Gill Simon, Bailey John, Nafees Sadia, Poole Rob
Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, United Kingdom.
Centre for Mental Health and Society, Bangor University, Bangor, United Kingdom
BJGP Open. 2022 Dec 20;6(4). doi: 10.3399/BJGPO.2022.0085. Print 2022 Dec.
Prescribing of opioid medication has increased over the past 20 years. Most occurs in primary care for chronic pain. There is little evidence that these drugs are effective for this indication. There are concerns about the continuing prescribing of opioids, particularly in the long term and at high doses.
To explore GPs' experiences of prescribing opioids, problems encountered, and factors militating against good prescribing practice.
DESIGN & SETTING: Qualitative interviews with GPs who prescribe opioids in primary care in North East Wales.
Semi-structured interviews with 20 GPs were transcribed and subjected to thematic analysis utilising the framework approach.
Participating GPs identified a range of problems associated with prescribed opioids. They were concerned about limited effectiveness of the drugs and what they perceived as addiction resulting from their use. They identified healthcare system factors that were obstacles to good prescribing practice such as lack of continuity of care, poor access to secondary care pain management support, and, most importantly, constant time pressure. They reported adverse effects on relationships with patients. Unrealistic expectations that pain could be eliminated resulted in pressure to prescribe stronger drugs and increased doses. It led to difficulties in establishing and maintaining trust and in persuading patients to agree to, and to carry out, dose reductions.
Themes emerging from this study suggest that GPs lack appropriate control of opioid prescribing. There is a need to develop methods to help patients and GPs to work together to manage chronic pain safely.
在过去20年中，阿片类药物的处方量有所增加。大多数情况发生在初级保健中用于治疗慢性疼痛。几乎没有证据表明这些药物对该适应症有效。人们对阿片类药物的持续处方存在担忧，尤其是长期和高剂量使用时。
探讨全科医生开具阿片类药物的经验、遇到的问题以及不利于良好处方实践的因素。
对威尔士东北部初级保健中开具阿片类药物的全科医生进行定性访谈。
对20名全科医生进行的半结构化访谈进行了转录，并采用框架方法进行主题分析。
参与访谈的全科医生指出了一系列与阿片类药物处方相关的问题。他们担心药物效果有限以及他们所认为的使用药物导致的成瘾问题。他们确定了医疗系统因素是良好处方实践的障碍，如缺乏连续护理、难以获得二级保健疼痛管理支持，以及最重要的是持续的时间压力。他们报告了对医患关系的不良影响。对消除疼痛的不切实际期望导致了开具更强效药物和增加剂量的压力。这导致在建立和维持信任以及说服患者同意并实施剂量减少方面存在困难。
本研究中出现的主题表明，全科医生对阿片类药物处方缺乏适当的控制。需要开发方法来帮助患者和全科医生共同努力安全地管理慢性疼痛。
