number of facilities providing substance use services . 12 Providers and patients who utilize opioids for treatment { Sanders , 2017 # 50241 } are directly impacted by these policies , guidelines , and legislative actions , some with unintended consequences for those who seek treatment and providers who may offer it . In this study , we explore the viewpoints of providers on the use of opioids and additional treatments for OUD following enactment of the aforementioned laws and policies .
METHODS SURVEY DEVELOPMENT
Survey development consisted of three stages . Initially , literature was reviewed on state and federal policy and provider practices in pain management and MAT and supplemented with expert discussion of practice and policy fields of WV . Secondly , preliminary versions of the survey were built and reviewed by several MAT prescribers for refinement . Lastly , an updated survey version was piloted with a focus group of 12 providers practicing across specialties and site locations in WV to assess the tool for relevance , functionality , and readability for the target population .
This survey was anonymous and included a mixed-methods approach piloted and refined with MAT prescribers . Both quantitative and qualitative questions were included to encourage more candid and comprehensive feedback from providers without posing risk of identification on controversial and value-laden topic areas . Domains assessed by the survey included provider selfreported characteristics of acute and chronic pain management and MAT and specific factors as follows : practice , treatment , and prescribing ; pertinent training , waivers , and continuing medical education ; legislative and licensure requirements and restrictions ; treatment guidelines ; screening and risk assessment tools ; accountability and monitoring systems ; and perceived barriers and benefits , as well as capacity , support , and resource needs .
Among 162 total question fields , 20 core questions were presented to every respondent . Through branching logic , respondents opted into additional question fields based on prior responses to practice and treatment characteristics . Respondents who answered affirmatively to the core questions , “ Does your current practice include treatment for [ Chronic Pain / Acute Pain / Medication-Assisted Treatment ]?” were presented . An additional 19 questions were presented to participants across treatment areas dependent on prior responses to treatment guidelines , risk assessment tools , restrictions , willingness to expand practice , benefits , barriers , and so on . Remaining questions were open-ended items such as , “ Which restrictions should be placed on prescriptions from licensed providers ? Please explain .”
The majority of question items were multiple choice and contained a five-point Likert scale , asking respondents to answer questions and rate agreement related to their practice , experiences , and perceptions in chronic pain , acute pain , and MAT management , as applicable . Numerical scales ( 0-100 ) were utilized for questions involving estimates of patients , prescribing , and unmet need .
DATA COLLECTION
Data collection occurred between February and July 2019 . This survey was authorized and distributed electronically by email to licensees and members of the following state institutions : West Virginia Board of Medicine ( on behalf of the West Virginia Bureau for Public Health ), West Virginia Osteopathic Medical Association , West Virginia Board of Veterinary Medicine , West Virginia Board of Optometry , West Virginia Board of Dentistry (* emailed licensees directly with approval of board ), West Virginia Nurses Association , and the West Virginia RN Board ( published in newsletter ). Electronic survey distribution was consistent with best practices for anonymous and accessible survey design in this demographic of providers . REDCap ® , a cloud-based Health Information Portability and Accountability Act compliant platform , was utilized and tested by a focus group prior to administration . Upon documented agree - ment / consent to participate , the board / association representative emailed an Institutional Review Board ( IRB ) -approved survey introductory email , including the unique study link to their members / licensees . The survey link was active for four months ( February-June 2019 ), with a reminder sent to respondents in approved instances six to eight weeks following the initial email . All active providers qualified to practice and prescribe controlled substances in WV were eligible to participate in this survey a single time , as agreed upon in the study ’ s initial consent page and determined by demographic and practice questions within the survey itself . Data in Figure 3 was provided as de-identified categorical data from WV Medicaid .
DATA ANALYSIS
Survey responses were displayed via RED- Cap ® as basic descriptive statistics and aggregate graphical format as well as exported into SPSS format . Descriptive statistics summarized respondents ’ quantitative survey responses . Open-ended items offered respondents additional opportunities to share their insight . Qualitative responses were analyzed using an inductive analysis technique to form themes and patterns throughout . Major messages expressed were compiled and reviewed with consensus by authors .
ETHICS APPROVAL
This study was granted exemption status by Marshall University ’ s Human Research Protection Program in conjunction with IRB Authorization Agreement of the West Virginia School of Osteopathic Medicine .
RESULTS
A total of 303 respondents ( 2.7 % response rate from a single mailing ) completed the survey with a mean of 22.04 practice years ( range = 0-50 years ). Response rate was calculated from all surveys from a distribution of all prescribers . Gender breakdown included 54.1 % men , 43.8 % men , and 2.1 % other / no answer . Respondents included the following : primary care physician ( 25.1 % - Doctor of Medicine , Doctor of Osteopathic Medicine ; n = 76 ), Specialist ( 19.5 % - Doctor of Medicine , Doctor of Osteopathic Medicine ; n = 59 ), mid-level provider ( 6.3 % - nurse practitioner , physician assistant ; n = 19 ), other ( 49.2 % - dentist , optometrist , veterinarian , administration , Doctor of Philosophy ; n = 149 ).
Of respondents who provide MAT treatment , 93.1 % ( 27 of 29 ) of participants
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