Institute for Musculoskeletal Health, Sydney, NSW, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
Pain. 2022 Apr 1;163(4):e518-e526. doi: 10.1097/j.pain.0000000000002340.
Deprescribing is the systematic process of discontinuing drugs when harms outweigh the benefits. We conducted semistructured telephone interviews with 22 general practitioners (GPs) who had prescribed or deprescribed opioids in patients with chronic noncancer pain within the past 6 months to investigate the barriers and facilitators to deprescribing opioid analgesics in patients with chronic noncancer pain. We also explored GPs' perspectives on the available resources to assist them with opioid deprescribing. Interviews were audio-recorded, transcribed verbatim, and then coded using an iterative process until data saturation reached. The thematic analysis process identified themes, first as concepts, and then refined to overarching themes after the merging of similar subthemes. Themes exploring barriers to deprescribing highlighted the difficulties GPs face while considering patient factors and varying prescribing practices within the confines of the health system. Patient motivation and doctor-patient rapport were central factors to facilitate deprescribing and GPs considered the most important deprescribing resource to be a multidisciplinary network of clinicians to support themselves and their patients. Therefore, although GPs emphasised the importance of deprescribing opioid analgesics, they also expressed many barriers relating to managing complex pain conditions, patient factors, and varying prescribing practices between clinicians. Some of these barriers could be mitigated by GPs having time and resources to educate and build rapport with their patients. This suggests the need for further development of multimodal resources and improved support through the public health system to enable GPs to prioritise patient-centred care.
撤药是指当药物的危害超过益处时，系统地停止使用药物的过程。我们对半结构化电话采访了 22 名全科医生（GP），他们在过去 6 个月内为慢性非癌痛患者开处或撤处了阿片类药物，以调查在慢性非癌痛患者中撤处阿片类镇痛药的障碍和促进因素。我们还探讨了全科医生对现有资源的看法，以帮助他们进行阿片类药物撤药。采访进行了录音、逐字转录，然后使用迭代过程进行编码，直到达到数据饱和。主题分析过程确定了主题，首先是概念，然后在合并类似的子主题后细化为总体主题。撤药障碍主题强调了全科医生在考虑患者因素和在医疗体系限制内改变处方实践时面临的困难。患者动机和医患关系是促进撤药的关键因素，全科医生认为最重要的撤药资源是多学科临床医生网络，以支持自己和患者。因此，尽管全科医生强调了撤处阿片类镇痛药的重要性，但他们也表达了许多与管理复杂疼痛状况、患者因素和临床医生之间不同的处方实践有关的障碍。通过为全科医生提供教育和与患者建立融洽关系的时间和资源，这些障碍中的一些可以得到缓解。这表明需要进一步开发多模式资源，并通过公共卫生系统提供更好的支持，使全科医生能够优先考虑以患者为中心的护理。
