Physicians would prescribe opioids less often to patients at high risk for abuse if they had information that could help them identify these patients, a new study shows.
“It seemed to help simplify the decision making process,” said Alison Vargovich, PhD, from the Cleveland Clinic in Ohio.
Dr Vargovich presented the finding here at the American Pain Society (APS) 2015 Annual Scientific Meeting.
Primary care physicians often feel frustrated when dealing with patients who have chronic pain, she said. One reason is that they aren’t able to know which patients are most likely to abuse opioids, Dr Vargovich said. In the absence of good information about the risk for abuse, previous studies have shown that physicians fall back on assumptions based on demographic characteristics, such as the patient’s sex and age, she said.
When Dr Vargovich came to the West Virginia University Department of Family Medicine in Morgantown, she was looking for a way to reduce opioid prescription abuse.
“The point was to help new residents learn more about treating chronic pain and help them understand about other options,” she said.
So psychologists helped the department design a system for evaluating which patients with chronic pain were most likely to abuse opioids. They based it on risk factors identified by previous research. It combined a clinical interview with self-reports.
On the basis of these evaluations, the department sorted 151 patients into three levels of risk for abuse or misuse: low, moderate, and high.
“The physicians had this information going into the next appointment and that way they could decide whether to prescribe an opioid,” Dr Vargovich said.
Dr Vargovich and her colleagues wanted to know whether these evaluations really affected physicians’ decisions about prescribing.
The researchers found that the physicians were 4.22 times more likely to prescribe opioids if the patients were in a lower risk level: moderate instead of high, or low instead of moderate.
But they wondered whether other factors besides the risk level were affecting the physicians’ decisions.
They found that physicians were less likely to prescribe opioids to patients who had higher pain scores, a history of abuse, or higher scores on the Beck Depression Inventory II, the Pain Catastrophizing Scale, or the Screener and Opioid Assessment for Patients in Pain.
They were more likely to prescribe opioids to patients who were in a long-term relationship or had a higher level of education.
Demographic factors such as age and sex did not affect their prescriptions.
In a multivariate analysis, the researchers found that the patients’ risk level was still a key predictor of the physicians’ prescribing, even after adjusting for these other factors.
“This suggests that interdisciplinary care can have an impact on chronic pain treatment,” Dr Vargovich said.
“They didn’t need to spend the extra time,” she said. “They could read the evaluation and give the recommendations, and already have a lot of information going into the next appointment. This could increase physician availability, which obviously is very important in primary care medicine.”
Dr Vargovich said she is hoping to follow up with the patients to find out which ones ended up abusing opioids.
That’s a key point, session moderator Benedict J. Kolber, PhD, from Duquesne University in Pittsburgh, Pennsylvania said.
“I think any information is going to help physicians once it has been vetted,” he said. “You have to have hundreds of patients and hundreds of physicians to validate it to make sure it works not just in West Virginia but elsewhere.”
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