Department of Maternal, Child, and Family, School of Health Sciences, University of Surrey, Guildford; associate, Department of Primary Care and Population Health, University College London, London.
Department of Primary Care and Population Health, University College London, London.
Br J Gen Pract. 2018 Apr;68(669):e234-e244. doi: 10.3399/bjgp18X695309. Epub 2018 Feb 26.
Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower.
To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies.
A semi-structured qualitative interview study of GPs working in general practices across England.
Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis.
The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR.
When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.
药物滥用是一个严重的公共卫生问题。来自以往的流行病学研究证据表明，全科医生正在电子病历（EPR）中记录药物滥用。然而，尽管记录趋势与全国性调查相似，但记录率要低得多。
探索影响全科医生在 EPR 中记录药物滥用的因素，并更清楚地了解初级保健中记录的药物滥用量与全国性调查和其他研究之间的差距。
一项在英格兰全科医生诊所工作的全科医生的半结构式定性访谈研究。
采用目的抽样法，从英格兰各地招募了 12 名对药物滥用有特殊兴趣和无特殊兴趣的全科医生。进行半结构化的面对面访谈，以考虑全科医生是否记录药物滥用，记录的方法，以及如果患者要求不记录信息时全科医生的行为，以及如果全科医生认为患者滥用药物但未披露信息时的行为。使用归纳和演绎主题分析相结合的方法对所得数据进行分析。
询问药物滥用的复杂性先于全科医生决定记录。他们描述了全科医生诊所协议的背景、医生与患者之间的互动以及询问过程如何影响他们询问药物使用的情况、方式和情况，这导致全科医生在 EPR 中做出关于记录的临床决策。
在决定是否记录药物滥用时，全科医生面临着复杂的选择。除了他们自己的观点外，他们还报告了来自他们工作的全科医生诊所环境以及他们的临床委托组以及政府政策的压力。
