July 9, 2018

Patient-doctor trust withstands opioid risk reduction

Risk-reduction initiative for chronic opioid therapy sustains patient-doctor trust, Dr. Karen Sherman finds

By Karen J. Sherman, PhD, a senior investigator at Kaiser Permanente Washington Health Research Institute and an affiliate professor of epidemiology at the University of Washington (UW) School of Public Health.

What can we do about the opioid epidemic? Over the past decade, federal and state guidelines have recommended lowering the risk of chronic opioid therapy. Initiatives to lower the risk of chronic opioid therapy often involve reducing dosage and monitoring patients, including urine testing.

Concerns have been raised that such initiatives could affect the doctor-patient relationship negatively. This would be unfortunate since research has shown that good communication and mutual trust between patients and doctors are linked to better outcomes for many conditions, including chronic pain. Fortunately, my colleagues and I were delighted and surprised by the results in our latest publication.

We conducted the first survey of patient perceptions of trust in the patient-doctor relationship about managing opioid medications.

As part of a study to evaluate a risk reduction initiative at Kaiser Permanente Washington that started before 2010, we surveyed a random sample of more than 1,500 primary care patients at Kaiser Permanente Washington who were prescribed chronic opioid therapy. We included questions related to patient perceptions of trust in the patient-doctor relationship about managing opioid medications.

These patients’ perceived levels of trust in their doctors’ judgment in managing their opioid medications was generally high, at 82 percent. And 86 percent thought their doctors trusted them in managing their medications. These percentages were only slightly (5 percent to 10 percent) lower for those who had experienced four years of the group practice’s risk-reduction intervention, compared to those in network clinics that served as a control group. And less than 30 percent of participants worried that their doctor would stop prescribing opioids.

We concluded that it seems possible to implement opioid risk-reduction initiatives while sustaining high levels of doctor-patient trust for most patients on chronic opioid therapy.

Special thanks

My colleagues on this work are Michael Von Korff, ScD; Sascha Dublin, MD, PhD; Michael Parchman, MD, MPH; Susan M. Shortreed, PhD; Manu Thakral, PhD, NP; Evette J. Ludman, PhD; Rod L. Walker, MS; and Kathleen Saunders, JD, all of KPWHRI; and Ryan N. Hansen, PharmD, PhD, a KPWHRI affiliate investigator who is at the UW School of Pharmacy.

We’re all grateful to the Patient-Centered Outcomes Research Institute (HIS-1306–02198) and the National Institute on Aging (T32-AG02767709) for funding our work — and especially to our Patient Advisory Committee. The committee included Catherine Cartwright, Penny Cowen, David Duhrkoop (chairperson), Mariann Farrell, Ada Giudice-Tompson, Kathryn Guthrie, Catherine Lippincott, Max Sokolnicki, and Betts Tully. They guided this research, commented on the findings — and even suggested this series of questions in the first place.

The Journal of the American Board of Family Medicine published our results as “Doctor-Patient Trust among Chronic Pain Patients on Chronic Opioid Therapy after Opioid Risk Reduction Initiatives: A Survey.”

Our findings jibe with other recent research done by our colleagues at Kaiser Permanente Southern California: Reducing Opioids Not Associated with Lower Patient Satisfaction Scores.

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