Table 2.

Needs Met After the PASS Consultation

Met Need (No. of PCPs Identifying Need)DescriptionExemplar Quote
“Bargaining chip” to the patient (11 PCPs)PCPs expressed a need to take ownership of the decisions off themselves to some degree. Using the PASS consultation service as a way to externalize the decision-making process allowed them to maintain their relationship with the patient to help increase patient buy-in and collaboration with the patient.“And so looking for additional—like I said, I think the biggest thing was that bargaining chip with the patient. I needed something that could take the pressure off of me in making this decision around whether she should be prescribed opiates or not.” (P1)
Communication strategies and skills (13 PCPs)PCPs needed PASS to help with boundary setting, patient engagement with/buy-in for nonpharmacologic treatment options or any change in the treatment plan, and a reframing of the visit that focused on the patient’s function, values, and goals.“...or the young lady who I wasn’t so sure she should be on opioids, they talked about how to drill down to what her priorities are, and how you might frame it as, like, ‘I do really want to help you with your pain. I’m not sure that the pain is ever going to go away completely, but you know, I’m wondering what would feel good to you in terms of your quality of life, if we were able to get the pain decreased? What would you be able to do, what are your goals?’ And so, trying to frame it in more of that strength-based approach, rather than, ‘These medicines are dangerous. You need to get off of them.’ (P11)
Comprehensive review of the case (12 PCPs)PCPs appreciated the chance to both (a) go through the referral process itself, which gave them time and space to think about the case, clarify their own needs as they prepared for the meeting, and talk through ambiguity in the case; and (b) hear an outside team’s comprehensive summary of the case.“It was very helpful. I think the great thing was that [PASS member] always starts off with doing a summary, based on a very intensive chart review, to get everybody on the same page about what this case is about. Which I think works beautifully, because it’s also helpful for me to see what an outsider who’s reviewing the chart is taking away from all our massive documentation and notes and everything like that. And I think, in this particular case, she captured probably 90% of the essence of the patient, which I was very happy about. Because it was a very complicated patient.” (P5)
Confirmation of current plan (13 PCPs)PASS helped reinforce PCPs’ decision that they were leaning toward before the consultation. PCPs had trepidation about changing the plan at times, and they felt their need was met when PASS said they were on the right track or validated their assessment and/or treatment plan.“So it was useful just in backing up what I thought needed to happen...” (P10)
Emotional validation (13 PCPs)PCPs expressed needing an acknowledgment of how difficult and/or complex the case was so they did not feel so alone with a challenging case. This included validation of complexity of the case and feeling a sense of relief in discussing the case with the PASS team.“I think it’s also been helpful to have a group of folks review the case and also validate the feelings that this is a really tough situation. And there’s no one great answer to things. And also just feeling like, okay, I’m not alone in feeling overwhelmed with this patient. So I think that’s all been helpful.” (P5)
Interdisciplinary expertise (14 PCPs)PCPs needed to take a more global, biopsychosocial approach to management. They also needed specific knowledge and resources that they may not have including approaches to chronic pain management, assessment of potential underlying OUD, opioid dosing and tapering, nonopioid pharmacologic options, and other treatment options.“It wasn’t just physicians on the PASS team. There were— there’s a social worker, and a behavioral therapist. There’s so many different perspectives. And having each person’s input, and saying, ‘We’re available to do these kinds of things for pain,’ it was helpful to know what kind of resources they had that were beyond what we normally think of in primary care.” (P4)
Need to feel more control (13 PCPs)PCPs experienced feeling “stuck” with patients after exhausting all options. At times, PCPs held mistrust of the patient and needed help with managing complications with the health care system. This was especially true for legacy patients (“inherited patients”) whose plan was set before the PCP assumed his/her role. As a result, PCPs were looking for a concrete plan with specific recommendations from PASS.“It kind of felt like Groundhogs Day where I was—we were saying kind of the same thing over and over, and he was still resisting over and over. And I felt like I really wasn’t going anywhere for multiple visits at a time. That I was like ‘Okay, this is not productive for either of us. So I feel like we need to kind of get this from a different angle.’” (P4)
Outsider lens (11 PCPs)PCPs needed a new perspective on the case from clinicians not currently immersed in the patient’s care. They stated that they valued an outsider perspective that incorporated multiple angles when doing a case review.“I think, well, part of it was just to have someone else look at the picture..., because you’re so involved in that case that you’re not sure if you’re just making things up or not.” (P8)
  • OUD = opioid use disorder; PASS = Pain & Addiction Supportive Services; P = participant; PCP = primary care provider.