Kilaru Austin S, Gadsden Sarah M, Perrone Jeanmarie, Paciotti Breah, Barg Frances K, Meisel Zachary F
Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Ann Emerg Med. 2014 Nov;64(5):482-489.e1. doi: 10.1016/j.annemergmed.2014.03.015. Epub 2014 Apr 16.
An increase in prescriptions for opioid pain medications has coincided with increasing opioid overdose deaths. Guidelines designed to optimize opioid prescriptions written in the emergency department have been implemented, with substantial controversy. Little is known about how physicians perceive and apply these guidelines. We seek to identify key themes about emergency physicians' definition, awareness, use, and opinions of opioid-prescribing guidelines.
We conducted semistructured qualitative interviews with a convenience sample of 61 emergency physicians attending the American College of Emergency Physicians Scientific Assembly (October 2012, Denver, CO). Participants varied with respect to age, sex, geographic region, practice setting, and years of practice experience. We analyzed the interview content with modified grounded theory, an iterative coding process to identify patterns of responses and derive key themes. The study team examined discrepancies in the coding process to ensure reliability and establish consensus.
When aware of opioid-prescribing guidelines, emergency physicians often defined them as policies developed by individual hospitals that sometimes reflected guidelines at the state or national level. Guidelines were primarily used by physicians to communicate decisions to limit prescriptions to patients on discharge rather than as tools for decisionmaking. Attitudes toward guidelines varied with regard to general attitudes toward opioid medications, as well as the perceived effects of guidelines on physician autonomy, public health, liability, and patient diversion.
These exploratory findings suggest that hospital-based opioid guidelines complement and occasionally supersede state and national guidelines and that emergency physicians apply guidelines primarily as communication tools. The perspectives of providers should inform future policy actions that seek to address the problem of opioid abuse and overdose through practice guidelines.
阿片类止痛药物处方量的增加与阿片类药物过量致死人数的上升同时出现。旨在优化急诊部门开具的阿片类药物处方的指南已经实施，但引发了诸多争议。对于医生如何理解和应用这些指南，人们知之甚少。我们试图确定急诊医生对阿片类药物处方指南的定义、认知、使用情况及看法的关键主题。
我们对参加美国急诊医师学会科学大会（2012年10月，科罗拉多州丹佛）的61名急诊医生进行了便利抽样的半结构化定性访谈。参与者在年龄、性别、地理区域、执业环境和执业年限方面存在差异。我们采用改良的扎根理论分析访谈内容，这是一个迭代编码过程，以识别回答模式并得出关键主题。研究团队检查了编码过程中的差异，以确保可靠性并达成共识。
当了解阿片类药物处方指南时，急诊医生通常将其定义为个别医院制定的政策，这些政策有时反映了州或国家层面的指南。指南主要被医生用于传达对出院患者限制处方的决定，而非作为决策工具。对指南的态度因对阿片类药物的总体态度以及对指南对医生自主权、公共卫生、责任和患者药物转移的感知影响而异。
这些探索性研究结果表明，基于医院的阿片类药物指南补充并偶尔取代州和国家指南，并且急诊医生主要将指南作为沟通工具应用。提供者的观点应为未来旨在通过实践指南解决阿片类药物滥用和过量问题的政策行动提供参考。
