Evidence map›Paper›PMID 31068401›Full record

ArticleJournal of the American Board of Family Medicine : JABFM

Sources and Impact of Time Pressure on Opioid Management in the Safety-Net.

Shannon Satterwhite, Kelly R Knight, Christine Miaskowski, Jamie Suki Chang, Rachel Ceasar, Kara Zamora, Margot Kushel

Open access · diamondAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Board of Family Medicine : JABFM. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed
4.2field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 29 citations in OpenAlex.

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  19. A Scoping Review of Nursing's Contribution to the Management of Patients with Pain and Opioid Misuse.Pain management nursing : official journal of the American Society of Pain Management Nurses · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

Shannon SatterwhiteFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK).
Kelly R KnightFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK). kelly.knight@ucsf.edu.
Christine MiaskowskiFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK).
Jamie Suki ChangFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK).
Rachel CeasarFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK).
Kara ZamoraFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK).
Margot KushelFrom Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, (SS, KRK, KZ); UCSF Medical Scientist Training Program, San Francisco (SS); School of Nursing, University of California San Francisco, San Francisco (CM); Public Health Program, Santa Clara University, Santa Clara, California (JSC); Department of Anthropology, University of California, Berkeley, Berkeley, (RC); San Francisco Veterans Affairs Medical Center, San Francisco, California, (KZ); UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, California, (MK); Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital, San Francisco, (MK).
University of California, San Francisco · USSan Francisco General Hospital · USSan Francisco VA Medical Center · USUniversity of California, Berkeley · US

Funding

MEDICAL SCIENTIST TRAINING PROGRAMT32GM007618 · NIGMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI ANDERSON, MARK S · 1985 to 2020
$29.6M
Substance Use Disorders Treatment/Services Research Training ProgramT32DA007250 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Derek D Satre, Janice Y Tsoh · 1991 to 2026
$7.4M
Examining the Consequences of Reductions in Opioid Prescribing on Patients, Clinical Care, and Community HealthR01DA043631 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KNIGHT, KELLY RAY · 2017 to 2021
$2.7M
Mentoring Researchers in Aging in Vulnerable PopulationsK24AG046372 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KUSHEL, MARGOT B · 2015 to 2025
$1.9M
Pain Management in the Clinic & CommunityR01DA034625 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KNIGHT, KELLY RAY · 2013 to 2015
$893k
NIA NIH HHS K24 AG046372NIDA NIH HHS R01 DA034625NIDA NIH HHS R01 DA043631NIDA NIH HHS T32 DA007250NIGMS NIH HHS T32 GM007618
6 · The paper itself

Abstract

purposeThis study sought to understand clinicians' and patients' experience managing chronic noncancer pain (CNCP) and opioids in safety-net primary care settings. This article explores the time requirements of safer opioid prescribing for medically and socially complex patients in the context of safety-net primary care.

methodsWe qualitatively interviewed 23 primary care clinicians and 46 of their patients with concurrent CNCP and substance use disorder (past or current). We also conducted observations of clinical interactions between the clinicians and patients. We transcribed, coded, and analyzed interview and clinical observation recordings using grounded theory methodology.

resultsClinicians reported not having enough time to assess patients' CNCP, functional status, and risks for opioid misuse. Inadequate assessment of CNCP contributed to tension and conflicts during visits. Clinicians described pain conversations consuming a substantial portion of primary care visits despite patients' other serious health concerns. System-level constraints (eg, changing insurance policies, limited access to specialty and integrative care) added to the perceived time burden of CNCP management. Clinicians described repeated visits with little progress in patients' pain or functional status due to these barriers. Patients acknowledged clinical time constraints and reported devoting significant time to following new opioid management protocols for CNCP.

conclusionsTime pressure was identified as a major barrier to safer opioid prescribing. Efforts, including changes to reimbursement structures, are needed to relieve time stress on primary care clinicians treating medically and socially complex patients with CNCP in safety-net settings.

Indexed as

AdultAnalgesics, OpioidAttitude of Health PersonnelChronic PainDrug PrescriptionsFemaleGuideline AdherenceHumansMaleMiddle AgedPain ManagementPhysicians, Primary CarePractice Guidelines as TopicPractice Patterns, Physicians'Primary Health CareQualitative ResearchAnalgesics, OpioidChronic DiseaseChronic PainGrounded TheoryMinority HealthOpioidsPrimary Health CareSubstance-Related DisordersVulnerable Populations

Identifiers

PMID31068401
PMCPMC6988512
OpenAlexW2944254619

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.