title: Veterans affairs primary care clinicians' attitudes toward chronic pain and correlates of opioid prescribing rates.
abstract: OBJECTIVE
  The primary objective of this study was to identify veterans affairs (VA) primary care clinicians' attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates.
  
  
  METHODS
  Cross-sectional study of clinician survey and pharmacy data.
  
  
  METHODS
  Forty-five VA clinicians from five primary care clinics of one VA medical center.
  
  
  METHODS
  Survey of pain-related attitudes and behaviors, satisfaction with treatment resources, and job satisfaction; percentage of patients in clinicians' panels prescribed opioids (PCPO).
  
  
  RESULTS
  Seventy-one percent of clinicians felt moderately or strongly confident in their ability to treat chronic pain, and 77% moderately or strongly agreed that skilled pain management is a high priority. However, 73% moderately or strongly agreed that patients with chronic pain are a major source of frustration and 38% reported moderate or greater dissatisfaction with their ability to provide optimal pain treatment. Fifty-two percent moderately or strongly agreed that their management is influenced by previous experiences with patients addicted to drugs. The mean PCPO was 16.5% (SD = 6.7). In bivariate comparisons, clinician panel size, job and resource satisfaction, and professional training were associated with opioid prescribing rates.
  
  
  CONCLUSIONS
  High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.
authors.affiliation: Columbia Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, Oregon 97207, USA. steven.dobscha@va.gov
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.forename: Kathryn
authors.initials: K
authors.lastname: Corson
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Flores
authors.forename: Erin C
authors.initials: EC
authors.lastname: Tansill
authors.forename: Martha S
authors.initials: MS
authors.lastname: Gerrity
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D007722:Health Knowledge, Attitudes, Practice; D006787:Hospitals, Veterans; D006801:Humans; D007588:Job Satisfaction; D010146:Pain / Q000188:drug therapy*; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid