142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

308335
Emergency physician attitudes and management strategies toward chronic pain and “drug-seeking behavior”: A survey of emergency physicians

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Adina S. Rauchwerger, MPH , Division of Research, Kaiser Permanente, Oakland, CA
Steven R. Offerman, MD , Department of Emergency Medicine, Kaiser Permanente Medical Center, South Sacramento, Sacramento, CA
Karen L. Murrell, MD , Kaiser Permanente Medical Center, South Sacramento
Dustin W. Ballard, MD, MBE , Department of Emergency Medicine, Kaiser Permanente Medical Center, San Rafael, San Rafael, CA
Uli K. Chettipally, MD, MPH , Department of Emergency Medicine, Kaiser Permanente Medical Center, South San Francisco, South San Francisco, CA
Alexander J. Azuma, MS , School of Medicine, St. George’s University, Grenada, West Indies, Grenada
David R. Vinson, MD , Department of Emergency Medicine, Kaiser Permanente Medical Center, Sacramento, Sacramento, CA
Prescription drug abuse and diversion are highly prevalent in the United States. The use of Emergency Departments (EDs) to acquire prescription narcotic medications for abuse is a serious concern among emergency physicians (EPs) and their clinical experiences are meaningful and instructive. 

We performed a cross-sectional survey study of EPs working for a large integrated delivery system in Northern California. Questions were designed to evaluate EP attitudes as well as management principles used for these complicated patients. 

In total, 393 physicians completed the online survey (response rate 65.8%). We found the majority of EPs surveyed do not believe that chronic pain is an emergency condition (88.3%).  Additionally, they feel drug-seeking behavior (DSB) diverts resources from patients with more serious conditions (90.9%). The electronic health record (EHR) is seen as an effective tool when managing DSB patients (95.9% agreed). A minority of physicians (17.9%) report that they “always” document DSB and many more (79.8%) “usually” or “sometimes” document it. Although the use of prescription drug history in the California Prescription Drug Monitoring Program is viewed positively, it is underutilized by many EPs (39.5% did not have access).

Our results highlight particular EP attitudes regarding DSB, documentation strategies, and access to controlled substance history information at the point of care.  Although the majority of EPs report that they “usually” document DSB, it is concerning that a minority are hesitant. Better ED guidelines regarding DSB documentation might help improve the use of EHRs and dispel concerns about placing this information in the medical record.

Learning Areas:

Administration, management, leadership
Clinical medicine applied in public health
Ethics, professional and legal requirements

Learning Objectives:
Identify challenges faced by emergency physicians in treating and documenting chronic pain and drug-seeking patients at the point-of-care.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the project manager for the Clinical Research on Emergency Services and Treatment Network at Kaiser Permanente Northern California. Among my scientific interests has been emergency physician behavior and attitudes toward clinical decision support in the electronic health record and use of tools for risk stratification.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.