Att J- Screenshots- Primary Care Clinician Survey

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Chronic Pain Study – Primary Care Clinician Survey
Introduction

Abt Associates and AMGA (the American Medical Group Association) are working with the
Centers for Disease Control and Prevention (CDC) to evaluate the effects of your health system’s
implementation of policies and guidelines regarding chronic pain management and opioid
prescribing, including access to medications for opioid use disorder (MOUD). This 10-minute
survey aims to get a better understanding of your health system’s implementation of such
policies and guidelines, and their effects on patient outcomes. This study is funded by the CDC.
When answering the following questions, please consider your adult (18 years and older)
patients, including those with chronic pain and those who are currently or were previously
prescribed long-term opioid therapy (LTOT), where LTOT is defined as use of opioids on most
days for more than 3 months. Please consider only patients seen in primary care, outpatient
settings. Please note that this survey is intended for clinicians who possess the necessary
licensure and certification to prescribe opioids, or clinicians who work under the supervision of a
physician with such licensure/certification.
For the purposes of this evaluation, “chronic pain management policies/guidelines” refers to
policies/guidelines that may include prescribing of opioid medications, nonpharmacologic
therapies, and/or non-opioid medications for chronic pain, as well as opioid use disorder (OUD)
assessment and treatment.

Consent – Please note the following:
•
•
•
•
•
•

Your participation is voluntary, and you may quit at any time.
This survey will last approximately 10 minutes.
You can decline to answer any question without affecting your continued participation in
the survey or your relationship with your organization or the CDC. There is a small risk of
loss of confidentiality. We have many procedures in place to reduce this risk.
Your responses will only be shared in aggregate with other responses with no individual
attribution.
This study has a “Certificate of Confidentiality” from the CDC to protect your privacy.
Unless you consent, researchers cannot share or release information that may identify you1,
with a few exceptions2 (please see footnotes).
You will be given $25 as a token of our appreciation.

If you wish to continue with this survey, please click next page.

1

Unless you consent, researchers cannot release information that may identify you for a legal action, a lawsuit, or as
evidence. This protection applies to requests from federal, state, or local civil, criminal, administrative, legislative,
or other proceedings. As an example, the Certificate would protect your information from a court subpoena.
2

The Certificate does not protect your information if a federal, state, or local law says it must be reported. For
example, some laws require reporting of abuse, communicable (contagious, infectious) diseases, and threats of harm
to yourself or others. The Certificate cannot be used stop a federal or state government agency from checking
records or evaluating programs. The Certificate does not stop reporting required by the U.S. Food and Drug
Administration (FDA). The Certificate also does not stop your information from being used for other research if
allowed by federal regulations.
Researchers may release your information when you consent. For example, you may give them permission to release
information to insurers, your doctors, or any other person not connected with the research. The Certificate of
Confidentiality does not stop you from releasing your own information. It also does not stop you from getting copies
of your own information.

Care Provided to Patients with Chronic Pain
1. Approximately how large has your outpatient primary care panel of patients aged 18 years
and older been over the past 6 months?
Approximately ____ patients

2. In the last 6 months, approximately how many patients with chronic pain aged 18 years and
older did you treat in an outpatient setting? Chronic pain is defined as pain lasting longer than
3 months, or past the time of normal tissue healing. This does not include patients receiving
palliative care or with pain related to active cancer. This question asks about patients with
chronic pain receiving any kind of treatment, including opioid or nonopioid treatments, or no
treatment at all.
Approximately ____ patients

3. In the last 6 months, approximately how many patients with chronic pain previously or
currently prescribed LTOT aged 18 years and older did you see in an outpatient setting? Again,
chronic pain is defined as pain lasting longer than three months, or past the time of normal
tissue healing, and this does not include patients receiving palliative care or with pain related
to active cancer. This question is specifically asking about patients with chronic pain currently
under your care who have been prescribed opioids to treat chronic pain (including patients who
may have been previously prescribed opioids by another clinician).
Approximately ____ patients

4a. In the last 6 months, approximately how many patients aged 18 years and older did you
newly start on opioid medication in an outpatient setting? This includes patients for whom
opioids were prescribed for acute indications.
Approximately ____ patients

4b. Approximately how many of these patients that were newly started on opioid medication
(answer to 4a) were prescribed opioids specifically to treat chronic pain?
Approximately ____ patients

Are you familiar with your health system’s chronic pain management policies/guidelines that
were implemented [insert month(s) and year]?
o No, I am not aware of any of the chronic pain policies or guidelines
o Yes, I am aware of the chronic pain policies or guidelines.

