Development of an Instrument to Assess Influences on Family Physician Opioid Therapy Prescribing

Rationale: Prescription drug abuse and misuse (PDA/M) is a significant problem in Central Appalachia and continues to grow. Since 2000, Tennessee has seen a 250% increase in prescription overdose deaths. Nationally, most prescription painkillers are prescribed by primary care doctors and dentists, rather than specialists. Objective: To develop and test a survey instrument aimed at understanding family physician knowledge, attitudes, and beliefs about opioid therapy prescribing. Design: Survey development. Setting: Survey questions were developed based on results of five focus groups held in primary care clinics in Northeast Tennessee and Southwest Virginia. Surveys were validated and tested by faculty and residents in three family medicine residency clinics in Northeast Tennessee. Participants: Survey questions were face validated for clarity and relevance by family physician attendings and third year residents (N=29). All faculty attendings and residents (N≈85) at the same family medicine residency clinics will be invited to complete the survey for psychometric testing. Main and Secondary Outcome Measures: Survey questions have been face validated for clarity and relevance. Data from the psychometric testing phase will be analyzed for internal consistency and inter-item correlations. Exploratory factor analysis will be used to identify underlying constructs. Results: Based on the results of the focus groups and physician expertise, a 51-item instrument was developed. Following face validation, wording was clarified on 25 questions, 3 questions were removed, and 5 questions were added, resulting in a 53-item instrument. Psychometric testing has not been completed at this time, but will be completed at the time of presentation. Conclusions: Researchers intend to use the findings to improve policies and practice guidelines for primary care clinics in the Appalachian region. Results will be used to design CME activities to decrease PDA/M and to help foster more effective and responsible prescribing of pain medication