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Primary care physicians’ perspectives on Veterans who obtain prescription opioids from multiple healthcare systems

Felicia R. Bixler, MS, Thomas R. Radomski, MD, MS, Susan L. Zickmund, PhD, KatieLynn M. Roman, BA, Leslie R. M. Hausmann, PhD, Carolyn T. Thorpe, PhD, MPH, Jennifer A. Hale, BS, Florentina E. Sileanu, MS, Walid F. Gellad, MD, MPH


Objective: To characterize primary care physicians’ (PCPs’) perceptions of the reasons patients receive opioid medications from both VA and non-VA healthcare systems.

Design: Qualitative.

Setting: Department of Veterans Affairs (VA).

Participants: Forty-two VA PCPs who prescribed opioids to at least 15 patients and who practiced in Massachusetts, Illinois, or Pennsylvania.

Methods: Thirty-minute, semistructured telephone interviews were conducted in 2016, addressing topics regarding PCPs’ experiences and perspectives on patients who use both VA and non-VA healthcare systems to obtain prescription opioids. The analysis focused on two questions: attributes that PCPs believe characterize dual-use patients and reasons that PCPs believe patients obtain opioids from both VA and non-VA sources.

Results: PCPs identified multiple attributes of, and reasons for, patients obtaining opioid medications from both VA and non-VA healthcare systems, including pain issues, opioid misuse, having healthcare managed through multiple healthcare systems, and transferring care between systems. More than half of the PCPs identified addiction and diversion as key attributes and reasons why patients obtain prescription opioids from multiple sources. PCPs also identified several behavioral and psychological factors as attributes of these patients.

Conclusions: PCPs within the VA have varying perceptions of patients obtaining opioid medications from multiple healthcare systems, with pain complaints and opioid misuse as the primary themes. This knowledge about PCPs’ perceptions can be incorporated into interventions to better manage pain and prescription opioid use by VA patients.


primary care, opioids, pain management, Veterans, dual use

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