Date of Award

5-2016

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Graduate Department of Clinical Psychology

First Advisor

Marie-Christine Goodworth, PhD

Second Advisor

Mary Peterson, PhD

Third Advisor

Kathleen Gathercoal, PhD

Abstract

Although half of all patients with chronic pain seek treatment with their primary care practitioner, many physicians report being overburdened, with limited confidence in their training in the treatment of chronic pain. Opiate monotherapy remains the most common treatment utilized, despite strong correlations with addiction issues and increased distrust between patients and providers. In response to these issues, multidisciplinary stepped-care approaches utilizing psychoeducation, cognitive therapies, movement-based therapy, pharmaceutical treatment, yoga, and acupuncture have been developed. However, treatment within Federally Qualified Health Centers (FQHC) are complicated by financial constraints and high complexity in patient populations. This study examined the perspectives of staff members at an FQHC in Portland, Oregon on barriers to chronic pain treatment as well as the perceived efficacy and feasibility of potential interventions. Surveys including Likert-type responses and a free response section were administered in staff meetings, collected by team coordinators, and at other times convenient to the respondent. After survey results were analyzed, semi-structured interviews were conducted with a selection of participants’ representative of the various roles within the clinic. Themes derived from this approach highlighted a need for training for all staff, concerns regarding utilization of resources, desirability of non-opioid treatments, increased care coordination and policy adherence, and treatment for opioid dependence, distress regarding opioid-based treatment, and concern regarding the impact of systemic, financial, and legal barriers. Recommendations are discussed, specifically as they relate to the FQHC.

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