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Lilja V, Wallström S, Saarijärvi M, Lundberg M, Segertoft VA, Ekman I. Balancing between being the most valuable player (MVP) and passing the ball: a qualitative study of support when living with chronic pain in Sweden. BMJ Open 2024; 14:e079229. [PMID: 38296288 PMCID: PMC10831426 DOI: 10.1136/bmjopen-2023-079229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE This study aimed to elucidate the meaning of lived experiences of support from social networks and the healthcare sector in persons with chronic pain. DESIGN A qualitative, phenomenological hermeneutic method was used to analyse interview data. SETTING Participants were recruited from patient organisations in Sweden. PARTICIPANTS Ten (seven women, two men and one non-binary) individuals with chronic musculoskeletal pain were included. FINDINGS The meaning of lived experiences of support in persons with chronic pain involves balancing between being the most valuable player (MVP) and passing the ball, meaning balancing between being a capable person and accepting support to be that capable person. CONCLUSION For participants who lived with chronic pain, support means balancing between being capable (the MVP) and willing to accept support (passing the ball), which aligns with the concept of person-centred care. Our findings may be useful for policy-makers, managers and clinical professionals when planning and performing care for persons with chronic pain. Future research should focus on how the healthcare sector can create support to enable persons with chronic pain to be the MVP while being able to pass the ball to their social networks and the healthcare sector.
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Affiliation(s)
- Veronica Lilja
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Sara Wallström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Forensic Psychiatry, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Markus Saarijärvi
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Healthcare Sciences and E-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mari Lundberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Vivi-Anne Segertoft
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg, Sweden
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Ramsay-Seaner K, Letcher A, Hoffman MS, Anderson E, Heckmann C. Perceptions of prescription opioid use among rural farming and ranching communities: Preliminary implications for outreach and treatment. Subst Abus 2022; 43:1245-1250. [PMID: 35670770 DOI: 10.1080/08897077.2022.2074599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: In 2017, 45% of rural adults reported being directly impacted by the opioid epidemic. While research on the experiences of those using prescription opioids in rural communities is increasing, less is known about a unique sub-population who may have high rates of exposure: rural agricultural workers. The purpose of this study was to explore the prevalence and perceptions related to prescription opioids among rural producers and farmworkers. Methods: A questionnaire was mailed in spring 2019 and spring 2020 to rural residents living in one of two agricultural-based states in the Upper Midwest. Individuals were eligible to participate if any member of their family was involved in the agricultural industry. A total of 1116 questionnaires were returned for a 27.9% response rate. Results: Participants were 68.1 years old on average. The majority identified as white, male, and married. Prescription opioid use was found in 8.2% of households currently, and 15.7% in the past year. There were no gender differences in prevalence of use, but women and older individuals reported significantly more perceived risk than men and younger individuals. Nearly half used alternative pain management, and received most information about prescription opioids from the radio (65.5%) and newsletters (13.5%). Conclusions. Despite their elevated age and working in an occupation at high risk of injury and chronic pain, study participants reported few opioid prescriptions and moderate use of alternative pain management. Perceived risk of prescription opioids may explain low prevalence. Outreach efforts that increase access to healthcare services and alternative pain management treatments for agricultural workers may mitigate the experience of chronic pain that can interfere with their overall quality of life.
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Affiliation(s)
- Kristine Ramsay-Seaner
- School of Education, Counseling, and Human Development, South Dakota State University, Brookings, SD, USA
| | - Amber Letcher
- School of Education, Counseling, and Human Development, South Dakota State University, Brookings, SD, USA
| | - Meagan Scott Hoffman
- NDSU Extension Center for 4-H Youth Development, North Dakota State University, Fargo, ND, USA
| | - Emily Anderson
- Department of Counseling, University of Montana, Missoula, MT, USA
| | - Charlotte Heckmann
- School of Education, Counseling, and Human Development, South Dakota State University, Brookings, SD, USA
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Callister C, Lockhart S, Holtrop JS, Hoover K, Calcaterra SL. Experiences with an addiction consultation service on care provided to hospitalized patients with opioid use disorder: a qualitative study of hospitalists, nurses, pharmacists, and social workers. Subst Abuse 2022; 43:615-622. [PMID: 34666634 PMCID: PMC8888039 DOI: 10.1080/08897077.2021.1975873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: In response to the opioid epidemic, addiction consultation services (ACS) increasingly provide dedicated hospital-based addiction treatment to patients with substance use disorder. We assessed hospitalist and medical staff perceptions of how the presence of 2 hospitals' ACS impacted care for hospitalized patients with opioid use disorder (OUD). We inquired about ongoing challenges in caring for this patient population.Methods: We conducted a qualitative study of hospital-based providers utilizing focus groups and key informant interviews for data collection. Transcripts were analyzed using a mixed inductive-deductive approach. Emergent themes were identified through an iterative, multidisciplinary team-based process using a directed content analysis approach.Results: Hospitalists (n = 20), nurses (n = 13), social workers (n = 11), and pharmacists (n = 18) from a university hospital and a safety-net hospital in Colorado participated in focus groups or key informant interviews. In response to the availability of an ACS, hospitalists described increased confidence using methadone and buprenorphine to treat opioid withdrawal, which they perceived as contributing to improved patient outcomes and greater job satisfaction. Participants expressed concern about inconsistent care provided to patients with OUD that varied by the admitting team's specialty and the physician's background and training. Nurses and hospitalists reported frustrations with achieving adequate pain control among patients with OUD. Last, pharmacists reported practice variations when physicians dosed buprenorphine for acute pain among patients with OUD. A lack of standardized dosing led to concerns of inadequate analgesia or return to opioid use following hospital discharge.Conclusions: An ACS reportedly supports hospitalists and medical staff to best care for hospitalized patients with OUD. Notably, care provided to patients with OUD may not be uniform depending on various physician-level factors. Future work to address the concerns reported by study participants may include education for OUD treatment, early involvement of the ACS, and incorporation of buprenorphine prescribing algorithms to standardize care.
