EA SPURBO, Universite de Bretagne Occidentale, Brest, France
addictologie, CHRU de Brest, Brest, France.
BMJ Open. 2021 Jan 19;11(1):e044433. doi: 10.1136/bmjopen-2020-044433.
In the last 30 years, opioid maintenance treatment prescription (OMT) has changed patients' and also changed physicians' practices. General practitioners (GPs) have to deal with patients on OMT who are in acute pain. The objective of this qualitative study was to explore medical care challenges and solutions identified by GPs in the management of acute pain among patients receiving OMT.
Qualitative study with semistructured interviews were used as a data collection technique with a sampling strategy using a snowball sampling method to obtain a purposive sample of practicing GPs. Analysis was undertaken using a thematic analysis method.
Twelve GPs, working in France (Brittany) who prescribe OMT were interviewed.
The thematic analysis resulted in two main themes relating to specificities and difficulties identified: (1) Medical care and training challenges identified by GPs treating patients on OMT with acute pain, with four subthemes : management of these situations not concerning primary care, lack of training prompts GPs to rely on peer and specialist support, lack of guidelines and conflicting recommendations between clinicians in different settings (2) linked to the patient-GP relationship, with six subthemes: Implementing an individualised centred approach, acute pain management during OMT relies on a relationship based on trust, GPs found difficulties in evaluating and treating pain, difficulties in care adherence, fear of patients destabilisation, fear of misuse and diversion.
The complexity of acute pain and OMT entails significant challenges for clinicians and patients. In primary care, it is hard to achieve a balance between pain relief and opioid use disorder treatment, in a global patient-centred approach. Fear of misuse or diversion was not a important factor, except for patients not known to the practitioners, but GPs were concerned with the risks of patient destabilisation in situations of acute pain.
在过去的 30 年中，阿片类药物维持治疗处方（OMT）改变了患者，也改变了医生的实践。全科医生（GP）必须处理接受 OMT 的急性疼痛患者。本定性研究的目的是探讨全科医生在管理接受 OMT 的急性疼痛患者时发现的医疗保健挑战和解决方案。
使用半结构化访谈作为数据收集技术，并采用滚雪球抽样方法进行抽样策略，以获得接受 OMT 的实践全科医生的目的样本。分析采用主题分析方法。
采访了 12 名在法国（布列塔尼）开 OMT 的全科医生。
主题分析产生了与特殊性和困难有关的两个主要主题：（1）治疗接受 OMT 的急性疼痛患者的全科医生发现的医疗保健和培训挑战，有四个子主题：管理这些不属于初级保健的情况，缺乏培训促使全科医生依赖同行和专家支持，缺乏指南以及不同环境下临床医生之间的建议相互冲突；（2）与医患关系相关，有六个子主题：实施以患者为中心的个体化方法，在 OMT 期间管理急性疼痛依赖于基于信任的关系，GP 发现评估和治疗疼痛存在困难，难以坚持治疗，担心患者不稳定，担心滥用和转移。
急性疼痛和 OMT 的复杂性给临床医生和患者带来了重大挑战。在初级保健中，在以患者为中心的整体方法中，很难在缓解疼痛和治疗阿片类药物使用障碍之间取得平衡。除了不熟悉患者的医生外，滥用或转移的恐惧并不是一个重要因素，但医生担心在急性疼痛情况下患者不稳定的风险。