Care Provided to Patients Who are Prescribed Opioids Including for Opioid Use
Disorder
6. Do you regularly access your state Prescription Drug Monitoring Program (PDMP)?
o
o
o
o
o
o

Yes, as a prescriber → Continue to Question 7a
Yes, as a delegate → Continue to Question 7a
No, SKIP TO Q8
Not applicable, SKIP TO Q8
Don’t know, SKIP TO Q8
Other: ___________________________

7a. If yes, when you check the PDMP, is it for:
o
o
o
o

Every patient, every time
Every patient, sometimes
Some patients, every time
Some patients, sometimes

7. Are you familiar with your health system’s opioid prescribing policies/guidelines that
were implemented [insert month(s) and year]?
o No, I am not aware of any recently implemented opioid prescribing policies or
guidelines.
o Yes, I am aware of recently implemented opioid prescribing policies or guidelines.

8. Do you have the required certification (i.e., X-waiver) to prescribe buprenorphine to
patients with opioid use disorder (OUD)?
o Yes
o No → SKIP TO Q11

9.

In the last 6 months, have you prescribed buprenorphine to patients with opioid use
disorder (OUD)?
o Yes
o No

10. In the last 6 months, have you referred patients with OUD to another clinician for
OUD treatment?
o Yes
o No

Management of Chronic Pain with Opioid Therapy
When answering the next set of questions, please think about how you have treated patients with
chronic pain who are currently or were previously prescribed LTOT, both before and after
changes in your health systems’ policies or guidelines implemented around [insert month and
year]. (If your health system has implemented multiple policies/guidelines in recent years, in
answering this question please consider the first change that occurred starting in 2016.)
11. When caring for patients with chronic pain previously or currently prescribed
LTOT, did you or your team conduct these specific aspects of care before and
after guideline implementation?

NOTE: If you were not working at the health system before implementation of the first change
that occurred starting in 2016, please just respond to questions in the “Currently or After
Implementation” column.

Discussed risks and
benefits of opioid
therapy with patients
Discussed an opioid
treatment agreement
Engaged in shared
decision-making with
patients regarding
treatment of chronic
pain
Referred patients to
non-pharmacologic
therapies for pain, when
indicated (physical
therapy, acupuncture,
cognitive behavioral
therapy, etc.)
Prescribed or
recommended nonopioid pharmacologic
pain treatment, when

Before Policy/Guideline
Implementation

Currently or After
Policy/Guideline Implementation

1 (Never)..3 (Sometimes)..5 (Always)

1 (Never)..3 (Sometimes)..5 (Always)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

indicated (e.g.,
acetaminophen,
NSAIDs)
Prescribed the lowest
effective dosage when
initiating opioids (e.g.,
“start low and go slow”)
Carefully reassessed
evidence of risks and
benefits when
increasing opioid
dosage to >50 morphine
milligram equivalents
(MME)/day
Avoided increasing
opioid dosages to >90
MME/day, or carefully
justified a decision to do
so
Engaged in periodic reevaluation of opioid
therapy (i.e., dose
change; benefits/risks of
continued opioid
treatment)
Referred patients to a
pain management
specialist or clinic
Checked patients’
records in the
prescription drug
monitoring program
(PDMP) as per state
regulations
Ordered and/or
interpreted urine drug
test results
Assessed for drug-drug
interactions (e.g.,
benzodiazepines and
opioids)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5
1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Assessed patients’
current and past use of
benzodiazepines, other
sedatives, and/or
controlled substances
Assessed patients’
current use of alcohol or
illicit drugs
Assessed patients’ past
use of alcohol or illicit
drugs
Assessed whether
patients are taking more
opioids than prescribed
Assessed patients for
opioid use disorder
For patients with opioid
use disorder, provided
treatment yourself or in
your health system
For patients with opioid
use disorder, referred
outside of your health
system for treatment
Prescribed or referred
patients for naloxone
(overdose reversal drug)
when indicated
Discussed safe storage
and disposal of opioids
with patients

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Management of Acute Pain with Opioid Therapy
12. Recognizing that long-term opioid use often begins with the treatment of acute pain,
please consider how you have managed acute pain with opioids before and after
implementation of policies/guidelines in 2016 or later. When treating acute pain with
opioids, how often did you or your team conduct these specific aspects of care before
and after guideline implementation?
Before Policy/Guideline
Implementation

