Exploring the facilitators and barriers in opioid deprescribing for non-cancer pain treatment experienced by general practitioners: A qualitative study

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-01-30 DOI:10.1002/ejp.2243

Loes de Kleijn, Elsemiek A. W. Jansen-Groot Koerkamp, Iris van der Kooij, Mario Veen, Hanneke J. B. M. Rijkels-Otters, Bart W. Koes, Alessandro Chiarotto

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Abstract

Background

Guidelines recommend opioid deprescribing in patients on long-term opioid treatment for chronic non-cancer pain. This study aims to explore facilitators and barriers in opioid deprescribing among general practitioners in the Netherlands. In addition, this study aims to identify possibilities for improvement regarding opioid deprescribing in primary care.

Methods

Focus group discussions with Dutch General practitioners were held by two skilled moderators. The focus group discussions were transcribed verbatim and analysed using MAXQDA software. Three independent reviewers searched for overarching themes using thematic analysis with an inductive approach. Discussions were organized until data saturation was reached.

Results

Twenty-two general practitioners participated in four focus group discussions. Five main themes emerged from the data: (1) patient-centred care; (2) ensuring proper pain management (3) dilemmas and hardships in dealing with opioid use disorder; (4) the competency gap; (5) needs and possibilities to improve opioid deprescribing in primary care. The first theme addresses the main facilitators in opioid tapering. The following three themes emerged as main barriers in opioid deprescribing. The fifth theme identified possibilities for change.

Conclusions

This study indicates the importance of intrinsic motivation and a tailored approach to deprescribe opioids in patients with chronic pain on long-term opioid treatment. Identified barriers include struggles in pain management, challenges caused by opioid use disorder, insufficient capacities such as time constraints and lack of skills. Recommendations for improvement involve enhanced collaboration with healthcare professionals in primary and secondary care, provision of practical tools and assurance of sufficient time.

Significance

This focus group study among 22 Dutch general practitioners elucidates the complexities of opioid deprescribing and reveals pivotal themes such as patient-centred care, pain management challenges, and competency gaps. The findings underscore the crucial role of intrinsic motivation and that of a tailored approach in opioid deprescribing, while demonstrating how a lack in effective pain treatments, practical capacities and challenges caused by opioid dependence, impede opioid deprescribing. By uncovering these complexities, this study aims to inform future deprescribing strategies.

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探索全科医生在非癌症疼痛治疗中开具阿片类药物处方的促进因素和障碍：定性研究。

背景：指南建议对长期接受阿片类药物治疗的慢性非癌性疼痛患者停用阿片类药物。本研究旨在探讨荷兰全科医生在开具阿片类药物处方时遇到的促进因素和障碍。此外，本研究还旨在确定在初级医疗中改进阿片类药物处方的可能性：方法：由两名熟练的主持人与荷兰全科医生进行焦点小组讨论。对焦点小组讨论进行逐字记录，并使用 MAXQDA 软件进行分析。三位独立审稿人采用归纳法进行主题分析，寻找总体主题。讨论一直持续到数据饱和为止：22 名全科医生参加了四次焦点小组讨论。从数据中得出了五大主题：（1）以患者为中心的护理；（2）确保适当的疼痛管理；（3）处理阿片类药物使用障碍的困境和困难；（4）能力差距；（5）改善初级保健中阿片类药物处方的需求和可能性。第一个主题涉及阿片类药物减量的主要促进因素。以下三个主题是阿片类药物减量的主要障碍。第五个主题确定了变革的可能性：本研究表明，对于长期接受阿片类药物治疗的慢性疼痛患者来说，内在动力和有针对性的方法对于阿片类药物的减量非常重要。已发现的障碍包括疼痛管理方面的困难、阿片类药物使用障碍造成的挑战、能力不足（如时间限制和缺乏技能）。改进建议包括加强与初级和二级医疗保健专业人员的合作、提供实用工具和保证充足的时间：这项针对 22 名荷兰全科医生的焦点小组研究阐明了阿片类药物处方的复杂性，并揭示了以患者为中心的护理、疼痛管理挑战和能力差距等关键主题。研究结果强调了内在动机和量身定制的方法在阿片类药物处方中的关键作用，同时也表明了有效疼痛治疗方法的缺乏、实际能力的不足以及阿片类药物依赖所带来的挑战是如何阻碍阿片类药物处方的。通过揭示这些复杂性，本研究旨在为未来的去处方化战略提供参考。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.