Dentist Interview Guide

Attachment E. Dentist Interview Guide

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OMB No: xxxx-xxxx

Exp. Date: xx-xx-xxxx

Public Reporting burden of this collection of information is estimated at 60 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn:  PRA (xxxx-xxxx).

Introduction 

 

Hello, I’m (NAME) from Abt Global. Thank you for taking the time to speak with me.

As a reminder, in 2022 the Centers for Disease Control and Prevention (CDC) released the Clinical Practice Guideline for Prescribing Opioids for Pain, which provided up to date evidence regarding pain management approaches and emphasizes the need for prescribers to be focused on patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. For shorthand, we call it the 2022 CDC Clinical Practice Guideline throughout this interview.

General Dynamics Information Technology (GDIT) and Abt Global are conducting a research study for the CDC to better understand the adoption, implementation, and outcomes of the 2022 CDC Clinical Practice Guideline on evidence-based care for pain management.

This interview aims to better understand your experiences as a dentist with managing patients’ pain and implementing pain management policies and guidelines, and the effects of these policies and guidelines on patient outcomes. This study is funded by the CDC.

Before we begin, I want to read a few points about this interview:

• Participating in this interview is voluntary.

• You will receive a $75 virtual gift card for participating in this interview.

• Your answers will not be connected to any information that could individually identify you, such as your name in any internal CDC reports or publicly-facing publications.

• You can decline to answer any question, without affecting your continued participation in the interview or your relationship with the CDC. There is a small risk of loss of privacy. We have many procedures in place to reduce this risk.

• This interview will last approximately 60 minutes.

We also would like to record the interview, so we do not miss anything. The recording will not be shared with anyone outside Abt Global, GDIT or CDC. We will use this recording to make de-identified transcripts of the recordings, which will be shared with GDIT and CDC. This recording will be deleted once our notes from the interview have been completed. 

Do any of you have any questions before we get started?

Do I have your consent to participate in this interview? Yes _____ No _____

May we record this interview? Yes _____ No _____

INDIVIDUAL APPROACH TO PAIN AND OPIOID MANAGEMENT

SAY: I’m going to ask a few questions about your prescribing and management of patients who have acute, subacute, or chronic pain.

1. Could you start by describing what types of pain (e.g., acute subacute, chronic) and specific example pain conditions do you treat (e.g., extraction, abscess) in your dental practice?

PROBES: What is the typical length of treatment for dental pain? Do you commonly treat dental pain long-term?

2. Can you describe your overall approach to prescribing and management of patients’ various types of dental pain you encounter?

PROBES: How do you discuss goals of pain management with your patients? Discuss treatment options? Discuss risks/benefits of opioids? Does your approach differ depending on the type of pain (i.e., acute, subacute, chronic)? How often do you refill medications for patients’ dental pain? How is your approach different if the patient suffers from chronic pain or is already taking pain medications? Do you check a prescription drug monitoring program (electronic database that tracks controlled substance prescriptions in a state, PDMP) before prescribing an opioid?

3. Tell me about a time when you had a patient with an acute dental condition and discussed pain treatment options, including the risks/benefits of opioid therapy? How did you approach the situation?

4. Tell me about a time when you had a new patient who was taking what you consider to be a high dosage of opioids already but had dental pain you needed to manage? How did you approach the situation?

5. In what situations would you not feel comfortable providing pain management?

6. In what situations would you not feel comfortable using opioids for pain management?

DENTAL PRACTICE POLICIES

SAY: I’m now going to ask a few questions about your dental practice’s policies, processes, procedures, and supports that are in place to manage patients with acute, subacute, or chronic pain.

7. Does your dental practice have specific protocols, policies, or guidelines for pain management? If so, what are they? What about policies specifically for prescribing opioids?

PROBES: Check the PDMP before prescribing, treatment agreements, prescribing when patient is taking opioid for another pain condition, not prescribing opioids except for specific situations, ADA guidelines, etc.

8. What are first line therapy options for dental pain (e.g., NSAIDs)? When, if at all, do you consider opioid medications? Which opioids do you consider to treat dental pain? What nonpharmacologic therapies do you use for dental pain, if any?

IMPLEMENTATION SUPPORT

SAY: I’m now going to ask a few questions about YOU and YOUR practice’s role in supporting the roll out, awareness, and uptake of the 2022 CDC Clinical Practice Guideline with clinicians and in clinical practices.

9. How did you learn of the 2022 CDC Clinical Practice Guideline?

10. What is your general sense of the 2022 CDC Clinical Practice Guideline and its recommendations?

PROBES: Communication from your practice? Communication from your professional association? Communication from CDC?

