PDF(Pubmed)
Abstract：
BACKGROUND: Chronic pain is a debilitating and common health issue. General Practitioners (GPs) often prescribe opioids to treat chronic pain, despite limited evidence of benefit and increasing evidence of harms, including prescription Opioid Use Disorder (pOUD). Australian GPs are worried about the harms of long-term opioids, but few are involved in the treatment of pOUD. There is little research on GPs\' experiences diagnosing and managing pOUD in their chronic pain patients.
METHODS: This qualitative research used semi-structured interviews and a case study to investigate GPs\' experiences through the lens of the Theory of Planned Behaviour (TPB). TPB describes three factors, an individual\'s perceived beliefs/attitudes, perceived social norms and perceived behavioural controls. Participants were interviewed via an online video conferencing platform. Interviews were transcribed verbatim and thematically analysed.
RESULTS: Twenty-four GPs took part. Participants were aware of the complex presentations for chronic pain patients and concerned about long-term opioid use. Their approach was holistic, but they had limited understanding of pOUD diagnosis and suggested that pOUD had only one treatment: Opioid Agonist Treatment (OAT). Participants felt uncomfortable prescribing opioids and were fearful of difficult, conflictual conversations with patients about the possibility of pOUD. This led to avoidance and negative attitudes towards diagnosing pOUD. There were few positive social norms, few colleagues diagnosed or managed pOUD. Participants reported that their colleagues only offered positive support as this would allow them to avoid managing pOUD themselves, while patients and other staff were often unsupportive. Negative behavioural controls were common with low levels of knowledge, skill, professional supports, inadequate time and remuneration described by many participants. They felt OAT was not core general practice and required specialist management. This dichotomous approach was reflected in their views that the health system only supported treatment for chronic pain or pOUD, not both conditions.
CONCLUSIONS: Negative beliefs, negative social norms and negative behavioural controls decreased individual behavioural intention for this group of GPs. Diagnosing and managing pOUD in chronic pain patients prescribed opioids was perceived as difficult and unsupported. Interventions to change behaviour must address negative perceptions in order to lead to more positive intentions to engage in the management of pOUD.
METHODS: This qualitative research used semi-structured interviews and a case study to investigate GPs\' experiences through the lens of the Theory of Planned Behaviour (TPB). TPB describes three factors, an individual\'s perceived beliefs/attitudes, perceived social norms and perceived behavioural controls. Participants were interviewed via an online video conferencing platform. Interviews were transcribed verbatim and thematically analysed.
RESULTS: Twenty-four GPs took part. Participants were aware of the complex presentations for chronic pain patients and concerned about long-term opioid use. Their approach was holistic, but they had limited understanding of pOUD diagnosis and suggested that pOUD had only one treatment: Opioid Agonist Treatment (OAT). Participants felt uncomfortable prescribing opioids and were fearful of difficult, conflictual conversations with patients about the possibility of pOUD. This led to avoidance and negative attitudes towards diagnosing pOUD. There were few positive social norms, few colleagues diagnosed or managed pOUD. Participants reported that their colleagues only offered positive support as this would allow them to avoid managing pOUD themselves, while patients and other staff were often unsupportive. Negative behavioural controls were common with low levels of knowledge, skill, professional supports, inadequate time and remuneration described by many participants. They felt OAT was not core general practice and required specialist management. This dichotomous approach was reflected in their views that the health system only supported treatment for chronic pain or pOUD, not both conditions.
CONCLUSIONS: Negative beliefs, negative social norms and negative behavioural controls decreased individual behavioural intention for this group of GPs. Diagnosing and managing pOUD in chronic pain patients prescribed opioids was perceived as difficult and unsupported. Interventions to change behaviour must address negative perceptions in order to lead to more positive intentions to engage in the management of pOUD.
摘要：
背景：慢性疼痛是一种使人衰弱且常见的健康问题。全科医生（GP）经常开阿片类药物来治疗慢性疼痛，尽管有益的证据有限，危害的证据越来越多，包括处方阿片类药物使用障碍（pOUD）。澳大利亚全科医生担心长期阿片类药物的危害，但很少有人参与pOUD的治疗。关于全科医生在其慢性疼痛患者中诊断和管理pOUD的经验的研究很少。
方法：这项定性研究使用半结构化访谈和案例研究，通过计划行为理论（TPB）的镜头来调查全科医生的经验。城规会描述三个因素，个人感知的信念/态度，感知的社会规范和感知的行为控制。参与者通过在线视频会议平台接受了采访。访谈被逐字转录和主题分析。
结果：24名全科医生参加。参与者意识到慢性疼痛患者的复杂表现，并担心长期使用阿片类药物。他们的方法是整体的，但他们对pOUD诊断的了解有限,认为pOUD只有一种治疗方法:阿片类激动剂治疗(OAT).参与者对处方阿片类药物感到不舒服，并且害怕困难，与患者就pOUD的可能性进行冲突对话。这导致对诊断pOUD的回避和消极态度。很少有积极的社会规范，很少有同事诊断或管理pOUD。参与者报告说，他们的同事只提供了积极的支持，因为这将使他们避免自己管理pOUD，而患者和其他工作人员往往不支持。负面行为控制在知识水平低的情况下很常见，技能，专业支持,许多参与者描述的时间和报酬不足。他们认为OAT不是核心的一般做法，需要专家管理。这种二分法反映在他们的观点中，即卫生系统只支持慢性疼痛或pOUD的治疗，不是两个条件。
结论：消极信念，消极的社会规范和消极的行为控制降低了这组全科医生的个人行为意向.慢性疼痛患者处方阿片类药物的诊断和管理pOUD被认为是困难和不支持的。改变行为的干预措施必须解决负面看法，以导致更积极的意图参与pOUD的管理。
方法：这项定性研究使用半结构化访谈和案例研究，通过计划行为理论（TPB）的镜头来调查全科医生的经验。城规会描述三个因素，个人感知的信念/态度，感知的社会规范和感知的行为控制。参与者通过在线视频会议平台接受了采访。访谈被逐字转录和主题分析。
结果：24名全科医生参加。参与者意识到慢性疼痛患者的复杂表现，并担心长期使用阿片类药物。他们的方法是整体的，但他们对pOUD诊断的了解有限,认为pOUD只有一种治疗方法:阿片类激动剂治疗(OAT).参与者对处方阿片类药物感到不舒服，并且害怕困难，与患者就pOUD的可能性进行冲突对话。这导致对诊断pOUD的回避和消极态度。很少有积极的社会规范，很少有同事诊断或管理pOUD。参与者报告说，他们的同事只提供了积极的支持，因为这将使他们避免自己管理pOUD，而患者和其他工作人员往往不支持。负面行为控制在知识水平低的情况下很常见，技能，专业支持,许多参与者描述的时间和报酬不足。他们认为OAT不是核心的一般做法，需要专家管理。这种二分法反映在他们的观点中，即卫生系统只支持慢性疼痛或pOUD的治疗，不是两个条件。
结论：消极信念，消极的社会规范和消极的行为控制降低了这组全科医生的个人行为意向.慢性疼痛患者处方阿片类药物的诊断和管理pOUD被认为是困难和不支持的。改变行为的干预措施必须解决负面看法，以导致更积极的意图参与pOUD的管理。
