A Qualitative Assessment of Emergency Physician Perceptions and Experiences with Acute Pain Management
Author(s)
Scott J. Keating, MS, MSc1, Scott G. Weiner, MD, PhD2, Emilio Garcia, MD, PhD1, KD Jacobs, PhD3, Elizabeth Brennan, PhD3, Laura Tesler-Waldman, PhD3, Ann M. Menzie, MS1;
1Vertex Pharmaceuticals Incorporated, Boston, MA, USA, 2Brigham and Women’s Hospital, Boston, MA, USA, 3QualityMetric, Johnston, RI, USA
1Vertex Pharmaceuticals Incorporated, Boston, MA, USA, 2Brigham and Women’s Hospital, Boston, MA, USA, 3QualityMetric, Johnston, RI, USA
Presentation Documents
OBJECTIVES: To understand emergency physician perceptions of the challenges and facilitators related to acute pain management in adult patients.
METHODS: This cross-sectional, qualitative study analyzed responses from emergency physicians who manage acute pain. Individual interviews were conducted using a semi-structured interview guide; coding and thematic analyses were performed based on narrative responses and thematic saturation was reached. This study was reviewed and approved by a central institutional review board.
RESULTS: Interviews were conducted with 15 emergency physicians. Most physicians were male (n=9, 60.0%), white (n=8, 53.3%), had a median (range) of 23 (11-29) years of clinical experience, and worked a median (range) of 14 (8-20) shifts in an emergency setting per month. Physicians reported being “satisfied” (n=5, 33.3%), “moderately satisfied” (n=9, 60.0%) or “very unsatisfied” (n=1, 6.7%) with current acute pain treatments. Six (40.0%) emergency physicians were comfortable prescribing opioids, eight (53.3%) reported comfort varied or were comfortable within limits, and one (6.7%) was not comfortable. Physicians described concerns prescribing opioids to patients at risk for dependency, addiction, and/or diversion; the elderly; and patients with painful chronic conditions. Several reported satisfaction with opioid analgesic efficacy (n=8, 53.3%), however, almost all (n=14, 93.3%) were concerned about adverse events, the most worrisome being respiratory depression and altered cognition. All physicians reported opioid-related administrative tasks, including checking state prescription drug monitoring databases or pharmacy shortages; about half described these tasks as burdensome. The most commonly reported ideal characteristics of an acute pain medication included an improved safety profile (86.7%), non-addictive/non-euphoric mechanism of action (73.3%), more convenient administration (53.3%), and high analgesic efficacy (46.7%).
CONCLUSIONS: This research describes the emergency physician perspective on the challenges and facilitators of managing acute pain and highlights a desire for therapeutics with improved safety, analgesic efficacy, reduced administrative burden, and no addiction potential.
METHODS: This cross-sectional, qualitative study analyzed responses from emergency physicians who manage acute pain. Individual interviews were conducted using a semi-structured interview guide; coding and thematic analyses were performed based on narrative responses and thematic saturation was reached. This study was reviewed and approved by a central institutional review board.
RESULTS: Interviews were conducted with 15 emergency physicians. Most physicians were male (n=9, 60.0%), white (n=8, 53.3%), had a median (range) of 23 (11-29) years of clinical experience, and worked a median (range) of 14 (8-20) shifts in an emergency setting per month. Physicians reported being “satisfied” (n=5, 33.3%), “moderately satisfied” (n=9, 60.0%) or “very unsatisfied” (n=1, 6.7%) with current acute pain treatments. Six (40.0%) emergency physicians were comfortable prescribing opioids, eight (53.3%) reported comfort varied or were comfortable within limits, and one (6.7%) was not comfortable. Physicians described concerns prescribing opioids to patients at risk for dependency, addiction, and/or diversion; the elderly; and patients with painful chronic conditions. Several reported satisfaction with opioid analgesic efficacy (n=8, 53.3%), however, almost all (n=14, 93.3%) were concerned about adverse events, the most worrisome being respiratory depression and altered cognition. All physicians reported opioid-related administrative tasks, including checking state prescription drug monitoring databases or pharmacy shortages; about half described these tasks as burdensome. The most commonly reported ideal characteristics of an acute pain medication included an improved safety profile (86.7%), non-addictive/non-euphoric mechanism of action (73.3%), more convenient administration (53.3%), and high analgesic efficacy (46.7%).
CONCLUSIONS: This research describes the emergency physician perspective on the challenges and facilitators of managing acute pain and highlights a desire for therapeutics with improved safety, analgesic efficacy, reduced administrative burden, and no addiction potential.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD21
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)