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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

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      Is Open Access

      Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

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          Abstract

          Introduction

          Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics.

          Materials and methods

          The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman’s rho.

          Results

          Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol ( P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse ( P=0.006), and 3) using a consistent practice-based approach to improve their comfort level with prescribing opioids ( P<0.001). Provider confidence was negatively correlated with the perception that treating pain patients was a “problem in my practice” ( P=0.005).

          Conclusion

          In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain.

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          Most cited references19

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          Overconfidence as a cause of diagnostic error in medicine.

          The great majority of medical diagnoses are made using automatic, efficient cognitive processes, and these diagnoses are correct most of the time. This analytic review concerns the exceptions: the times when these cognitive processes fail and the final diagnosis is missed or wrong. We argue that physicians in general underappreciate the likelihood that their diagnoses are wrong and that this tendency to overconfidence is related to both intrinsic and systemically reinforced factors. We present a comprehensive review of the available literature and current thinking related to these issues. The review covers the incidence and impact of diagnostic error, data on physician overconfidence as a contributing cause of errors, strategies to improve the accuracy of diagnostic decision making, and recommendations for future research.
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            Beliefs and attitudes about opioid prescribing and chronic pain management: survey of primary care providers.

            There is growing concern of medication misuse and noncompliance among patients with chronic pain prescribed opioids for pain. The aim of this survey was to obtain information from primary care providers (PCPs) about their perception of prescribing opioids for patients with chronic pain.
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              Physicians' comfort in caring for patients with chronic nonmalignant pain.

              More than 100 million U.S. adults experience chronic nonmalignant pain. Many physicians are uncomfortable managing such patients. We sought to determine the timing and intensity of training that primary care physicians receive in chronic pain treatment, and the effect of training on their comfort in managing patients. The 4P Study was a cross-sectional study conducted at 12 academic medical centers in the United States. More than 500 primary care physicians completed a survey regarding their attitudes toward patients with chronic nonmalignant pain and their education in chronic pain management. We received 572 surveys out of 753 distributed. The respondents' mean age was 35 years; 64% were white, non-Hispanic and 41% were women. Eighty-eight percent were internists, and mean years spent in practice were 7.6. Fifty-seven percent of the physicians felt that they should serve as the principal doctor managing patients with chronic nonmalignant pain. Only 34% of physicians felt comfortable in managing patients with chronic pain. More intensive education after entry into practice was associated with the highest comfort level. Most primary care physicians are not comfortable treating patients with chronic nonmalignant pain. Education increases primary care physicians' comfort in managing these patients. Increased comfort was associated with the willingness of primary care physicians to take charge of managing chronic pain. In addition, physician comfort is greatest when pain management skills are taught after residency training.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                07 June 2017
                : 10
                : 1395-1400
                Affiliations
                [1 ]Department of Anesthesiology & Perioperative Medicine, Mayo School of Graduate Medical Education, Mayo Clinic
                [2 ]Mayo Clinic School of Medicine
                [3 ]Department of Anesthesiology & Perioperative Medicine, Mayo College of Medicine, Rochester, MN, USA
                Author notes
                Correspondence: Amy CS Pearson, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA, Tel +1 507 266 9670, Fax +1 507 266 7732, Email amy.schultz.pearson@ 123456gmail.com
                Article
                jpr-10-1395
                10.2147/JPR.S136478
                5476583
                28652805
                e16b321b-43ce-48b2-99fb-3d4e390635c2
                © 2017 Pearson et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Anesthesiology & Pain management
                chronic pain,opioids,confidence,continuing medical education
                Anesthesiology & Pain management
                chronic pain, opioids, confidence, continuing medical education

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