It made my life a little easier: primary care providers' beliefs and attitudes about using opioid treatment agreements.
OBJECTIVE
To understand primary care providers (PCPs)' experiences, beliefs, and attitudes about using opioid treatment agreements (OTAs) for patients with chronic pain.


METHODS
Qualitative research study.


METHODS
Twenty-eight internists and family medicine physicians at two health centers.


METHODS
Semistructured telephone interviews, informed by the Integrative Model of Behavioral Prediction. Themes were analyzed using a Grounded Theory approach, and similarities and differences in themes were examined among OTA adopters, nonadopters, and selective adopters.


RESULTS
Participants were 64 percent female and 68 percent white, and practiced for a mean of 9.5 years. Adoption of OTAs varied: seven were adopters, five were nonadopters, and 16 were selective adopters. OTA adoption reflected PCPs' beliefs and attitudes in the following three thematic categories: 1) perceived effect of OTA use on the therapeutic alliance, 2) beliefs about the utility of OTAs for patients or providers, and 3) perception of patients' risk for opioid misuse. PCPs commonly believed that OTAs were useful for physician self-protection, but few believed that they prevent opioid misuse. Selective adopters expressed ambivalent beliefs and made decisions about OTA use for individual patients based on both observed data and a subjective sense of each patient's risk for misuse.


CONCLUSIONS
Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices.
Assistant Professor of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Joanna L
JL
Starrels
Candidate, MD/MPH Program at Oregon Health & Sciences University, Portland, Oregon.
Bryan
B
Wu
Doctoral Candidate, Clinical Psychology PhD Program, Rutgers University, New Brunswick, New Jersey.
Deena
D
Peyser
Assistant Professor of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Aaron D
AD
Fox
Predoctoral Fellow in the Clinical Psychology Training Program at University of California, San Francisco.
Abigail
A
Batchelder
Associate Professor of Family Medicine and Community Health at the Hospital of the University of Pennsylvania, and Associate Professor of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania.
Frances K
FK
Barg
Professor of Medicine and Chief, Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Julia H
JH
Arnsten
Associate Professor of Medicine and Family & Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Chinazo O
CO
Cunningham
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003469:Culture; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care
D000701:Analgesics, Opioid