BACKGROUND: Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes. OBJECTIVE: Conduct a national survey of providers who use PPAs to describe the process of administering them, assess views on their utility, and obtain PPAs to evaluate thematic content and readability. DESIGN: Cross-sectional electronic survey and request for PPAs. PARTICIPANTS: Registrants for the Safer/Competent Opioid Prescribing Education (SCOPE of Pain) Program between March 2013 and June 2017. MAIN MEASURES: Respondents' reports on how PPAs are administered and views on their usefulness. A sample of PPAs assessed for themes and readability. KEY RESULTS: Using a convenience sample of 62,530 SCOPE of Pain registrants, we obtained a cohort of 430 individuals from 43 states who use PPAs. The majority of respondents worked in primary care (64%) and pain (18%) specialties. Reviewing PPAs with patients was primarily done by prescribers (80%), and the average perceived time to administer PPAs was 13 min. Although 66% of respondents thought PPAs were "often" or "always" worth the effort, only 28% considered them "often" or "always" effective in reducing opioid misuse. The PPA reading burden surpassed recommended patient education standards, with only 2.5% at or below fifth-grade reading level. PPAs focused more on rules and consequences of patients' non-compliance than on a shared treatment plan. CONCLUSIONS: Most respondents perceive patient provider agreements (PPAs) as time-consuming and minimally effective in reducing opioid misuse yet still view them as valuable. PPAs are written far above recommended reading levels and serve primarily to convey consequences of non-compliance. Because PPAs are recommended by national safer opioid prescribing guidelines as a risk mitigation strategy, it would be beneficial to develop a standard PPA and study its effectiveness.
BACKGROUND: Many national guidelines recommend the use of patient provider agreements (PPAs) when prescribing opioids for chronic pain. There are no standards for PPA content, readability, or administration processes. OBJECTIVE: Conduct a national survey of providers who use PPAs to describe the process of administering them, assess views on their utility, and obtain PPAs to evaluate thematic content and readability. DESIGN: Cross-sectional electronic survey and request for PPAs. PARTICIPANTS: Registrants for the Safer/Competent Opioid Prescribing Education (SCOPE of Pain) Program between March 2013 and June 2017. MAIN MEASURES: Respondents' reports on how PPAs are administered and views on their usefulness. A sample of PPAs assessed for themes and readability. KEY RESULTS: Using a convenience sample of 62,530 SCOPE of Pain registrants, we obtained a cohort of 430 individuals from 43 states who use PPAs. The majority of respondents worked in primary care (64%) and pain (18%) specialties. Reviewing PPAs with patients was primarily done by prescribers (80%), and the average perceived time to administer PPAs was 13 min. Although 66% of respondents thought PPAs were "often" or "always" worth the effort, only 28% considered them "often" or "always" effective in reducing opioid misuse. The PPA reading burden surpassed recommended patient education standards, with only 2.5% at or below fifth-grade reading level. PPAs focused more on rules and consequences of patients' non-compliance than on a shared treatment plan. CONCLUSIONS: Most respondents perceive patient provider agreements (PPAs) as time-consuming and minimally effective in reducing opioid misuse yet still view them as valuable. PPAs are written far above recommended reading levels and serve primarily to convey consequences of non-compliance. Because PPAs are recommended by national safer opioid prescribing guidelines as a risk mitigation strategy, it would be beneficial to develop a standard PPA and study its effectiveness.
Authors: Jane M Liebschutz; Ziming Xuan; Christopher W Shanahan; Marc LaRochelle; Julia Keosaian; Donna Beers; George Guara; Kristen O'Connor; Daniel P Alford; Victoria Parker; Roger D Weiss; Jeffrey H Samet; Julie Crosson; Phoebe A Cushman; Karen E Lasser Journal: JAMA Intern Med Date: 2017-09-01 Impact factor: 21.873
Authors: Richard C Dart; Hilary L Surratt; Theodore J Cicero; Mark W Parrino; S Geoff Severtson; Becki Bucher-Bartelson; Jody L Green Journal: N Engl J Med Date: 2015-01-15 Impact factor: 91.245
Authors: Joanna L Starrels; William C Becker; Daniel P Alford; Alok Kapoor; Arthur Robinson Williams; Barbara J Turner Journal: Ann Intern Med Date: 2010-06-01 Impact factor: 25.391
Authors: Jennifer S Albrecht; Bilal Khokhar; Françoise Pradel; Michelle Campbell; Jacqueline Palmer; Ilene Harris; Francis Palumbo Journal: J Pharm Health Serv Res Date: 2015-06-16