• Julie Diiulio, Laura G Militello, Barbara T Andraka-Christou, Robert L Cook, Robert W Hurley, Sarah M Downs, Shilo Anders, Burke W Mamlin, Elizabeth C Danielson, and Christopher A Harle.
• From Applied Decision Science, LLC, Dayton, OH (JD, LGM); Department of Health Management & Informatics, University of Central Florida, Orlando, FL (BTAC); University of Florida Gainesville, FL (RLC); Department of Anesthesiology and Public Health Science, Wake Forest University School of Medicine, Winston Salem, NC (RWH); Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN (SMD, ECD, CAH); Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN (SA); Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN (BWM); Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN (BWM, CAH). j.diiulio@applieddecisionscience.com.
• J Am Board Fam Med. 2020 Jan 1; 33 (1): 42-50.

BackgroundThe objective of this qualitative study is to better understand primary care clinician decision making for managing chronic pain. Specifically, we focus on the factors that influence changes to existing chronic pain management plans. Limitations in guidelines and training leave clinicians to use their own judgment and experience in managing the complexities associated with treating patients with chronic pain. This study provides insight into those judgments based on clinicians' first-person accounts. Insights gleaned from this study could inspire innovations aimed at supporting primary care clinicians (PCCs) in managing chronic pain.MethodsWe conducted 89 interviews with PCCs to obtain their first-person perspective of the factors that influenced changes in treatment plans for their patients. Interview transcripts were analyzed thematically by a multidisciplinary team of clinicians, cognitive scientists, and public health researchers.ResultsSeven themes emerged through our analysis of factors that influenced a change in chronic pain management: 1) change in patient condition; 2) outcomes related to treatment; 3) nonadherent patient behavior; 4) insurance constraints; 5) change in guidelines, laws, or policies; 6) approaches to new patients; and 7) specialist recommendations.ConclusionsOur analysis sheds light on the factors that lead PCCs to change treatment plans for patients with chronic pain. An understanding of these factors can inform the types of innovations needed to support PCCs in providing chronic pain care. We highlight key insights from our analysis and offer ideas for potential practice innovations.© Copyright 2020 by the American Board of Family Medicine.

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