) about the phenomenon can be found and enhanced by studying the phenomenon from multiple perspectives, which is a positivistic claim. By contrast, one of the strengths of ethnography is that it can highlight the nuances and differences that exist around a particular phenomenon from different stakeholders’ perspectives . (p. 183‐4) From this perspective, collecting data from multiple sources helps develop analytical insights between individuals or social groups, which is aligned with the subjective epistemology of ethnography.…”

“…By contrast, one of the strengths of ethnography is that it can highlight the nuances and differences that exist around a particular phenomenon from different stakeholders' perspectives. 22,34,37,38 (p. 183-4) From this perspective, collecting data from multiple sources helps develop analytical insights between individuals or social groups, which is aligned with the subjective epistemology of ethnography.…”

Blurring the boundaries: using institutional ethnography to inquire into health professions education and practice

“…42,43 We concur with the argument for a nuanced approach to show how education impacts practice, and suggest that, as the boundaries of HPE become clearer and firmer with the field's legitimation, 29,44 opportunities to blur boundaries can be productive and achieved through IE. 45 As is the case in the formation of interdisciplinary fields, HPE has gained the ability to set boundaries for what constitutes HPE scholarship. 46 We thus suggest that a conceptual dichotomy of research belonging to the clinical practice world and research belonging to the HPE world is simultaneously productive and unnecessary.…”