School of Biological Sciences, University of Auckland, Auckland, New Zealand.
Department of Management, Marketing and Entrepreneurship, University of Canterbury, UC Business School, Christchurch, New Zealand.
Drug Alcohol Rev. 2022 Sep;41(6):1355-1366. doi: 10.1111/dar.13476. Epub 2022 May 23.
Many countries are changing their regulations for prescribing medical cannabis. As gatekeepers, physicians significantly impact patient access to cannabis treatments. It is important to explore how physicians view prescribing cannabis in terms of their existing beliefs, knowledge, possible concerns and personal perceptions.
Individual, semi-structured telephone interviews were undertaken with 14 New Zealand physicians from various specialties. The interviews were thematically analysed using a phenomenological approach.
The physician-patient relationship was of extreme importance in making prescription decisions, driven largely by trust in the patient. Barriers to prescribing included concern over possible side effects, the quality and standardisation of medication, uncertainty about indications and equity concerns from the high cost for lower socio-economic patients. Some physicians held concerns over their liability and risks to their reputation if issues arose for patients.
The way physicians regard prescribing medical cannabis is based on their personal beliefs and knowledge built up over their medical career. It is important that these are taken into consideration in the design of future guidelines to help alleviate uncertainties and reduce barriers for informed prescribing. While our research and previous research find that physicians generally will follow clinical guidelines based on institutional logics (i.e. the standardised approach to medicine), we find that physicians often allow their personal construals to determine their perceptions and prescribing behaviour to a considerable extent when they practice medicine. Our findings have implications for Continuing Medical Education, marketing and regulation for medical cannabis, especially about the wording of guideline adherence.
许多国家正在改变其医用大麻处方规定。作为把关人，医生对患者获得大麻治疗的机会有重大影响。了解医生在开具大麻处方时的看法，包括他们现有的信念、知识、可能的担忧和个人看法，这一点很重要。
对来自不同专业的 14 名新西兰医生进行了单独的、半结构化的电话访谈。采用现象学方法对访谈进行了主题分析。
在做出处方决定时，医患关系至关重要，主要是基于对患者的信任。处方的障碍包括对可能的副作用、药物的质量和标准化、对适应症的不确定性以及对较低社会经济地位患者的高成本的公平性问题的担忧。一些医生对自己的责任以及患者出现问题时对自己声誉的风险感到担忧。
医生对开具医用大麻处方的看法基于他们在医疗生涯中积累的个人信念和知识。在设计未来的指南时，考虑这些因素对于减轻不确定性和减少知情处方的障碍很重要。虽然我们的研究和之前的研究发现，医生通常会根据机构逻辑（即标准化的医学方法）遵循临床指南，但我们发现，医生在行医时往往会在很大程度上允许个人理解来决定他们的看法和处方行为。我们的研究结果对继续教育、医用大麻的营销和监管具有影响，尤其是关于指南遵循的措辞。
