Parbery-Clark Charlotte L, Portice Jennie Sofia, Sowden Sarah
Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.
BJGP Open. 2025 Apr 24;9(1). doi: 10.3399/BJGPO.2024.0160. Print 2025 Apr.
Opioid and gabapentinoid prescribing has increased substantially in recent years despite having limited effectiveness in treating chronic primary pain. This is concerning, with the prescribing rates and adverse effects of these medications being higher in more socioeconomically disadvantaged groups. Guidance for prescribing and deprescribing these medications exists but the understanding of how deprescribing is operationalised, especially in areas of socioeconomic disadvantage, is limited.
To explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid and gabapentinoid prescribing.
DESIGN & SETTING: A qualitative evaluation, using participant observation and semi-structured interviews with primary healthcare professionals, working in practices serving areas of substantial socioeconomic disadvantage in the North East of England.
Interviewees were purposively recruited with subsequent snowballing with participant observation of the peer-support meetings. Interview transcripts and notes from the participant observation were inductively coded and thematically analysed.
Thirteen healthcare professionals from five practices were interviewed. Person-centred care with shared decision-making was strived for, which was time-consuming owing to the complexity of the problem and patients. Where shared decision-making was not possible, owing to patient refusal or non-engagement, risk was used to determine the appropriate action. This work involved an emotional toll on staff and patients, but was at times conversely easier and more rewarding than expected. Ultimately, demedicalising pain with a culture change is required to ensure patients are not prescribed these medications for inappropriate reasons or doses.
This study demonstrates key operational aspects to consider when undertaking opioid and gabapentinoid deprescribing in primary care, such as funding dedicated time to enable deprescribing.
尽管阿片类药物和加巴喷丁类药物在治疗慢性原发性疼痛方面效果有限，但近年来其处方量仍大幅增加。这令人担忧，因为在社会经济地位较低的群体中，这些药物的处方率和不良反应更高。虽然存在关于这些药物处方和减药的指导意见，但对于如何实施减药，尤其是在社会经济不利地区，了解有限。
探讨初级医疗保健专业人员对设计和实施减少阿片类药物和加巴喷丁类药物处方干预措施的看法和经验。
一项定性评估，采用参与观察法，并对在英格兰东北部社会经济状况严重不利地区工作的初级医疗保健专业人员进行半结构化访谈。
通过目的抽样招募受访者，随后通过参与观察同伴支持会议进行滚雪球抽样。对访谈记录和参与观察笔记进行归纳编码和主题分析。
来自五个医疗机构的13名医疗保健专业人员接受了访谈。努力实现以患者为中心的共同决策护理，但由于问题和患者的复杂性，这一过程耗时较长。当由于患者拒绝或不参与而无法进行共同决策时，则使用风险来确定适当的行动。这项工作给工作人员和患者带来了情感上的负担，但有时反而比预期的更容易且更有意义。最终，需要通过文化变革使疼痛非医学化，以确保患者不会因不适当的原因或剂量而被开具这些药物。
本研究展示了在初级保健中进行阿片类药物和加巴喷丁类药物减药时需要考虑的关键操作方面，例如为减药投入专门时间的资金。
