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Open Access Research article

Narcotic analgesic utilization amongst injured workers: using concept mapping to understand current issues from the perspectives of physicians and pharmacists

Janet A Parsons12*, Muhammad Mamdani134, Onil Bhattacharyya356, Claire Marie Fortin7, Magda Melo1, Christina Salmon8, Stavroula R Raptis1, Donna Bain9 and Patricia O'Campo108

Author Affiliations

1 Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada

2 Dept. of Physical Therapy, University of Toronto, Suite 160, 500 University Ave., Toronto, Ontario, M5G 1V7, Canada

3 Dept. of Health Policy Management & Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St., Toronto, Ontario, M5T 3M6, Canada

4 Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario, M5S 3M2, Canada

5 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada

6 Dept. of Family & Community Medicine, University of Toronto, 5th Floor, 256 McCaul St., Toronto, Ontario, M5T 1W7, Canada

7 Canadian Institute for Health Information, Suite 300, 4110 Yonge St., Toronto, Ontario, M2P 2B7, Canada

8 Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada

9 Health Services Division, Workplace Safety and Insurance Board of Ontario, 200 Front St. West, Toronto, Ontario, M5V 3J1, Canada

10 Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th Floor, 155 College St., Toronto, Ontario, M5T 3M6, Canada

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BMC Health Services Research 2011, 11:280  doi:10.1186/1472-6963-11-280

Published: 20 October 2011



Work-related injuries result in considerable morbidity, as well as social and economic costs. Pain associated with these injuries is a complex, contested topic, and narcotic analgesics (NA) remain important treatment options. Factors contributing to NA utilization patterns are poorly understood. This qualitative study sought to characterize the factors contributing to NA utilization amongst injured workers from the perspectives of physicians and pharmacists.


The study employed concept mapping methodology, a structured process yielding a conceptual framework of participants' views on a particular topic. A visual display of the ideas/concepts generated is produced. Eligible physicians and pharmacists (n = 22) serving injured workers in the province of Ontario (Canada) were recruited via purposive sampling, and participated in concept mapping activities (consisting of brainstorming, sorting, rating, and map exploration). Participants identified factors influencing NA utilization, and sorted these factors into categories (clusters). Next, they rated the factors on two scales: 'strength of influence on NA over-utilization' and 'amenability to intervention'. During follow-up focus groups, participants refined the maps and discussed the findings and their implications.


82 factors were sorted into 7 clusters: addiction risks, psychosocial issues, social/work environment factors, systemic-third party factors, pharmacy-related factors, treatment problems, and physician factors. These clusters were grouped into 2 overarching categories/regions on the map: patient-level factors, and healthcare/compensation system-level factors. Participants rated NA over-utilization as most influenced by patient-level factors, while system-level factors were rated as most amenable to intervention. One system-level cluster was rated highly on both scales (treatment problems - e.g. poor continuity of care, poor interprofessional communication, lack of education/support for physicians regarding pain management, unavailability of multidisciplinary team-based care, prolonged wait times to see specialists).


Participants depicted factors driving NA utilization among injured workers as complex. Patient-level factors were perceived as most influential on over-utilization, while system-level factors were considered most amenable to intervention. This has implications for intervention design, suggesting that systemic/structural factors should be taken into account in order to address this important health issue.