Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.
Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, ON, Canada.
BMC Fam Pract. 2019 May 10;20(1):59. doi: 10.1186/s12875-019-0947-2.
Longstanding variation in the views of family physicians (FPs) on the role of opioids seems to translate into widely varying prescribing rates. Improvement interventions are unlikely to achieve change if they do not understand and explicitly target the factors that determine physician prescribing behaviour. The aim of this work was to understand (1) the perspectives of FPs as it relates to opioid prescribing, and (2) the perceived barriers and enablers to guideline-adherent opioid prescribing and management of chronic non-cancer pain.
A qualitative study involving one-on-one, semi-structured interviews with a sample of FPs in Ontario, Canada. Interviews were analyzed using a directed content analysis informed by the Theoretical Domains Framework. A framework approach was used to explore interaction across behavioural determinants (factors influencing behaviour) as well as demographic sources of variation. The behaviour of interest for the current study was the prescribing of opioid medications (including initiation, renewal, and dose reduction) for patients with chronic, non-cancer pain. Associated issues in the overall management of such patients were also explored.
Interviews were conducted with 22 FPs. Behavioural determinants interacted with one another to influence FPs prescribing behavior. The TDF domain Beliefs about Consequences played a central role in explaining physician prescribing behaviours as they related to the management of chronic non-cancer pain. Individual beliefs about prescribing consequences and patient behaviour interacted with prescriber beliefs about capabilities and perceptions of the FP's professional role to influence prescriber behaviour. Emotion and the environmental context influenced the impact of these determinants on opioid prescribing and the management of chronic non-cancer pain.
FPs face a wide range of complex (and often interacting) challenges when prescribing opioid therapy to their patients. Solution-based strategies should target these determinants directly using evidence-based strategies that move beyond guideline dissemination and general education. Shared decision-making strategies and patient-facing decision aids are likely to decrease the tension experienced in challenging conversations.
家庭医生（FP）对阿片类药物作用的长期看法差异似乎导致了处方率的广泛差异。如果改进干预措施不了解并明确针对决定医生处方行为的因素，那么它们不太可能实现改变。这项工作的目的是了解（1）FP 与阿片类药物处方相关的观点，以及（2）遵医嘱开具阿片类药物和管理慢性非癌性疼痛的潜在障碍和促进因素。
这是一项在加拿大安大略省进行的定性研究，涉及对家庭医生进行一对一的半结构化访谈。访谈使用基于理论领域框架的定向内容分析进行分析。使用框架方法探索行为决定因素（影响行为的因素）之间的相互作用以及人口统计学来源的差异。当前研究的行为是为慢性非癌性疼痛患者开具阿片类药物（包括起始、续药和减少剂量）。还探讨了此类患者整体管理中的相关问题。
对 22 名 FP 进行了访谈。行为决定因素相互作用，影响 FP 的处方行为。TDF 领域的信念对后果在解释与慢性非癌性疼痛管理相关的医生处方行为方面发挥了核心作用。关于处方后果和患者行为的个体信念与处方者对能力的信念以及对 FP 专业角色的看法相互作用，影响处方者的行为。情绪和环境背景会影响这些决定因素对阿片类药物处方和慢性非癌性疼痛管理的影响。
FP 在为患者开具阿片类药物治疗时面临着广泛的复杂（且经常相互作用）挑战。基于解决方案的策略应使用基于证据的策略直接针对这些决定因素，这些策略应超越指南传播和一般教育。共享决策策略和面向患者的决策辅助工具可能会减少在具有挑战性的对话中所经历的紧张。
