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J Pharm Health Serv Res. 2015 Sep;6(3):139-144. doi: 10.1111/jphs.12099. Epub 2015 Jun 16.

Perceptions of patient provider agreements.

Journal of pharmaceutical health services research : an official journal of the Royal Pharmaceutical Society of Great Britain

Jennifer S Albrecht, Bilal Khokhar, Françoise Pradel, Michelle Campbell, Jacqueline Palmer, Ilene Harris, Francis Palumbo

Affiliations

  1. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Maryland, USA.
  2. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy.
  3. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy; Health Economics & Outcomes Research: Critical Care, Novartis Pharmaceuticals, Basel, Switzerland.
  4. Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy; Health Division, IMPAQ International, LLC, Columbia, Maryland, USA.

PMID: 27293486 PMCID: PMC4902116 DOI: 10.1111/jphs.12099

Abstract

OBJECTIVES: Use of patient provider agreements (PPAs) is increasing, yet there is limited evidence on the effectiveness of PPAs to prevent prescription opioid misuse and diversion, and few guidelines for providers. We conducted eight focus groups to understand patient and prescriber perceptions of PPAs.

METHODS: We recruited 40 patients who had been asked to sign a PPA and 40 prescribers who had administered at least one PPA. We developed topic guides for the two groups based on prior literature. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently performed the content analysis of the transcripts and reached consensus on recurring themes.

KEY FINDINGS: PPA use varied according to physician specialty. General practitioners used PPAs the least but reported increasing pressure from liability insurers to use them. Many patients reported signing a PPA in the emergency room of a hospital. Prescribers and patients reported a lack of understanding among patients concerning the purpose and content of the PPA. Prescribers questioned the legal status of the PPA, while patients believed that the PPA was a legal document intended to protect prescribers. Patients and prescribers valued PPA content items differently, although both groups agreed that signing a PPA would not prevent opioid misuse.

CONCLUSIONS: We identified several themes concerning the administration, content, effectiveness and utility of PPAs that highlight areas of research to improve PPAs. We also describe trends requiring further investigation. Understanding content of importance to patients will facilitate the development of a patient-centred PPA.

Keywords: focus group; opioid contract; opioids; patient provider agreement

References

  1. Am J Bioeth. 2010 Nov;10(11):15-7 - PubMed
  2. Am J Med. 2006 Apr;119(4):292-6 - PubMed
  3. Pain Physician. 2012 Jul;15(3 Suppl):ES9-38 - PubMed
  4. J Pain Palliat Care Pharmacother. 2009;23(4):357-64 - PubMed
  5. J Pain. 2009 Feb;10(2):113-30 - PubMed
  6. Compr Ther. 2004 Summer;30(2):101-4 - PubMed
  7. J Law Med Ethics. 2009 Winter;37(4):841-5 - PubMed
  8. J Pain. 2007 Oct;8(10):753-8 - PubMed
  9. Expert Rev Neurother. 2010 May;10(5):775-89 - PubMed
  10. Am J Bioeth. 2010 Nov;10(11):5-12 - PubMed
  11. BMJ. 1995 Jul 29;311(7000):299-302 - PubMed
  12. Ann Intern Med. 2010 Jun 1;152(11):712-20 - PubMed
  13. J Adv Nurs. 2006 Dec;56(5):491-7 - PubMed
  14. Pain Physician. 2012 Jul;15(3 Suppl):S1-65 - PubMed

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