1 Survey of Primary Care Clinicians about Opioid Use among

OMB

Attachment A

Survey of Primary Care Clinicians about Opioid Use among Older Adults

Please return this survey in the enclosed envelope to:

Abt Associates

10 Fawcett Street, Ste. 5

Cambridge, MA 02138

DIRECTIONS

This survey is for clinicians who treat older adults in primary care settings in the United States. We would like to know about your experiences caring for older adults with chronic pain on opioids. Your participation in this survey is greatly appreciated!

• This survey is supported by the Agency for Healthcare Research and Quality (AHRQ) and is designed to assess clinician experiences caring for older adult patients with chronic pain on opioids. Abt Associates, a private research company, is conducting this study on behalf of AHRQ. You were randomly selected to participate in the survey. We anticipate that it will take you roughly 15 minutes to complete the survey and are offering $25 as a token of our appreciation for completing the survey.

• The survey is voluntary, but your input is critical for helping us understand and support clinicians in caring for patients with chronic pain on opioids.

• If you participate, you do not have to answer every question. However, we encourage you to respond to this survey as completely and accurately as possible.

• Your answers to this survey will be kept private and secure and will be confidential, and only combined with other survey responses and presented in aggregate form in our reports. Abt Associates, and AHRQ are committed to protecting data confidentiality and privacy.

• This survey and the answers you provide will reside in a secure, protected computing environment, and measures are in place to prevent a breach of the information collected.

If you have any questions about this survey, please do not hesitate to contact us at OpioidsOlderAdults@abtassoc.com.

Instructions (paper survey only):

When providing each response:

• Please read each question carefully and shade in the circle next to the response that most closely represents your experience.

• Please shade only one circle for each question, unless asked to mark all that apply.

• Please use a PENCIL in case you want to change your answer.

• Please do NOT use felt tip pens.

• Please erase cleanly or white out any marks you wish to change.

Opioid Prescribing and Managing Opioids in Your Practice

We would like to know about your personal experience caring for patients with chronic pain on opioids.

	17 years old or younger	18 to 64 years old	65 to 79 years old	80 years old or older
What is the approximate age distribution of your patients? Your best estimate is fine.	%	%	%	%	= 100%

2. In a typical work week, about how much of your time is spent on the following?

   	Almost all of my time	Most of my time	Some of my time	Hardly any of my time	None of my time
   Caring for patients with chronic pain	⚪	⚪	⚪	⚪	⚪
   Caring for patients with chronic pain on opioids	⚪	⚪	⚪	⚪	⚪  GO TO #24

3. In the last three months, have you prescribed opioids to patients with chronic pain?

• Yes

• No

4. Approximately what proportion of the patients aged 65 or older that you saw in the last six months were currently prescribed opioids by you or someone else?

• I do not treat patients aged 65 or older  GO TO #24

• No patients aged 65 or older were prescribed opioids  GO TO #24

• 1-5% of all patients aged 65 or older were prescribed opioids

• 6-10% of all patients aged 65 or older were prescribed opioids

• 11-25% of all patients aged 65 or older were prescribed opioids

• 26-50% of all patients aged 65 or older were prescribed opioids

• 51-100% of all patients aged 65 or older were prescribed opioids

5. Thinking about your patients aged 65 or older who are currently on opioids, approximately what proportion have been taking opioids for three months or more?

   • No patients aged 65 or older currently taking opioids have used them for 3 months or more

   • 1-5% of patients aged 65 and older currently taking opioids have used them for 3 months or more

   • 6-10% of patients aged 65 and older currently taking opioids have used them for 3 months or more

   • 21-25% of patients aged 65 and older currently taking opioids have used them for 3 months or more

   • 26-50% of patients aged 65 and older currently taking opioids have used them for 3 months or more

   • 51-100% of patients aged 65 and older currently taking opioids have used them for 3 months or more

6. When caring for patients aged 65 and older with chronic pain on opioids in the last three months, about how often did you or your team conduct these specific aspects of care? Please answer each item thinking specifically about your patients aged 65 and older.

