Barriers and facilitators to use of non-pharmacological treatments in chronic pain
JournalBMC Family Practice
PublisherBioMed Central Ltd.
MetadataShow full item record
AbstractBackground: Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs). Methods: We convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group's responses and categorized them based on staff consensus. Results: Overall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs. Conclusions: In a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development. Copyright 2017 The Author(s).
SponsorsDr. Becker was supported by a Veterans Health Administration Health Services Research and Development Career Development Award (08?276) and olytrauma/Blast-related QUERI locally-initiated project (SUDQ-LIP1302); Dr. Fraenkel was supported by NIAMS K24 AR060231-02. Dr. Heapy was supported by the Veterans Health Administration Health Services Research and Development Service Center of Innovation (CIN 13?407).
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85015960945&doi=10.1186%2fs12875-017-0608-2&partnerID=40&md5=4c706e069c51d60388df79dda47996bd; http://hdl.handle.net/10713/11358