Date of Award

Summer 2024

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Deborah DeLuca, JD

Committee Member

Genevieve Zipp, EdD

Committee Member

Michelle D ' Abundo , PhD

Committee Member

Cary Reid, PhD

Keywords

Chronic pain, older adults, prescribing practitioner, primary care, opioid clinical practice guidelines, Knowledge to Acton Framework

Abstract

Background: Chronic pain is a common complaint in older adults,’ and they often seek treatment from their primary care provider who may prescribe opioids to treat their chronic pain. Treating and managing an older adult chronic pain can be complex due to several factors such as the patient’s co-morbidities (other medical conditions), impaired cognition, and advanced age. Opioids have been used since the 1890s for treatment of pain (acute and chronic). Opioid use can cause fractures, falls, kidney failure, addiction, respiratory depression, and overdose in older adults. According to Tong et al. (2016) primary care providers were responsible for writing 45% of all opioid prescriptions in the United States. The American Geriatrics Society (AGS) in 1998 published the first clinical practice guidelines on managing chronic pain in older adults. The Centers for Disease Control Prevention (CDC) the United States federal public health agency in 2016 published clinical practice guidelines in response to the opioid crisis. The opioid clinical practice guidelines (OCPG) introduced by the AGS (1998), and CDC (2016) were intended to facilitate the transfer of evidence-based knowledge for primary prescribing practitioner’s treating older adults for chronic pain. Since the introduction of the opioid clinical practice guidelines primary care providers lack of implementation and non- adherence in primary care persists.

Purpose: The purpose of this basic qualitative study was to explore the prescribing practitioners’ experiences and perceptions associated with opioid clinical practice guidelines adherence when treating older adults for chronic pain in primary care practice settings.

Methods: Semi-structured interviews were used to collect data, using a basic qualitative approach. Purposeful, criterion, and chain sampling was employed. Voluntary participants were asked fifteen open-ended questions using an interview guide questionnaire that was developed based on the review of the literature and the Knowledge to Action Framework by Graham et al. (2006). A modified Delphi process (Hasson et al., 2000) was conducted for face and content validity of the interview questions. Interviews were audio recorded and transcribed verbatim. Transcripts were then coded using in-vivo coding then organized into categories for thematic analysis. Interviews were conducted until saturation was met and no new themes emerged. Intercoder consensus was obtained for reliability.

Results: Twelve semi -structed one-on-one interviews were conducted with prescribing practitioners who prescribe opioids for chronic pain to older adults in primary care practice settings. Six main themes emerged from the data analysis which were: Multimodal Treatment Approach, Inconsistent OCPG Adherence, Multiple Barriers to OCPG Adherence, Perceived Facilitators of OCPG Adherence, Lack of Control, and Prescribing Practitioners need for Peer Support.

Conclusion: Prescribing practitioners continue to express concerns with opioids prescribing and varied perceptions persist regarding the validity and applicability of opioid clinical practice guidelines. Future research studies should focus on developing improved opioid dosing guidelines, exploring strategies to provide access to alternative treatment options, access to peer support, and enhancing prescribing practitioner education and training.

Key Words: Chronic pain, older adults, prescribing practitioner, primary care, opioid clinical practice guidelines, Knowledge to Acton Framework

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