在全科医疗中为慢性非恶性疼痛开具阿片类镇痛药——态度与实践的调查
Prescribing opioid analgesics for chronic non-malignant pain in general practice - a survey of attitudes and practice.
作者信息
Blake Holly, Leighton Paul, van der Walt Gerrie, Ravenscroft Andrew
机构信息
School of Health Sciences, University of Nottingham, Nottingham, UK.
School of Medicine, University of Nottingham, Nottingham, UK.
出版信息
Br J Pain. 2015 Nov;9(4):225-32. doi: 10.1177/2049463715579284.
BACKGROUND
This study replicates a previous postal survey of general practitioners (GPs) to explore whether attitudes to opioid prescribing have changed at a time when the number of opioid prescriptions issued in primary care has increased.
METHODS
With permission, a 57-item survey instrument previously utilised with GPs in the South-west of England was circulated to 214 GPs in city-centre practices in the East Midlands. The survey instrument included items relating to practice context, prescribing patterns and attitudes about analgesic medication, perceived prescribing frequency and reluctance to prescribe.
RESULTS
Responses were received from 94 GPs (45%). Almost three-quarters (72.7%) of GPs reported that they sometimes or frequently prescribed strong opioids for chronic non-cancer pain. Over two-thirds (67.8%) reported that they were sometimes or frequently reluctant to prescribe strong opioids for chronic non-cancer pain. No significant relationships were observed between perceived frequency of prescribing and a range of demographic factors; however, concerns about 'physical dependence', 'long-term commitment to prescribing' and 'media reports' were associated with less frequent reported prescribing of, and greater reluctance to prescribe, strong opioids.
DISCUSSION
Given the national trend for increased opioid prescriptions, it is unsurprising that more frequent self-reported prescribing is reported here; however, increased frequency does not translate into less reluctance about prescribing. The effectiveness of strong opioids for chronic pain is recognised, but concerns about addiction, dependence and misuse inform a reluctance to use strong opioids. These juxtapositions highlight a continued need for clearer understanding of GPs' perceptions of strong opioids and point to the potential benefit of dedicated guidelines or specialist education and training to address their uncertainties.
背景
本研究重复了之前针对全科医生（GP）的邮寄调查，以探讨在初级保健中开具的阿片类药物处方数量增加之际，对阿片类药物处方的态度是否发生了变化。
方法
经许可，一份先前在英格兰西南部的全科医生中使用的包含57个条目的调查问卷被分发给东米德兰兹市中心诊所的214名全科医生。该调查问卷包括与执业环境、处方模式、对镇痛药的态度、感知的处方频率以及不愿开具处方等相关的条目。
结果
收到了94名全科医生（45%）的回复。近四分之三（72.7%）的全科医生报告称，他们有时或经常为慢性非癌性疼痛开具强效阿片类药物。超过三分之二（67.8%）的医生报告称，他们有时或经常不愿为慢性非癌性疼痛开具强效阿片类药物。在感知的处方频率与一系列人口统计学因素之间未观察到显著关系；然而，对“身体依赖”、“长期开具处方的责任”和“媒体报道”的担忧与报告的强效阿片类药物开具频率较低以及更不愿开具处方有关。
讨论
鉴于全国范围内阿片类药物处方增加的趋势，这里报告的自我报告的开具处方频率增加并不令人惊讶；然而，频率的增加并不意味着开具处方时的不情愿减少。强效阿片类药物对慢性疼痛有效性得到认可，但对成瘾、依赖和滥用的担忧导致不愿使用强效阿片类药物。这些矛盾之处凸显了持续需要更清楚地了解全科医生对强效阿片类药物的看法，并指出制定专门指南或提供专业教育和培训以解决他们的不确定性的潜在益处。
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