Welham, Grace C. (2015). Prescriber perceptions while managing pain. Doctoral dissertation, Social and Administrative Science in Pharmacy, University of Wisconsin – Madison.
Abstract:
Introduction: This study used Q methodology to explore and describe prescriber perceptions while managing pain. Patient psychological and sociocultural context impact the pain experienced by different patients. From a quality of care perspective, it is important for prescribers who manage and treat pain to recognize these differences. Objectives: Phase 1: Objective 1a explored a prescriber-level model of what influences decision-making in pain management. Objective 1b created a sample of items from Objective 1a to be sorted and ranked in Phase 2. Phase 2: Objective 2a used a by-person factor analysis to identify prescriber “types.” Objective 2b described the prescriber types through interpretation of the factors that emerged from Objective 2a. Methods: Phase 1 of this study used semi-structured interviews to qualitatively explore Primary Care Prescriber perceptions of pain management to develop the Concourse of responses. From the Concourse, the Q-set was developed, which forms the statements that were sorted and ranked by prescribers who completed the Q-sort. The Q-sort is a method of data collection that allowed by-person factor analysis. The Q-sort was administered as part of a self-administered, paper-based questionnaire. By-person factor analysis identified prescriber types that emerged from the Q-sort data. Results: Three prescribers types were identified. Confident Clinicians focused on clinical characteristics of the patient, developed a treatment plan based on those characteristics, and worked with the patient to determine the best treatment. Sensitive Psychologists, while also considering clinical characteristics, focused more intently on patient psycho-behavioral characteristics. They were sensitive to the increased potential for abuse or addiction in patients with poor psychological status. The Seasoned Realists considered the patients most holistically, and recognized that no matter their treatment of choice, the patient must be able to access the treatment. Conclusions: The three prescriber types that emerged from the data share common perspectives of pain as they are all trained in the allopathic tradition. However, certain perceptions distinguished the Sensitive Psychologists and the Seasoned Realists from the Confident Clinicians. These distinguishing perceptions are what can be used to differentiate prescribers by their perceptions. The main limitations of this study are the lack of generalizability and a reliance on self-report.