Currently or After
Policy/Guideline Implementation

1 (Never)..3 (Sometimes)..5 (Always)

1 (Never)..3 (Sometimes)..5 (Always)

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Prescribed the
lowest effective dose
Prescribed immediaterelease opioids
Prescribed no greater
quantity than needed for
acute pain, usually 3 or
less days

Confidence and Awareness
Confidence in Caring for Patients with Chronic Pain

13. On a scale from 1 to 5, how confident are you in your care team’s ability to conduct
each of the following clinical care activities with patients with chronic pain on
LTOT?

Provide care according to evidence-based
chronic pain guidelines for patients with
chronic pain who may be receiving opioid
therapy

1
(Not at all
confident)

2

3

4

5
(Very
confident)

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14. On a scale from 1 to 5, how confident are you in your ability to conduct each of the

following clinical care activities with patients with chronic pain on LTOT?

Provide care according to evidence-based
guidelines for patients with chronic pain who may
be receiving LTOT
Engage in difficult conversations with patients
(e.g., tapering, urine drug test or prescription drug
monitoring program results)
Develop an opioid tapering plan collaboratively
with the patient when the risks of LTOT outweigh
the benefits
Diagnose co-occurring behavioral or mental health
conditions among patients with chronic pain on
opioids
Identify patients with chronic pain who are
receiving opioids who are misusing opioids
Diagnose opioid use disorder (OUD),
distinguishing it from physical dependence, among
patients with chronic pain who receive opioids
Prescribe medications for opioid use disorder such
as buprenorphine or naltrexone
Refer patients for OUD treatment such as
methadone, buprenorphine or naltrexone

1
Not at all
confident

2

3

4

5
Very
confident

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Observations of Patients
Observations of Patients with Chronic Pain
15. When caring for patients with chronic pain who are prescribed LTOT, how often have

you noted the following with patients in the past 6 months?

Misuse of opioids

a

Use of illicit opioids
Challenges with side effects related to
opioids b
Patient experiencing poorly
controlled pain
Patient leaving practice
Patient willing to try nonpharmacologic therapy for pain
Patient willing to try non-opioid
pharmacologic treatments

Always Often Sometimes Rarely Never
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a. Drug Misuse: The use of illegal drugs and/or the use of prescription drugs in a manner other than as directed by a doctor, such as use in greater
amounts, more often, or longer than told to take a drug or using someone else’s prescription (CDC)
https://www.cdc.gov/drugoverdose/opioids/terms.html
b. Side Effects: In addition to the serious risks of addiction, abuse, and overdose, the use of prescription opioids can have a number of side
effects, even when taken as directed . https://www.cdc.gov/drugoverdose/opioids/prescribed.html#side-effects

Health System or Practice-Level Changes
Policies and Supports

16. Does your practice or health care system have a standardized opioid treatment
agreement for patients with chronic pain on LTOT?
o Yes
o No
o Don’t know
17. Does your practice or health care system have electronic health record tools (e.g.,
note templates, order sets, alerts, clinical decision support tools) to support pain
management for patients with chronic pain?
o Yes
o No
o Don’t know

Measures and Monitoring

18. Does your clinic use regular summary reports (e.g., data or quality performance
reports) for clinicians to monitor your own opioid prescribing practices?

o
o
o

Yes
No
Don’t know

19. What measures are included in the summary reports? [check all that apply]:

o Number of patients with chronic pain on long-term opioid therapy
o Patients’ opioid dosages (e.g., morphine equivalent dose [MED], or morphine
milligram equivalents [MME])

o Prescription opioid refills
o Patient-reported pain and function (e.g., PEG scores)
o Patient-reported quality of life
o Co-prescribing of benzodiazepines
o Whether treatment agreement is up-to-date
o Other (please specify): _____________________________________________
Improvement Efforts

20. Since the time that policies and guidelines were implemented in your practice, have
the strategies/interventions your health system has used for chronic pain management
impacted your day-to-day work with patients with chronic pain on LTOT?

o
o
o

Yes
No (Skip to Q21)
Don’t know (Skip to Q21)

21. How have these changes impacted your day-to-day work with patients with chronic
pain on LTOT?

o
o
o
o
o

Positively
Somewhat positively
Neither positively nor negatively
Somewhat negatively
Negatively

22. Please tell us a little more about how your day-to-day work has been impacted by
implementation of these policies/guidelines.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Challenges

23. In the last 6 months, have any of the following made it difficult for you to provide
care aligned with your health system’s current policies and guidelines for patients
with chronic pain especially those on LTOT? Please check all that apply.

