Lawrence Rebecca, Versteeg Everett, Pike Andrea, Etchegary Holly, Hall Amanda
Primary Healthcare Research Unit, Memorial University, St. John's, Newfoundland and Labrador, Canada.
Pasqua Hospital, Regina, Saskatchewan, Canada.
PLoS One. 2025 Jan 7;20(1):e0316730. doi: 10.1371/journal.pone.0316730. eCollection 2025.
Canada has the fourth highest per capita rate of opioid prescriptions in the world, contributing to the country's opioid crisis. Due to both their pain-relieving and euphoric properties, opioids can be highly addictive, leading to potential overdose and death. Deprescription is an endorsed and organized method of discontinuing a drug but very little is known about the barriers that Canadian physicians face when attempting to deprescribe opioids, particularly those who practice in rural areas (which have some of the highest rates of opioid users).
This was an explorative, qualitative study describing rural family doctors' experiences and practices regarding opioid deprescription in primary care. A convenience sample of family doctors who had experience working with patients taking opioid medications was recruited from the professional networks of study team members. After consenting to participate, data was collected using semi-structured telephone interviews and analyzed by researchers experienced in applying the Theoretical Domains Framework to assess barriers and enablers of behavior change.
10 physicians participated in this study. Our analysis revealed four barriers and five enablers related to opioid deprescription in rural primary care. Barriers include a lack of knowledge and skills related to deprescribing, discomfort initiating deprescription, patient pressure to continue prescribing opioids, and a lack of foundational support required to deprescribe. Enablers include working with colleagues who share common views on overuse of opioids and deprescription; access to other healthcare providers, community-based resources, and clinical tools; using a systematic approach to deprescription; previous experience successfully deprescribing opioids; and practicing in a rural setting.
Opioid dependence and over-prescription continue to be a problem for our health system. Deprescription is necessary but challenging for family physicians. Rural physicians are keenly aware of the importance of preserving the physician-patient therapeutic relationship and open and clear communication about opioid medications and deprescription but feel unprepared to manage this in the face of difficult issues surrounding deprescription. They also feel unprepared to deal with deprescription effectively without access to other resources, healthcare professionals, patient education materials and time. Rural physicians would benefit most from added foundational supports for deprescription.
加拿大的人均阿片类药物处方率在世界上排名第四，这加剧了该国的阿片类药物危机。由于阿片类药物具有止痛和欣快感特性，极易使人上瘾，从而可能导致过量用药和死亡。减药是一种被认可的、有组织的停药方法，但对于加拿大医生在尝试停用阿片类药物时所面临的障碍，尤其是在农村地区执业的医生（农村地区阿片类药物使用者比例较高），我们知之甚少。
这是一项探索性的定性研究，描述了农村家庭医生在初级保健中进行阿片类药物减药的经验和做法。从研究团队成员的专业网络中招募了有与服用阿片类药物患者合作经验的家庭医生作为便利样本。在同意参与后，通过半结构化电话访谈收集数据，并由有应用理论领域框架评估行为改变障碍和促进因素经验的研究人员进行分析。
10名医生参与了本研究。我们的分析揭示了农村初级保健中与阿片类药物减药相关的四个障碍和五个促进因素。障碍包括缺乏与减药相关的知识和技能、开始减药时的不适感、患者要求继续开具阿片类药物的压力以及减药所需的基础支持不足。促进因素包括与对阿片类药物过度使用和减药有共同看法的同事合作；能够接触到其他医疗服务提供者、社区资源和临床工具；采用系统的减药方法；以前成功减用阿片类药物的经验；以及在农村环境中执业。
阿片类药物依赖和过度处方仍然是我们卫生系统面临的一个问题。减药对于家庭医生来说是必要的，但具有挑战性。农村医生敏锐地意识到维护医患治疗关系以及就阿片类药物和减药进行开放、清晰沟通的重要性，但面对减药过程中出现的棘手问题时，他们觉得没有准备好应对。他们还觉得，如果无法获得其他资源、医疗专业人员、患者教育材料和时间，就无法有效地处理减药问题。农村医生将从增加的减药基础支持中受益最大。
