eScholarship@UMMS

Title

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

Authors

William C. Becker, Yale School of Medicine
Kristin M. Mattocks, University of Massachusetts Medical SchoolFollow
Joseph W. Frank, University of Colorado School of Medicine
Matthew J. Bair, Indiana University School of Medicine
Rebecca L. Jankowski, VA Central Western Massachusetts Healthcare System
Robert D. Kerns, Yale School of Medicine
Jacob T. Painter, University of Arkansas for Medical Sciences
Brenda T. Fenton, VA Connecticut Healthcare System
Amanda M. Midboe, VA Palo Alto Health Care System
Steve Martino, Yale School of Medicine

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date

2018-03-08

Document Type

Article

Disciplines

Health Services Administration | Health Services Research | Military and Veterans Studies | Pain Management | Primary Care | Substance Abuse and Addiction

Abstract

INTRODUCTION: Opioid prescribing and subsequent rates of serious harms have dramatically increased in the past two decades, yet there are still significant barriers to reduction of risky opioid regimens. This formative evaluation utilized a mixed-methods approach to identify barriers and factors that may facilitate the successful implementation of Primary Care-Integrated Pain Support (PIPS), a clinical program designed to support the reduction of risky opioid regimens while increasing the uptake of non-pharmacologic treatment modalities.

METHODS: Eighteen Department of Veterans Affairs (VA) employees across three sites completed a survey consisting of the Organizational Readiness for Implementing Change (ORIC) scale; a subset of these individuals (n=9) then completed a semi-structured qualitative phone interview regarding implementing PIPS within the VA. ORIC results were analyzed using descriptive statistics while interview transcripts were coded and sorted according to qualitative themes.

RESULTS: Quantitative analysis based on ORIC indicated high levels of organizational readiness to implement PIPS. Interview analysis revealed several salient themes: system-level barriers such as tension among various pain management providers; patient-level barriers such as perception of support and tension between patient and provider; and facilitating factors of PIPS, such as the importance of the clinical pharmacist role.

CONCLUSIONS: While organizational readiness for implementing PIPS appears high, modifications to our implementation facilitation strategy (e.g., establishing clinical pharmacists as champions; marketing PIPS to leadership as a way to improve VA opioid safety metrics) may improve capacity of the sites to implement PIPS successfully.

Keywords

Chronic pain, Formative evaluation, Implementation science, Mixed-methods, Opioid

DOI of Published Version

10.1016/j.addbeh.2018.03.009

Source

Addict Behav. 2018 Mar 8. pii: S0306-4603(18)30120-5. doi: 10.1016/j.addbeh.2018.03.009. Link to article on publisher's site

Journal/Book/Conference Title

Addictive behaviors

PubMed ID

29576479

Related Resources

Link to Article in PubMed

Repository Citation

Becker WC, Mattocks KM, Frank JW, Bair MJ, Jankowski RL, Kerns RD, Painter JT, Fenton BT, Midboe AM, Martino S. (2018). Mixed methods formative evaluation of a collaborative care program to decrease risky opioid prescribing and increase non-pharmacologic approaches to pain management. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.addbeh.2018.03.009. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1182