   	Always	Often	Sometimes	Rarely	Never
   Discuss risks and benefits of opioid therapy with patients	⚪	⚪	⚪	⚪	⚪
   Discuss a treatment agreement (pain contract)	⚪	⚪	⚪	⚪	⚪
   Discuss storage and disposal of opioids	⚪	⚪	⚪	⚪	⚪
   Engage in shared decision making with patients regarding treatment of chronic pain	⚪	⚪	⚪	⚪	⚪
   Refer patients to physical therapy for pain	⚪	⚪	⚪	⚪	⚪
   Refer patients to acupuncture for pain	⚪	⚪	⚪	⚪	⚪
   Refer patients to other non-pharmacologic therapies for pain	⚪	⚪	⚪	⚪	⚪
   Check patients’ records in the Prescription Drug Monitoring Program (PDMP)	⚪	⚪	⚪	⚪	⚪
   Order and/or interpreting urine drug test results	⚪	⚪	⚪	⚪	⚪
   Assess for constipation	⚪	⚪	⚪	⚪	⚪
   Assess for fatigue	⚪	⚪	⚪	⚪	⚪
   Assess for confusion	⚪	⚪	⚪	⚪	⚪
   Assess for functional status decline	⚪	⚪	⚪	⚪	⚪
   Assess for depression and/or anxiety	⚪	⚪	⚪	⚪	⚪
   Assess for decreased cognition	⚪	⚪	⚪	⚪	⚪
   Assess for drug-drug interactions	⚪	⚪	⚪	⚪	⚪
   Assess patients’ current and past use of benzodiazepines, other sedatives, and/or controlled substances	⚪	⚪	⚪	⚪	⚪
   Assess patients’ current and past use of alcohol or illicit drugs	⚪	⚪	⚪	⚪	⚪
   Assess whether patients are taking more opioids than prescribed	⚪	⚪	⚪	⚪	⚪
   Assess patients for opioid use disorder	⚪	⚪	⚪	⚪	⚪
   For patients with opioid use disorder, refer to or treat them with medication assisted treatment (MAT)	⚪	⚪	⚪	⚪	⚪
   Prescribe or refer patients for naloxone (overdose reversal drug)	⚪	⚪	⚪	⚪	⚪

7. Do you conduct any of the above aspects of care with only patients aged 65 and older (i.e., not with patients younger than 65

• No

• Yes, please describe: _______________________________________________

___________________________________________________________________

8. 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 aged 18 to 64 and 65 or older with chronic pain on opioids?

   	Patient age group	1 Not at all confident	2	3	4	5 Very confident
   Provide care according to regulations and guidelines for patients with chronic pain on opioids	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪
   Develop a taper plan collaboratively with the patient when appropriate	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪
   Engage in difficult conversations with patients (e.g., tapering, urine drug test or prescription drug monitoring program results)	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪
   Diagnose co-occurring behavioral or mental health conditions among patients with chronic pain on opioids	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪
   Identify patients with chronic pain on opioids who are misusing opioids	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪
   Diagnose opioid use disorder (OUD),distinguishing it from physical dependence, among patients with chronic pain on opioids	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪
   Prescribe or refer patients for medication-assisted treatment (MAT) like buprenorphine/naloxone or naltrexone	18-64	⚪	⚪	⚪	⚪	⚪
   	65+	⚪	⚪	⚪	⚪	⚪

9. When caring for patients with chronic pain on opioids during the last three months, how often have you observed the following with patients aged 18 to 64 and 65 or older?

	Patient age group	Always	Often	Sometimes	Rarely	Never
Misuse of opioids1	18-64	⚪	⚪	⚪	⚪	⚪
	65+	⚪	⚪	⚪	⚪	⚪
Challenges with side-effects related to opioids2	18-64	⚪	⚪	⚪	⚪	⚪
	65+	⚪	⚪	⚪	⚪	⚪
Patient experiencing confusion	18-64	⚪	⚪	⚪	⚪	⚪
	65+	⚪	⚪	⚪	⚪	⚪
Patient experiencing fatigue	18-64	⚪	⚪	⚪	⚪	⚪
	65+	⚪	⚪	⚪	⚪	⚪
Patient is willing to try non-pharmacologic therapy for pain	18-64	⚪	⚪	⚪	⚪	⚪
	65+	⚪	⚪	⚪	⚪	⚪

1. Misuse of opioids can include taking too much medicine, taking someone else’s medicine, taking it in a different way than you are supposed to, or taking the medicine to get high. Citation: National Library of Medicine (NLM), MedlinePlus. “Opioid Misuse and Addiction.”

2. Side-effects related to opioids can include drowsiness, mental fog, nausea, constipation, and slowed breathing. Citation: National Library of Medicine (NLM), MedlinePlus. “Opioid Misuse and Addiction.”

10. Are you waivered to prescribe buprenorphine to patients with opioid use disorder?

• Yes

• No  GO TO #12

11. In the last three months, have you prescribed buprenorphine or methadone to patients with opioid use disorder? Please select all that apply.

