White Ruth A, Hayes Chris, Boyes Allison W, Chiu Simon, Paul Christine L
Pain Physiotherapist, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
Pain Physiotherapist, Hunter Integrated Pain Service, Hunter New England Health, Newcastle, Australia.
BJGP Open. 2018 Nov 14;2(4):bjgpopen18X101609. doi: 10.3399/bjgpopen18X101609. eCollection 2018 Dec.
GPs are central to opioid strategy in chronic non-cancer pain (CNCP). Lack of treatment alternatives and providers are common reasons cited for not deprescribing opioids. There are limited data about availability of multidisciplinary healthcare providers (MHCPs), such as psychologists, physiotherapists, or dietitians, who can provide broader treatments.
To explore availability of MHCPs, and the association with GP opioid deprescribing and transition to therapeutic alternatives for CNCP.
DESIGN & SETTING: Cross-sectional survey of all practising GPs ( = 1480) in one mixed urban and regional Australian primary health network.
A self-report mailed questionnaire assessed the availability of MHCPs and management of their most recent patient on long-term opioids for CNCP.
Six hundred and eighty-one (46%) valid responses were received. Most GPs (71%) had access to a pain specialist and MHCPs within 50 km. GPs' previous referral for specialist support was significantly associated with access to a greater number of MHCPs ( = 0.001). Employment of a nurse increased the rate ratio of available MHCPs by 12.5% (incidence rate ratio [IRR] 1.125, 95% confidence interval [CI] = 1.001 to 1.264). Only one-third (32%) of GPs reported willingness to deprescribe and shift to broader CNCP treatments. Availability of MHCPs was not significantly associated with deprescribing decisions.
Lack of geographical access to known MHCPs does not appear to be a major barrier to opioid deprescribing and shifting toward non-pharmacological treatments for CNCP. Considerable opportunity remains to encourage GPs' decision to deprescribe, with employment of a practice nurse appearing to play a role.
全科医生是慢性非癌性疼痛（CNCP）阿片类药物策略的核心。缺乏治疗替代方案和医疗服务提供者是不减少阿片类药物处方的常见原因。关于多学科医疗服务提供者（如心理学家、物理治疗师或营养师）的可及性数据有限，他们可以提供更广泛的治疗。
探讨多学科医疗服务提供者的可及性，以及与全科医生减少阿片类药物处方和转向CNCP治疗替代方案的关联。
对澳大利亚一个城乡混合的初级卫生保健网络中的所有执业全科医生（n = 1480）进行横断面调查。
通过自我报告邮寄问卷评估多学科医疗服务提供者的可及性以及他们对最近一位长期使用阿片类药物治疗CNCP患者的管理情况。
共收到681份（46%）有效回复。大多数全科医生（71%）能够在50公里范围内找到疼痛专科医生和多学科医疗服务提供者。全科医生之前转诊寻求专科支持与可找到更多多学科医疗服务提供者显著相关（P = 0.001）。雇佣一名护士使可及的多学科医疗服务提供者的发生率比值增加了12.5%（发生率比值[IRR] 1.125，95%置信区间[CI] = 1.001至1.264）。只有三分之一（32%）的全科医生表示愿意减少阿片类药物处方并转向更广泛的CNCP治疗。多学科医疗服务提供者的可及性与减少处方决策没有显著关联。
在地理位置上难以找到已知的多学科医疗服务提供者似乎并不是减少阿片类药物处方和转向CNCP非药物治疗的主要障碍。鼓励全科医生做出减少处方决策仍有很大机会，雇佣一名执业护士似乎发挥了作用。
