Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

Abstract

Objectives: Most patients with chronic non-cancer pain (CNCP) are cared for, by primary care providers (PCPs). While some of the barriers faced by PCPs have been described, there is little information about PCPs' experience with factors that facilitate CNCP care. Design:The study design was descriptive and qualitative. Data were analyzed using qualitative content analysis. Krippendorff's thematic clustering technique was used to identify the repetitive themes regarding PCPs' experiences related to CNCP management. Subjects:Respondents were PCPs (n=45) in the VA Connecticut Healthcare System in two academically affiliated institutions and six community based sites.Results: Eleven themes were identified across systems, personal/professional, and interpersonal domains. Barriers included inadequate training, organizational impediments, clinical quandaries and the frustrations that accompany them, issues related to share care among PCPs and specialists, antagonistic aspects of provider-patient interactions, skepticism, and time factors. Facilitators included the intellectual satisfaction of solving difficult diagnostic and management problems, the ability to develop keener communication skills, the rewards of healing and building therapeutic alliances with patients, universal protocols, and the availability of complementary and alternative medicine resources and multidisciplinary care. Conclusion:PCPs experience substantial difficulties in caring for patients with pain while acknowledging certain positive aspects. There is a need for strategies that mitigate the barriers to pain management while bolstering the positive aspects to improve care and provider satisfaction.

Hearing New Voices: Registered Nurses and Health Technicians Experience Caring for Chronic Pain Patients in Primary Care Clinics

“…Another perceived barrier isolated by our analyses relates to the interpersonal challenges associated with delivering pain care; specifically, difficult staff - patient interactions. Many of the barriers identified by this study parallels data from our earlier researchof PCP's in the same healthcare network [11]. Our findings suggest that, similar to primary providers, PCC RNs need training and support in areas of pain assessment, pharmacology, specifically opioid management, and the role on non-pharmacologic interventions to address these practice deficits.…”

A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management

“…We employed mixed qualitative and quantitative methods to evaluate these quality improvement efforts on key processes and outcomes, and to inform the sustainable quality improvement approach. 22 While results of the qualitative evaluations have been reported elsewhere, [23][24][25] in this report, we focus on implementation efforts related to opioid safety, given the importance and timeliness of the topic with respect to public health and because this objective was prioritized by our VHA partners. Here we report solely on quantitative outcomes of primary care provider behavior based on the VHA electronic health record (EHR).…”

“…[23][24][25] Consistent with published recommendations 21,26 , a multifaceted, partnered approach to promote organizational improvements was identified and enacted. Although a comprehensive discussion of the initiatives undertaken is beyond the scope of this paper, we summarize initiatives that are most relevant to improving care among patients receiving long-term OT for chronic pain.…”

Mixed methods formative evaluation of a collaborative care program to decrease risky opioid prescribing and increase non-pharmacologic approaches to pain management

“…This theme has emerged in complementary qualitative studies of VA primary care providers' and nurses' attitudes about pain care. [23,24] In response to this challenge, the PIPS facilitation team increased efforts to engage facility leadership to emphasize the importance of collaboration among various disciplines to reach important VA healthcare system goals. For example, the external facilitator worked with the site-based internal facilitators and champions about marketing PIPS as a path to help facilities comply with the Opioid Safety Initiative, a directive from VA's Central Office to monitor and improve several metrics of opioid safety.…”