M. P. Klueh1, J. S. Lee1, K. R. Sloss1, L. A. Dossett1, M. J. Englesbe1, C. M. Brummett2, J. F. Waljee1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Department Of Anesthesiology,Ann Arbor, MI, USA
Introduction:
Persistent opioid use is common following surgery, even among previously opioid-naïve patients. To date, it remains unclear how clinicians coordinate opioid prescribing for patients who require ongoing opioid analgesics after routine postoperative care is complete. To better understand these transitions of care, we conducted a qualitative study of surgeons and primary care physicians to describe practices and barriers for opioid prescribing in surgical patients who develop new persistent opioid use.
Methods:
We conducted face-to-face interviews with 11 physicians at a single academic healthcare system using a semi-structured interview guide. Participants were comprised of surgeons (n=4 resident surgeons; n=4 attending surgeons) and primary care physicians (n=3 attending physicians). We developed open-ended questions to describe the clinical course of patients after surgery, practices and attitudes for postoperative opioid prescribing, and the transition to chronic pain management. Interviews (15 – 30 minutes) were audiotaped, transcribed verbatim, and independently coded for a priori and emergent themes using the constant comparative method. Open and axial coding were applied using narrative analysis.
Results:
Table 1 summarizes key themes in transitions of care for postoperative opioid prescribing. Participants reported a wide range of underlying causes for the need to transition patients to chronic pain management, including provider confidence, signs of addiction, and time from operation. Practices for transitioning care ranged from passive transitions with no closed loop communication, to active transitions with continued follow-up to ensure the patient had transitioned to another physician for pain management. Barriers to transitioning care included a lack of standardized practices, lack of time, and limited access to pain specialists.
Conclusion:
Surgeons and primary care physicians describe varying practices and barriers for transitions of care in patients who develop new persistent opioid use after surgery. These findings may help identify interventions to improve coordination of care for these vulnerable patients.