11. What, if anything, has changed in your practice because of the 2022 CDC Clinical Practice Guideline? What, if anything, has changed in your own approach to care?

PROBES: Which of the Guideline recommendations have you implemented? If there were changes in your practice how were those changes implemented? What supports did you receive for the changes? Did you experience any challenges with the changes?

12. From your perspective, how has the 2022 CDC Clinical Practice Guideline been received within the dental community?

13. It's been about two years since the 2022 CDC Clinical Practice Guideline was rolled out. In this time have you observed any benefits and challenges for patients? What about benefits or challenges for dentists? Any unintended consequences? If yes, please share some details or examples.

14. What, if any, has been the reaction from patients to any practice changes that resulted from the 2022 CDC Clinical Practice Guideline?

15. What, if any, has been the reaction from caregivers to any practice changes that resulted from the 2022 CDC Clinical Practice Guideline?

16. Part of the 2022 CDC Clinical Practice Guideline’s aim was to re-emphasize the need for patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. Do you think the recommendations in the 2022 CDC Clinical Practice Guideline facilitate accomplishing these goals? Let’s walk through each one…

FOLLOW-UPS: Does implementing the recommendations from the 2022 CDC Clinical Practice Guideline…

• Promote patient-centered care? In what ways?

• Encourage shared decision making between patients and dentists? In what ways?

• Improve equitable care for those in pain? In what ways?

• Address inequities between patients, or in patient care more generally? In what ways?

• Allow for needed flexibility for dentists as they care for patients in pain? In what ways?

• Are there specific recommendations that do NOT achieve some of these goals? Why not?

17. What have been some of the barriers to implementing the guideline recommendations in dental practices? What have been the facilitators to implementation?

18. What are some changes you have seen (positive or negative; intended or unintended) in clinical practice since the release of the 2022 CDC Clinical Practice Guideline that you weren't expecting?

RECOMMENDATIONS OR LESSONS LEARNED

Thinking about the release of the 2022 CDC Clinical Practice Guideline overall…

19. What are some of the key takeaways or lessons learned from implementing the recommendations in the 2022 CDC Clinical Practice Guideline?

PROBES: Any takeaways or lessons learned from YOUR experiences, with the 2022 CDC Clinical Practice Guideline?

PRACTICE AND CLINICIAN CHARACTERISTICS

Before we end today, we’d like to ask you some brief questions about your patient population and your demographics.

The following questions ask in more detail about the characteristics of your current patient panel, as well as yourself.

20. What is the size of your patient panel?

• 1 - 999

• 1,000 – 1,499

• 1,500 – 1,999

• 2,000 – 2,499

• 2,500 – 3,000

• 3,000+

• Don’t know

21. Zip code and state of your primary practice:

Zip Code: _________

State: ___________

22. What is the approximate age distribution of your patients? If you treat few or no patients in a group, report 0 percent. The percentages should total to 100%.¹

17 years old or younger _____%

18 to 64 years old _____%

65 years old or older _____%

Don’t know _____%

23. For the following question, please give your best estimate. If you treat few or no patients in a group, report 0 percent. The percentages should total to 100%. What percent of your current patient population identify as the following:

American Indian or Alaska Native? ____ %

Asian? ___%

Black or African American? ___ %

Hispanic or Latino? ____ %

Middle Eastern or North African? __ %

Native Hawaiian or Pacific Islander? ____%

White? ___%

Mixed race and/or ethnicity? __ %

Unknown/Not Sure __ %

24. To the best of your ability, please estimate what percent of your patient population identifies as the following: 

If you treat few or no patients in a group, report 0 percent. Because gender can be a complex identity, the percentages may not total to 100%.

Female____ %

Male____ %

Transgender, non-binary, or another gender _____%

Unknown/Not sure ___ %

25. Number of years practicing dentistry? ________

26. Which categories best describe your race and/or ethnicity? Select all that apply.

• American Indian or Alaska Native

• Asian

• Black or African American

• Hispanic or Latino

• Middle Eastern or North African

• Native Hawaiian or Pacific Islander

• White

• Not sure/Prefer not to say

27. Are you: [Mark all that apply.]

• Female

• Male

• Transgender, non-binary, or another gender

• Not sure/Prefer not to say

CLOSING

28. Before we conclude today’s interview, is there anything else that you would like to share?

29. Are there any questions before we wrap up? [Address questions]

1 Adapted from AHRQ Opioids among Older Adults – Clinician Survey