• Yes, including for patients aged 18-64

• Yes, including for patients aged 65 or older

• No

12. Before reading each of the following statistics on opioid use and misuse in older adults, how aware were you about these statistics?

	Not at all aware	Slightly aware	Somewhat aware	Moderately aware	Very aware
During 2018, an estimated 35% of persons aged 65 or older in the United States reported any opioid use during 20183	⚪	⚪	⚪	⚪	⚪
In 2018, it was estimated that 1.3% (681,000) persons aged 65 or older in the United States misused prescription pain relievers during the prior year4	⚪	⚪	⚪	⚪	⚪
In 2017, there were 1,724 opioid-related overdose deaths among persons aged 65 or older in the United States5	⚪	⚪	⚪	⚪	⚪
3. Substance Abuse and Mental Health Services Administration (SAMHSA). 2018 National Survey on Drug Use and Health (NSDUH), Public Online Data Analysis System. Retrieved from: https://pdas.samhsa.gov/#/survey/NSDUH-2018-DS0001?column=AGE2&results_received=true&row=PNRANYYR&run_chisq=false&weight=ANALWT_C 4. Substance Abuse and Mental Health Services Administration (SAMHSA). 2018 National Survey on Drug Use and Health (NSDUH), Public Online Data Analysis System. Retrieved from: https://pdas.samhsa.gov/#/survey/NSDUH-2018-DS0001?column=AGE2&results_received=true&row=OPINMYR&run_chisq=false&weight=ANALWT_C 5. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427. Available at: https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm

Available Practice or System Resources Related to Chronic Pain or Opioids

We would like to know whether the following resources are available in your practice.

13. Does your practice or health care system have policies or guidelines related to providing care for patients with chronic pain on opioids?

• Yes

• No  GO TO #15

• Don’t know  GO TO #15

14. Does your practice or health care system have policies or guidelines related to providing care for patients with chronic pain on opioids that are specific to adults aged 65 and older?

• Yes

• No

• Don’t know

15. Does your practice or health care system have a standardized treatment agreement (pain contract) for patients with chronic pain on opioids?

• Yes

• No  GO TO #17

• Don’t know  GO TO #17

16. Does your practice or health care system have a standardized treatment agreement (pain contract) for patients with chronic pain on opioids specific to adults aged 65 and older?

• Yes

• No

• Don’t know

17. Does your practice or health care system have electronic health record tools (e.g., notes templates, alerts, clinical decision-support tools) to support care for patients with chronic pain on opioids?

• Yes

• No

• Don’t know

18. Does your practice or health care system use a registry or other tracking system to help care for patients with chronic pain on opioids?

• Yes

• No

• Don’t know

19. Does your practice or health care system provide financial or administrative support to clinicians to apply for a buprenorphine waiver? Please select all that apply.

• Yes, financial support

• Yes, administrative support

• No

• Don’t know

20. If your practice is part of a health care system, does your system have any policies, guidelines or quality improvements efforts related to opioids that is specifically focused on older adults? If so, please briefly describe:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

21. What strategies has your practice successfully used to improve opioid prescribing and pain management practices specifically for adults aged 65 and older?

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

22. What resources or supports do you feel would most improve your ability to prescribe and manage opioids, manage opioid use disorder (OUD), and/or manage chronic pain specifically for adults aged 65 and older?

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

23. Is there anything else that would be helpful to understand about your experience providing care to patients on opioids, specifically for adults aged 65 and older?

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

About You and Your Practice

Finally, please tell us a little about you and your practice.

	Asian	Black or African American	White	Other
What is the approximate racial distribution of your patients? Your best estimate is fine.	%	%	%	%	= 100%

25. Approximately what percent of your clients identify as Hispanic? Your best estimate is fine.

    %

26. Do you have a specialty in or are you credentialed in geriatrics?

• Yes

• No

27. When caring for patients aged 65 or older, are you able to consult in-person or by phone, as needed, with the following staff working at your practice? Please select all that apply.

• Geriatrician or geriatric nurse practitioner (NP)

• Clinical pharmacist

• Pain management specialist

• Addiction specialist

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

28. Currently, how many physicians work in your practice, across all locations, including both full and part-time physicians? Your best estimate is fine.

    # physicians

29. Which of the following best describes your practice's ownership?

• Clinician-owned solo or group practice

• Hospital/health system owned

• Health Maintenance Organization

• Federally Qualified Health Center or look-alike

• Non-federal-government clinic (e.g., state, county, city, public health clinic, etc.)

• Academic health center/faculty practice

• Federal (military, Veterans Administration, Department of Defense)

• Other

Thank you very much.

We greatly appreciate your participation in this survey.