Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Qual Saf. 2021 Feb;30(2):133-140. doi: 10.1136/bmjqs-2020-010881. Epub 2020 Mar 27.
Chronic prescription opioid use is a major international public health issue associated with significant harms, including increased risk of hospitalisation, morbidity and death. Guidance for healthcare professionals on when and how to deprescribe or reduce opioids is required. A key step for guideline development for deprescribing pharmacotherapy is to understand the perspectives of stakeholders. The aim of this study was to explore the perspectives of healthcare professional stakeholders on the challenges associated with opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines.
A qualitative study was undertaken with a purposive sample of healthcare professionals including prescribers, pharmacists and nurses. An initial cohort of participants was identified at the 2018 Australian Deprescribing Network annual meeting and two focus groups were conducted (n=20). Individual interviews were conducted with a further 11 healthcare professionals. Focus groups and interviews were audio-recorded and transcribed verbatim. Data underwent inductive thematic analysis using a phenomenological perspective.
Healthcare professionals viewed opioid deprescribing as a challenge and identified several key barriers to deprescribing in clinical practice. Medication, patient, prescriber and health system level challenges were identified. Participants requested evidence-based guidance on the withdrawal of opioid therapies and suggested that prospective opioid deprescribing guidelines require a multitarget, multimodal intervention strategy that addresses patient psychosocial factors and incorporates behavioural change techniques.
Opioid deprescribing was perceived as a complex and challenging practice with continued prescribing the default behaviour. Evidence-based opioid deprescribing guidelines may be a valuable resource for clinicians to support clinical decision-making and reduce suboptimal opioid use.
慢性处方类阿片药物的使用是一个重大的国际公共卫生问题，会带来严重的危害，包括住院率、发病率和死亡率的增加。需要为医疗保健专业人员提供关于何时以及如何减少或停用阿片类药物的指导。制定减少药物治疗方案的指南的关键步骤是了解利益相关者的观点。本研究旨在探讨医疗保健专业利益相关者对与阿片类药物减少相关的挑战以及在制定阿片类药物减少指南时需要考虑的因素的看法。
采用目的抽样法选取了包括处方者、药剂师和护士在内的医疗保健专业人员进行定性研究。在 2018 年澳大利亚减少用药网络年会上确定了最初的参与者队列，并进行了两次焦点小组讨论（n=20）。对另外 11 名医疗保健专业人员进行了个人访谈。焦点小组和访谈均进行了录音，并逐字转录。采用现象学观点对数据进行了归纳主题分析。
医疗保健专业人员认为阿片类药物的减少是一项挑战，并确定了临床实践中减少用药的几个关键障碍。确定了药物、患者、处方者和卫生系统层面的挑战。参与者要求提供关于阿片类药物治疗停药的循证指导，并建议前瞻性的阿片类药物减少用药指南需要一种多目标、多模式的干预策略，以解决患者的社会心理因素，并纳入行为改变技术。
阿片类药物的减少被认为是一种复杂而具有挑战性的做法，继续开处方是默认行为。基于证据的阿片类药物减少用药指南可能是临床医生支持临床决策和减少阿片类药物使用不合理的有价值的资源。
