The hospitalist perspective on opioid prescribing: A qualitative analysis

BACKGROUND Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals, and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered, and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. OBJECTIVE We aimed to understand physicians' attitudes, beliefs, and practices toward opioid prescribing during hospitalization and discharge. DESIGN In-depth, semistructured interviews. SETTING Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. PARTICIPANTS Hospitalists (N = 25). MEASUREMENTS We systematically analyzed transcribed interviews and identified emerging themes using a team-based mixed inductive and deductive approach. RESULTS Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction when managing acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events that altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. CONCLUSIONS Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed. Journal of Hospital Medicine 2016;11:536–542. © 2016 Society of Hospital Medicine