A snap shot of patients' recall, attitudes, and perceptions of their pain contracts from a family medicine resident outpatient clinic

Abstract

Objective: Determine patient recall, attitudes, and perceptions of their pain contract in a family medicine resident outpatient clinic. Design: A cross-sectional study design using a telephone survey to all eligible subjects who signed a hardcopy pain contract from August 29, 2014 to May 19, 2016 at a resident outpatient clinic. Setting: Penn State Hershey Family and Community Medicine Residency clinic. Participants: All patients who signed a hardcopy pain contract at the practice site who met specific inclusion criteria. Main outcome measures: What proportions of items are remembered from the standardized Penn State Hershey pain contract and does recall vary with time of contract signing. Secondary outcome measures: Patient attitudes and perceptions of their pain contract. Results: Ninety-five percent of patients recalled agreeing to random urine drug screens (UDS) and 60 percent recalled they were not to receive prescriptions from another provider unless approved by their practice site. The recall rate for the remaining 33 items in the contract ranged from 0 percent to 20 percent. The highest recall rate was for contracts signed between 0-3 months. Patient feedback regarding the pain contract was recorded and while five were positive or neutral, 15 patients recorded negative attitudes toward the process, the physician, and/or the UDS. Conclusions: This study highlights limited recall and negative patient attitudes toward the pain contract. Considering the public health concerns with regard to the current opioid epidemic in the United States, additional training of providers, redesign of pain contracts and new models for informing patients about safe chronic pain management may be warranted.