Rural Clinicians Efforts to Maintain Relationship-Centered Care Amidst Conflicting Tensions with Inherited Opioid...

Area of Science:

• Qualitative Health Research
• Rural Health Systems
• Pain Management

Background:

• Rural primary care clinicians encounter significant challenges managing patients on chronic prescription opioid therapy.
• Existing research addresses the opioid crisis and management strategies, but less is known about clinicians' experiences with opioid deprescribing.
• This study focuses on rural clinicians inheriting patients requiring high-dose opioids.

Purpose of the Study:

• To explore the experiences of rural primary care clinicians managing patients on high-dose prescription opioids inherited from other providers.
• To understand the tensions and challenges faced during opioid deprescribing in rural settings.

Main Methods:

• An exploratory qualitative interview study was conducted using a constructivist grounded theory approach.
• Twelve rural primary care clinicians (physicians, physician associates, nurse practitioners) participated.
• Data from semi-structured interviews were analyzed using inductive thematic analysis within an interpretivist paradigm.

Main Results:

• Four key themes emerged, highlighting tensions in clinician-patient relationships, interprofessional collaboration, community resource availability, and regulatory environments.
• These tensions influenced opioid deprescribing efforts, often aligning with clinicians' relationship-centered philosophies.
• Participants recognized the importance of social determinants of health in patient care.

Conclusions:

• Conflicting tensions related to relationships, regulations, and resource scarcity in rural areas impede opioid deprescribing.
• Opioid deprescribing is viewed as a relationship-centered process that can conflict with population-focused harm reduction policies.
• Further research is needed to understand rural health systems and incorporate rural clinicians' perspectives into policy development.