Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study

BMC Family Practice

Research Article

Duncan Petty¹  Robert West²  Carolyn McCrorie²  Liz Glidewell²  Allan House²  Robbie Foy²  Lucy Ziegler²  S. José Closs³ 

[1] Bradford School of Pharmacy, University of Bradford, Richmond Rd, BD7 1DP, Bradford, Yorkshire, UK;Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, LS2 9LJ, Leeds, UK;School of Healthcare, Baines Wing, University of Leeds, LS2 9JT, Leeds, UK;

关键词: Focus Group;    Chronic Pain;    Opioid Prescribe;    Strong Opioid;    Chronic Pain Management;   

DOI  :  10.1186/s12875-015-0335-5

 received in 2015-07-09, accepted in 2015-08-31,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain.MethodsWe held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts.ResultsPatients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs’ responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient’s wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust.ConclusionsProblematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.

【 授权许可】

CC BY   
© McCrorie et al. 2015