Browsing by Author "MacKie, Palmer"

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    Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana
    (BMJ, 2017-11-12) Al Achkar, Morhaf; Revere, Debra; Dennis, Barbara; MacKie, Palmer; Gupta, Sumedha; Grannis, Shaun; Medicine, School of Medicine
    Objectives The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana’s opioid prescription legislation on the patient experiences around pain management. Setting This is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis. Participants Nine patient participants and five primary care providers were included in the study. Results Living with chronic pain is disruptive to patients’ lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient–provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change. Conclusions As a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.
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    “I’m Not Gonna Pull the Rug out from under You”: Patient-Provider Communication about Opioid Tapering
    (Elsevier, 2017) Matthias, Marianne S.; Johnson, Nicole L.; Shields, Cleveland G.; Bair, Matthew J.; MacKie, Palmer; Huffman, Monica; Alexander, Stewart C.; Department of Medicine, School of Medicine
    In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many healthcare organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients on long-term opioids who perceive benefits and are using their medications as prescribed. Given the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) Explaining—Patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential; 2) Negotiating—Patients needed to have input, even if it was simply the rate of tapering; 3) Managing difficult conversations—When patients and providers did not reach a shared understanding, difficulties and misunderstandings arose; 4) Non-abandonment—Patients needed to know that their providers would not abandon them throughout the tapering process.