Objectives Use of patient provider agreements (PPAs) is increasing yet there is limited evidence on the effectiveness of PPAs to prevent prescription opioid misuse and diversion and few guidelines for providers. the content analysis of the transcripts and reached consensus on recurring themes. LY2157299 Key findings PPA use varied according to physician specialty. General practitioners used PPAs the least but reported increasing pressure from liability insurers to use them. Many patients reported signing a PPA in the emergency room of a hospital. Prescribers and patients reported a lack of understanding among patients concerning the purpose and content of the PPA. Prescribers questioned the legal status of the PPA while patients believed that this PPA was a legal document intended to protect prescribers. Patients and prescribers valued PPA content items differently although both groups agreed that signing a PPA would not prevent opioid misuse. Conclusions We identified several themes concerning the administration content LY2157299 effectiveness and utility of PPAs that highlight areas of research to improve PPAs. We also describe trends requiring further investigation. Understanding content of importance to patients will facilitate the development of a patient-centred PPA. Keywords: focus group opioid contract opioids patient provider agreement Introduction There has been an explosion in the use of opioid analgaesics in the USA over the past decade. Prescriptions for opioid analgaesics dispensed by retail pharmacies increased 48% from 2000 to 2009 and the milligram per person use of prescription opioids increased 402%.[1 2 Opioids can cause serious adverse events and as a consequence of greater access increases in emergency department visits and drug overdose deaths due to opioids have been reported.[1 3 To increase patient safety and education and reduce adverse events evidence based guidelines for safe prescribing of opioids including patient prescriber agreements (PPAs) have been developed.[6 7 Many organizations including the American Pain Society American Society of Addiction Medicine and British Pain Society encourage their members LY2157299 to use PPAs when prescribing opioids for chronic pain relief to help prevent misuse and diversion. A PPA also called a patient prescriber contract opioid contract or opioid agreement is usually a formal written agreement between a patient and healthcare provider that details the responsibility of each participant during therapy with controlled substances typically opioid analgaesics. The purpose of the PPA is usually to improve the quality of patient care and reduce Rabbit Polyclonal to AF4. the potential for misuse and diversion of opioid analgaesics.[8] PPAs vary in content but most detail patient responsibilities concerning improper use of controlled substances refills drug testing one prescriber/one pharmacy rule and consequences of noncompliance with the PPA.[8 9 Although use of PPAs is increasing there is limited evidence on the effectiveness of PPAs to LY2157299 prevent misuse.[7] A 2010 systematic review examining the effectiveness of PPAs to reduce opioid misuse concluded that among 11 studies meeting inclusion criteria for the review there was only weak evidence of effectiveness.[10] However the authors noted several limitations of the studies in the review including multicomponent interventions and poor outcome definitions.[10] In addition to lack of evidence of effectiveness criticisms of PPAs include: use of language that is poorly understood by patients or has an adversarial or intimidating tone; use of the word ‘contract’ which has legal implications; and potential breach of trust of the patient-physician relationship.[10 11 Efforts to improve PPAs and to prevent opioid misuse require both patient and prescriber input. The objective of this study was to improve our understanding of patient and prescriber perceptions of the administration content and effectiveness of PPAs using focus group methodology. Methods We conducted eight focus groups from July 16 to 24 2013 to collect information on patient and prescriber experiences with and perceptions of PPAs. Focus groups are LY2157299 group discussions organized to explore a specific set of issues.[12-14] They produce information on participants’ experiences and perceptions and rely on interaction between group members. Focus groups are not intended to provide.