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Insufficient time in office with patients with chronic pain
Patient resistance to considering changes to opioid prescriptions
Poor, cumbersome, or limited tools within the electronic health record (EHR)
Alarm fatigue from the EHR
Limited access to non-opioid pharmaceutical therapies for chronic pain
Limited access to non-pharmacological therapies for chronic pain
Poor or no coverage of non-pharmacologic therapies by insurance
Limited access to medication for opioid use disorder, (e.g., buprenorphine,
methadone, or naltrexone)
Other clinicians abandoning patients who are receiving long-term opioids
Working with new patients already receiving opioids long-term
Limited education/knowledge on how to appropriately taper patients off of opioids
Limited confidence/experience in having difficult conversations with patients (e.g.,
tapering)
Patients using illicit opioids or other illicit drugs
Not knowing if and/or when a patient overdosed on opioids or other drugs
Social determinants of health factors (such as poverty, food insecurity,
homelessness) affecting patients
Too many other initiatives taking place that compete for time and/or resources
Not enough resources to change my practice to be more concordant with evidencebased guidelines
Other (please specify): ___________________________

Major Disruptions

24. Have there been any of the following major changes in your health system in the last
12 months?3

3

No major disruption

One major
disruption

More than one major
disruption

New electronic health record (EHR)
system
Moved practice to new location

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Expanded or acquired additional
clinics/practices/organizations
Lost one or more clinicians

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Lost one or more office managers

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Lost one or more head nurses

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Been purchased by, or affiliated with,
another organization
New billing system

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COVID-19 pandemic had significant
impact on our practice. Please
describe________________________
_______________________________
_______________________________

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Other: _________________________
_______________________________

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This item was used in AHRQ’s EvidenceNOW initiative, although the COVID-19 item was added. See:
Balasubramanian BA, Marino M, Cohen DJ, Ward RL, Preston A, Springer RJ, Lindner SR, Edwards S,
McConnell KJ, Crabtree BF, Miller WL. Use of quality improvement strategies among small to medium-size
US primary care practices. The Annals of Family Medicine. 2018 Apr 1;16(Suppl 1):S35-43.

Managing Work-Related Stress

25. In the last 6 months, how much did caring for patients with chronic pain who are on
long-term opioid therapy, or for whom you are considering initiating opioid therapy,
contribute to your overall level of stress at work? (please select one):

o
o
o
o
o

Not at all
Very little
Somewhat
Moderately
Extremely

26. Do you engage in strategies to overcome stress and burnout?

o
o
o

Yes
No
Don’t know

Respondent Characteristics
31.What is your age?
o
o
o
o
o
o

18-29 years
30-44 years
45-54 years
55-64 years
65 or older
Prefer not to answer

32. How do you describe your gender identity?
o Male
o Female
o Male-to-female transgender (MTF)
o Female-to-male transgender (FTM)
o Other gender identity (specify)_____________________

33. Which of the following best represents how you think of yourself?
o
o
o
o
o

Gay (lesbian or gay)
Straight, this is not gay (or lesbian or gay)
Bisexual
Something else
I don’t know the answer

34. What is your ethnicity?
o Hispanic or Latino
o Not Hispanic or Latino

35.What is your race?
o
o
o
o
o

American Indian or Alaskan Native
Asian
Black or African-American
Native Hawaiian or other Pacific Islander
White

36. How long have you worked in this health system?

o Less than one year
o 1-5 years
o 6-10 years
o More than 10 years
37. When caring for patients with chronic pain, are you able to consult with a specialist, as
needed, such as the following types of staff? Please select all that apply.
o Clinical pharmacist

o
o
o

Pain management specialist
Addiction specialist

Mental health clinicians (e.g., therapists, psychologists, psychiatrists, social
workers)

o

Specialists in nonpharmacologic treatment for pain (e.g., acupuncture, physical

therapy)

38. Is there anything else that would be helpful to understand about your experience providing
care to patients with chronic pain generally, or for those on long-term opioid therapy?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

END OF SURVEY
Thank you for completing this survey! Your input is greatly appreciated.