Fraeyman Jessica, Symons Linda, Van Royen Paul, Van Hal Guido, Peremans Lieve
a Department or Epidemiology and Social Medicine , Research Unit Medical Sociology and Health Policy, University of Antwerp , Antwerp , Belgium ;
b Department of Primary and Interdisciplinary Care , Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium ;
Eur J Gen Pract. 2016 Jun;22(2):134-40. doi: 10.3109/13814788.2015.1120286. Epub 2016 Jan 22.
Opiate substitution treatment (OST) is the administration of opioids (methadone or buprenorphine) under medical supervision for opiate addiction. Several studies indicate a large unmet need for OST in general practice in Antwerp, Belgium. Some hurdles remain before GPs engage in OST prescribing.
Formulate recommendations to increase engagement of GPs in OST, applicable to Belgium and beyond.
In 2009, an exploratory qualitative research was performed using focus group discussions and interviews with GPs. During data collection and analysis, purposive sampling, open and axial coding was applied. The script was composed around the advantages, disadvantages and conditions of engaging in OST in general practice.
We conducted six focus groups and two interviews, with GPs experienced in prescribing OST (n = 13), inexperienced GPs (n = 13), and physicians from addiction centres (n = 5). Overall, GPs did not seem very willing to prescribe OST for opiate users. A lack of knowledge about OST and misbehaving patients creates anxiety and makes the GPs reluctant to learn more about OST. The GPs refer to a lack of collaboration with the addiction centres and a need of support (from either addiction centres or experienced GP-colleagues for advice). Important conditions for OST are acceptance of only stable opiate users and more support in emergencies.
Increasing GPs' knowledge about OST and improving collaboration with addiction centres are essential to increase the uptake of OST in general practice. Special attention could be paid to the role of more experienced colleagues who can act as advising physicians for inexperienced GPs.
阿片类药物替代治疗（OST）是在医疗监督下为阿片类药物成瘾者使用阿片类药物（美沙酮或丁丙诺啡）。多项研究表明，比利时安特卫普的全科医疗中对OST存在大量未满足的需求。在全科医生开始开具OST处方之前，仍存在一些障碍。
制定建议以提高全科医生参与OST的程度，适用于比利时及其他地区。
2009年，通过焦点小组讨论和与全科医生的访谈进行了一项探索性定性研究。在数据收集和分析过程中，采用了目的抽样、开放编码和轴心编码。脚本围绕全科医疗中参与OST的优点、缺点和条件编写。
我们进行了六个焦点小组讨论和两次访谈，对象包括有开具OST经验的全科医生（n = 13）、无经验的全科医生（n = 13）以及成瘾中心的医生（n = 5）。总体而言，全科医生似乎不太愿意为阿片类药物使用者开具OST处方。对OST的知识缺乏以及行为不端的患者会引发焦虑，使全科医生不愿更多地了解OST。全科医生提到与成瘾中心缺乏合作，并且需要（来自成瘾中心或有经验的全科医生同事的）支持以获取建议。OST的重要条件是只接纳稳定的阿片类药物使用者以及在紧急情况下提供更多支持。
增加全科医生对OST的了解并改善与成瘾中心的合作对于提高全科医疗中OST的采用率至关重要。可以特别关注更有经验同事的作用，他们可以为无经验的全科医生担任顾问医生。
