Department of Community Health and Epidemiology, Anesthesia, Dalhousie University, Nova Scotia.
Pain Res Manag. 2013 Jul-Aug;18(4):177-84. doi: 10.1155/2013/528645. Epub 2013 May 28.
In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians' (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.
To determine FPs' practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP.
An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges.
A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the 'watchful dose' of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient's opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse.
While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.
2010 年 5 月，加拿大发布了一份新的关于为慢性非癌性疼痛（CNCP）开具阿片类药物的处方指南。为了评估在该指南发布后家庭医生（FPs）开具阿片类药物的变化，有必要了解在该指南广泛传播之前他们的实践情况。
确定 FPs 为 CNCP 开具阿片类药物的实践和知识与加拿大指南的关系，并确定妨碍或促进 FPs 为 CNCP 开具阿片类药物的因素。
开发了一项在线调查，并通过加拿大家庭医生学院、大学继续医学教育办公室和省级监管学院向管理 CNCP 的 FPs 进行电子联系。
共收到 710 份回复。FPs 在开具阿片类药物时采取了预防措施，并且已经按照加拿大指南的建议进行了实践，即讨论不良反应、监测异常药物相关行为并在驾驶时建议谨慎。然而，即使阿片类药物无效，FPs 也很少停止使用，并且不知道阿片类药物的“警惕剂量”，即患者可能需要重新评估或更密切监测的每日剂量。只有 9 个知识问题中的两个问题有超过 40%的 FPs 回答正确。促进最佳阿片类药物处方的主要因素是能够从省级处方监测计划中获取患者的阿片类药物使用史。最佳处方的主要障碍是对成瘾和滥用的担忧。
虽然 FPs 在为 CNCP 开具阿片类药物时采取了预防措施，但在实践和知识方面存在很大差距，这对患者的安全和成本都有影响。
