Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
Acad Emerg Med. 2018 Jan;25(1):15-24. doi: 10.1111/acem.13273. Epub 2017 Sep 19.
Benzodiazepines and opioids are prescribed simultaneously (i.e., "coprescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine-opioid coprescribing occurs and providers' reasons for coprescribing.
We conducted focus groups with emergency department (ED) providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semistructured interviews to elicit perspectives on benzodiazepine-opioid coprescribing. Discussions were audio-recorded and transcribed. We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach, aiming to identify priority categories that describe the phenomenon of benzodiazepine-opioid coprescribing.
Participants acknowledged coprescribing rarely and reluctantly and often provided specific discharge instructions when coprescribing. The decision to coprescribe is multifactorial, often isolated to specific clinical and situational contexts (e.g., low back pain, failed solitary opioid therapy) and strongly influenced by a provider's beliefs about the efficacy of combination therapy. The decision to coprescribe is further influenced by a self-imposed pressure to escalate care or avoid hospital admission. When considering potential interventions to reduce the incidence of coprescribing, participants opposed computerized alerts but were supportive of a pharmacist-assisted intervention. Many providers found the process of participating in peer discussions on prescribing habits to be beneficial.
In this qualitative study of ED providers, we found that benzodiazepine-opioid coprescribing occurs in specific clinical and situational contexts, such as the treatment of low back pain or failed solitary opioid therapy. The decision to coprescribe is strongly influenced by a provider's beliefs and by self-imposed pressure to escalate care or avoid admission.
苯二氮䓬类药物和阿片类药物在许多临床环境中同时开具（即“联合开具”），尽管指南建议避免这种做法，并越来越多的证据表明同时使用这两种药物会增加过量风险。本研究旨在描述苯二氮䓬类药物-阿片类药物联合开具的情况以及医生联合开具的原因。
我们在三家医院的急诊科（住院医生和主治医生、高级执业医师和药剂师）进行了焦点小组讨论，使用半结构化访谈来了解医生对苯二氮䓬类药物-阿片类药物联合开具的看法。讨论内容进行了录音和转录。我们使用共识定性研究方法对转录本进行了定性内容分析，旨在确定描述苯二氮䓬类药物-阿片类药物联合开具现象的优先类别。
参与者承认联合开具的情况很少且很不情愿，并且在联合开具时经常提供具体的出院指导。联合开具的决定是多因素的，通常限于特定的临床和情况背景（例如，腰痛，单独使用阿片类药物治疗失败），并强烈受到医生对联合治疗效果的信念的影响。联合开具的决定还受到医生自行施加的压力的影响，即需要升级治疗或避免住院。在考虑减少联合开具发生率的潜在干预措施时，参与者反对使用计算机化提醒，但支持药剂师协助干预。许多医生发现参与关于处方习惯的同行讨论过程是有益的。
在这项对急诊科医生的定性研究中，我们发现苯二氮䓬类药物-阿片类药物联合开具发生在特定的临床和情况背景下，例如治疗腰痛或单独使用阿片类药物治疗失败。联合开具的决定受到医生的信念和自行施加的压力的强烈影响，即需要升级治疗或避免住院。
