Longman Christine, Temple-Smith Meredith, Gilchrist Gail, Lintzeris Nicholas
Department of General Practice and Primary Health Care Academic Centre, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
Aust J Prim Health. 2012;18(4):346-51. doi: 10.1071/PY11100.
Opioid substitution therapy (OST) is a well-recognised, evidence-based treatment for opioid dependence. Since the early 1990s, Australia has used a community-based general practitioner (GP) model ofprescribing, particularly within the state of Victoria, where over 85% of OST prescribing is undertaken by GPs in community settings. Yet the majority of GPs invited to complete the required OST training decline the offer, while of those who complete training, the majority prescribe to few or no patients. This study aimed to determine the reasons for this. Twenty-two in-depth interviews were conducted with Victorian GPs exploring the reasons why the majority declined training, and for trained GPs, why they prescribed to few or no patients in the first 12 months after training. General practitioners who declined to train were predominantly influenced by negative experiences with drug-seeking patients, although other secondary reasons also affected their decision. Some GPs who completed the training were prevented from prescribing by several structural and operational barriers, many of which could be addressed. Fear of deskilling with time became a further impediment. General practitioners who became regular prescribers were highly committed with lengthy general practice experience. Concerns exist about the recruitment process for OST prescriber training, where nearly all GPs decline the offer of training, and the barriers that prevent GPs prescribing after training. Action is needed to address barriers to GP OST training and prescribing, and further research is necessary to ascertain measures required to facilitate long-term prescribing.
阿片类药物替代疗法（OST）是一种公认的、基于证据的阿片类药物依赖治疗方法。自20世纪90年代初以来，澳大利亚采用了一种以社区为基础的全科医生（GP）处方模式，特别是在维多利亚州，该州超过85%的OST处方由社区环境中的全科医生开具。然而，大多数被邀请完成所需OST培训的全科医生拒绝了这一提议，而在完成培训的医生中，大多数人很少或根本没有给患者开处方。本研究旨在确定其原因。对维多利亚州的全科医生进行了22次深入访谈，探讨大多数人拒绝培训的原因，以及对于接受培训的全科医生，他们在培训后的前12个月里很少或根本没有给患者开处方的原因。拒绝培训的全科医生主要受到与寻求药物患者的负面经历的影响，尽管其他次要原因也影响了他们的决定。一些完成培训的全科医生由于一些结构和操作障碍而无法开处方，其中许多障碍是可以解决的。对随着时间推移技能退化的恐惧成为了进一步的障碍。成为常规处方医生的全科医生有着长期的全科医疗经验且高度投入。人们对OST处方医生培训的招募过程存在担忧，几乎所有全科医生都拒绝培训提议，以及培训后阻止全科医生开处方的障碍。需要采取行动解决全科医生OST培训和开处方的障碍，并且有必要进行进一步研究以确定促进长期开处方所需的措施。
