The Department of General Practice, Monash University, Notting Hill, Australia.
Fam Pract. 2021 Jul 28;38(4):473-478. doi: 10.1093/fampra/cmaa148.
Approximately half of the opioids prescribed by Australian GP and GP registrars are for chronic non-cancer pain-despite limited therapeutic benefit, and serious risks of harm. Understanding the factors driving non-evidence-based opioid prescribing may improve GP training and education.
To explore attitudes, beliefs, knowledge and self-reported factors influencing the opioid-prescribing decisions of Australian GP registrars.
Telephone interviews were undertaken with 20 GP registrars in 2018-19. Interviews were 30-60 minutes in duration, audio-recorded and de-identified. Braun and Clarke's 6-phase framework was adopted for reflexive thematic analysis of data and managed using QSR NVivo software.
Twenty registrars were recruited; 8 men and 12 women. Three themes were identified.
Difficult chronic pain consultations negatively affected the registrar well-being. Registrars role modelled their supervisors' opioid-prescribing practices, even if they perceived it to be unsafe.
Registrars lacked confidence in initiating, prescribing and weaning opioids, recognizing drug-seeking behaviours and declining to prescribe-but felt confident in their knowledge of opioid pharmacology.
Registrars were aware of evidence-based prescribing recommendations and risk reduction strategies but struggled to translate this into practice.
Non-evidence-based opioid prescribing by Australian GP registrars is multifactorial. Emotionally difficult pain consultations, poor supervision and low prescriber confidence may contribute to unsafe prescribing. Improving registrar prescribing may require interventions to improve risk reduction, training in communication and role modelling by supervisors.
尽管阿片类药物的治疗益处有限，且存在严重的伤害风险，但澳大利亚全科医生和全科住院医师开具的阿片类药物中，约有一半用于治疗慢性非癌症疼痛。了解驱动非循证阿片类药物处方的因素可能会改善全科医生的培训和教育。
探讨澳大利亚全科住院医师阿片类药物处方决策的态度、信念、知识和自我报告因素。
2018 年至 2019 年期间，对 20 名全科住院医师进行了电话访谈。访谈时长 30-60 分钟，录音并匿名处理。采用 Braun 和 Clarke 的 6 阶段框架对数据进行反思性主题分析，并使用 QSR NVivo 软件进行管理。
共招募了 20 名住院医师，其中 8 名男性和 12 名女性。确定了三个主题。
艰难的慢性疼痛咨询会影响住院医师的健康。住院医师模仿他们的导师的阿片类药物处方实践，即使他们认为这是不安全的。
住院医师在开始、开处方和逐渐减少阿片类药物、识别药物寻求行为和拒绝开处方方面缺乏信心，但对阿片类药物药理学的知识有信心。
住院医师了解循证处方建议和降低风险策略，但难以将其转化为实践。
澳大利亚全科住院医师的非循证阿片类药物处方是多因素的。情绪上困难的疼痛咨询、监督不力和低处方者信心可能导致不安全的处方。改善住院医师的处方可能需要干预措施来改善风险降低、沟通培训和导师的角色扮演。
