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Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: A Qualitative Interview Study.
J Emerg Med. 2019 Jan; 56(1):15-22.JE

Abstract

BACKGROUND

Ohio has the fifth highest rate of prescription opioid overdose deaths in the United States. One strategy implemented to address this concern is a state-wide opioid prescribing guideline in the emergency department (ED).

OBJECTIVE

Our aim was to explore emergency physicians' perceptions on barriers and strategies for the Ohio ED opioid prescribing guideline.

METHODS

Semi-structured interviews with emergency physicians in Ohio were conducted from October to December 2016. Emergency physicians were recruited through the American College of Emergency Physicians Ohio State Chapter. The interview guide explored issues related to the implementation of the guidelines. Interview data were transcribed and thematically analyzed and coded using a scheme of inductively determined labels.

RESULTS

In total, we conducted 20 interviews. Of these, 11 were also the ED medical director at their institution. Main themes we identified were: 1) increased organizational responsibility, 2) improved prescription drug monitoring program (PDMP) integration, 3) concerns regarding patient satisfaction scores, and 4) increased patient involvement. In addition, some physicians wanted the guidelines to contain more clinical information and be worded more strongly against opioid prescribing. Emergency physicians felt patient satisfaction scores were perceived to negatively impact opioid prescribing guidelines, as they may encourage physicians to prescribe opioids. Furthermore, some participants reported that this is compounded if the emergency physicians' income was linked to their patient satisfaction score.

CONCLUSIONS

Emergency physicians interviewed generally supported the state-wide opioid prescribing guideline but felt hospitals needed to take additional organizational responsibility for addressing inappropriate opioid prescribing.

Authors+Show Affiliations

The University of Sydney School of Pharmacy, Camperdown, New South Wales, Australia.James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio.James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio.Boston University Law School, Boston, Massachusetts.Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, West Virginia.McMicken College of Arts and Science, University of Cincinnati, Cincinnati, Ohio.James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio.James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio.Ohio Department of Health, Columbus, Ohio.Ohio Department of Health, Columbus, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30342861

Citation

Penm, Jonathan, et al. "Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: a Qualitative Interview Study." The Journal of Emergency Medicine, vol. 56, no. 1, 2019, pp. 15-22.
Penm J, MacKinnon NJ, Connelly C, et al. Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: A Qualitative Interview Study. J Emerg Med. 2019;56(1):15-22.
Penm, J., MacKinnon, N. J., Connelly, C., Mashni, R., Lyons, M. S., Hooker, E. A., Winstanley, E. L., Carlton-Ford, S., Tolle, E., Boone, J., Koechlin, K., & Defiore-Hyrmer, J. (2019). Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: A Qualitative Interview Study. The Journal of Emergency Medicine, 56(1), 15-22. https://doi.org/10.1016/j.jemermed.2018.09.005
Penm J, et al. Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: a Qualitative Interview Study. J Emerg Med. 2019;56(1):15-22. PubMed PMID: 30342861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency Physicians' Perception of Barriers and Facilitators for Adopting an Opioid Prescribing Guideline in Ohio: A Qualitative Interview Study. AU - Penm,Jonathan, AU - MacKinnon,Neil J, AU - Connelly,Chloe, AU - Mashni,Rebecca, AU - Lyons,Michael S, AU - Hooker,Edmond A, AU - Winstanley,Erin L, AU - Carlton-Ford,Steve, AU - Tolle,Erica, AU - Boone,Jill, AU - Koechlin,Kathleen, AU - Defiore-Hyrmer,Jolene, Y1 - 2018/10/17/ PY - 2018/05/09/received PY - 2018/08/02/revised PY - 2018/09/01/accepted PY - 2018/10/22/pubmed PY - 2019/5/8/medline PY - 2018/10/22/entrez KW - Ohio KW - emergency KW - guidelines KW - opioid KW - prescribing SP - 15 EP - 22 JF - The Journal of emergency medicine JO - J Emerg Med VL - 56 IS - 1 N2 - BACKGROUND: Ohio has the fifth highest rate of prescription opioid overdose deaths in the United States. One strategy implemented to address this concern is a state-wide opioid prescribing guideline in the emergency department (ED). OBJECTIVE: Our aim was to explore emergency physicians' perceptions on barriers and strategies for the Ohio ED opioid prescribing guideline. METHODS: Semi-structured interviews with emergency physicians in Ohio were conducted from October to December 2016. Emergency physicians were recruited through the American College of Emergency Physicians Ohio State Chapter. The interview guide explored issues related to the implementation of the guidelines. Interview data were transcribed and thematically analyzed and coded using a scheme of inductively determined labels. RESULTS: In total, we conducted 20 interviews. Of these, 11 were also the ED medical director at their institution. Main themes we identified were: 1) increased organizational responsibility, 2) improved prescription drug monitoring program (PDMP) integration, 3) concerns regarding patient satisfaction scores, and 4) increased patient involvement. In addition, some physicians wanted the guidelines to contain more clinical information and be worded more strongly against opioid prescribing. Emergency physicians felt patient satisfaction scores were perceived to negatively impact opioid prescribing guidelines, as they may encourage physicians to prescribe opioids. Furthermore, some participants reported that this is compounded if the emergency physicians' income was linked to their patient satisfaction score. CONCLUSIONS: Emergency physicians interviewed generally supported the state-wide opioid prescribing guideline but felt hospitals needed to take additional organizational responsibility for addressing inappropriate opioid prescribing. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/30342861/Emergency_Physicians'_Perception_of_Barriers_and_Facilitators_for_Adopting_an_Opioid_Prescribing_Guideline_in_Ohio:_A_Qualitative_Interview_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(18)30921-1 DB - PRIME DP - Unbound Medicine ER -