TY - JOUR
KW - Analgesics, Opioid/adverse effects/standards
KW - Chronic Pain/therapy
KW - Decision Support Systems, Clinical/organization & administration
KW - Drug Prescriptions/standards
KW - Female
KW - Humans
KW - intersectoral collaboration
KW - Male
KW - Military Health Services/standards
KW - opioid epidemic
KW - Pain Management/methods
KW - Patient Education as Topic/organization & administration
KW - Practice Patterns, Physicians'/organization & administration/standards
KW - Prescription Drug Misuse/prevention & control
KW - Prescription Drug Monitoring Programs/organization & administration/standards
KW - Primary Health Care/organization & administration/standards
KW - Qualitative Research
KW - United States/epidemiology
KW - United States Department of Veterans Affairs/organization & administration/standards
AU - E. P. Finley
AU - S. Schneegans
AU - M. E. Curtis
AU - V. S. Bebarta
AU - J. K. Maddry
AU - L. Penney
AU - D. McGeary
AU - J. S. Potter
A1 - 
AB - BACKGROUND: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE: We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN: We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS: Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH: Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS: Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS: Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.
AD - UT Health San Antonio, San Antonio, Texas, United States of America.; South Texas Veterans Health Care System, San Antonio, Texas, United States of America.; UT Health San Antonio, San Antonio, Texas, United States of America.; UT Health San Antonio, San Antonio, Texas, United States of America.; University of Colorado School of Medicine, Aurora, CO, United States of America.; Emergency Department, Brooke Army Medical Center, San Antonio, Texas, United States of America.; 59th Medical Wing Science and Technology Cell, San Antonio, Texas, United States of America.; San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, United States of America.; UT Health San Antonio, San Antonio, Texas, United States of America.; South Texas Veterans Health Care System, San Antonio, Texas, United States of America.; UT Health San Antonio, San Antonio, Texas, United States of America.; UT Health San Antonio, San Antonio, Texas, United States of America.
BT - PloS one
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 6
DO - 10.1371/journal.pone.0234425
IS - 6
JF - PloS one
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE: We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN: We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS: Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH: Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS: Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS: Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.
PY - 2020
SN - 1932-6203; 1932-6203
T1 - Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts
T2 - PloS one
TI - Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 32542028
U3 - 10.1371/journal.pone.0234425
VL - 15
VO - 1932-6203; 1932-6203
Y1 - 2020
Y2 - Jun 15
ER -