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Affiliation(s)
- Catherine Callister
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
| | - Steven Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | | | - Kaitlyn Hoover
- Clinical Science Graduate Program, University of Colorado, Aurora, Colorado, USA
| | - Susan L. Calcaterra
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA,Division of General Internal Medicine, University of Colorado, Aurora, Colorado, USA
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Nederveld A, Phimphasone-Brady P, Connelly L, Fitzpatrick L, Holtrop JS. The Joys and Challenges of Delivering Obesity Care: a Qualitative Study of US Primary Care Practices. J Gen Intern Med 2021; 36:2709-2716. [PMID: 33532954 PMCID: PMC8390622 DOI: 10.1007/s11606-020-06548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Obesity is of epidemic proportion in the USA but most people with obesity do not receive treatment. OBJECTIVE To explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. The study's focus was on examining the use of the Medicare payment code for intensive behavioral therapy for obesity (IBT), but other obesity management services and payment mechanisms were also studied. DESIGN/PARTICIPANTS We conducted 85 interviews of clinicians (physician, advanced practice clinicians, registered dietitian, or other) practicing in primary care practices. Interviews gathered information about treatment approach to obesity, barriers, and facilitators to providing obesity care including the handling of billing and reimbursement (especially use of the IBT code), personal beliefs about the appropriateness of primary care providing weight loss services, and recommendations for improving weight management in primary care practice. The analysis was conducted using a grounded theory hermeneutic editing approach and the constant comparative method. KEY RESULTS Seventy-five interviews were included in this analysis. We identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile. CONCLUSIONS Treating obesity in primary care settings poses several challenges but can also be very satisfying and rewarding. To improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.
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Affiliation(s)
- Andrea Nederveld
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Lauri Connelly
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurie Fitzpatrick
- Department of Obstetrics and Gynecology, Michigan State University, East Lansing, MI, USA
| | - Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Pate JW, Tran E, Radhakrishnan S, Leaver AM. The Importance of Perceived Relevance: A Qualitative Evaluation of Patient's Perceptions of Value and Impact Following a Low-Intensity Group-Based Pain Management Program. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:46. [PMID: 33430427 PMCID: PMC7826549 DOI: 10.3390/medicina57010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 12/02/2022]
Abstract
Background and objectives: Limited evidence exists exploring perceptions of which aspects of a pain management program are perceived as valuable and impactful. The aim of this study was to explore patient beliefs about which aspects of a pain management program were valued and/or had perceived impact. Materials and Methods: One-on-one structured interviews were conducted with 11 adults three months after their completion of the Spark Pain Program at Westmead Hospital, Sydney, Australia. Concepts in the transcripts were inductively identified and explored, utilizing thematic analysis to better understand their relevance to the study aim. Results: Four themes emerged: (1) "The program overall was positive, but…"; (2) "I valued my improved knowledge and understanding of pain, but…"; (3) "I valued the stretching/relaxation/pacing/activity monitoring"; and (4) "I valued being part of a supportive and understanding group". Participants reported that they liked being treated as an individual within the group. A lack of perceived personal relevance of key messages was identified in some participants; it appears that patients in pain programs must determine that changes in knowledge, beliefs, and attitudes are personally relevant in order for the changes to have a significant impact on them. Conclusions: This study provides new insights into aspects of a pain management program that were perceived as valuable and impactful, areas that "missed the mark", and hypotheses to guide the implementation of service delivery and program redesign.
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Affiliation(s)
- Joshua W. Pate
- Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia
- Westmead Hospital Pain Management Centre, Sydney 2145, Australia; (E.T.); (S.R.); (A.M.L.)
- Faculty of Health Sciences, University of Sydney, Sydney 2141, Australia
| | - Elizabeth Tran
- Westmead Hospital Pain Management Centre, Sydney 2145, Australia; (E.T.); (S.R.); (A.M.L.)
| | - Seema Radhakrishnan
- Westmead Hospital Pain Management Centre, Sydney 2145, Australia; (E.T.); (S.R.); (A.M.L.)
| | - Andrew M. Leaver
- Westmead Hospital Pain Management Centre, Sydney 2145, Australia; (E.T.); (S.R.); (A.M.L.)
- Faculty of Health Sciences, University of Sydney, Sydney 2141, Australia
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