Qualitative insights into the opioid prescribing practices of Australian GP

Abstract Background Over the last three decades, Australian opioid-prescribing rates and related morbidity and mortality have dramatically increased. Opioids are frequently prescribed by general practitioners (GPs) to manage chronic non-cancer pain, despite evidence-based recommendations from the Centre for Disease Control, National Institute for Health and Care Excellence and World Health Organization widely cautioning their use. Little is known about the factors influencing the opioid prescribing decisions of Australian GPs, especially when not evidence based. Objective To explore the opioid prescribing knowledge, attitudes and practices of Australian GPs. Methods Semi-structured interviews with 20 GPs recruited from the Monash University practice-based research network in metropolitan, southeastern Melbourne. Thematic analysis was used to identify emergent themes. Data were managed using QSR NVivo. Ethics approval was granted by Monash University. Results Three key themes emerged. GP attitudes towards opioid use for chronic pain varied by age of patient and goals for therapy. Use of opioids for elderly patients was positively perceived. GPs were reluctant to use opioids in younger patients due to fears of addiction and difficulty weaning. GPs felt obliged to prescribe opioids recommended by specialists, even if they believed the opioids were unsafe. Conclusion This study identified and described the patient-centred nature of GP opioid prescribing decisions. Patient age and perceived age-related opioid harm were important factors influencing prescribing decisions. Future work should inform interventions that value GP autonomy while still encouraging a collaborative inter-speciality approach to managing chronic pain patients with opioids.

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Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing

Pain Medicine ◽

10.1093/pm/pny204 ◽

2018 ◽

Vol 20 (10) ◽

pp. 1934-1941 ◽

Cited By ~ 1

Author(s):

Zayd Razouki ◽

Bushra A Khokhar ◽

Lindsey M Philpot ◽

Jon O Ebbert

Keyword(s):

Monitoring Program ◽

Program Review ◽

Opioid Misuse ◽

Opioid Use ◽

Prescribing Practices ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Attitudes And Practices ◽

Urine Drug ◽

Noncancer Pain

Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.

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EXPLORINGTHE OPIOID PRESCRIBING PRACTICES OF GENERAL PRACTITIONERS (GPS) IN WEST AND SOUTH ESSEX, UK

International Journal of Advanced Research ◽

10.21474/ijar01/13123 ◽

2021 ◽

Vol 9 (07) ◽

pp. 245-257

Author(s):

Edwin Ugoh ◽

Vincent Icheku

Keyword(s):

Chronic Pain ◽

Pain Management ◽

General Practitioners ◽

Qualitative Data ◽

Prescription Medications ◽

Opioid Use ◽

Prescribing Practices ◽

Nominal Data ◽

Opioid Prescription ◽

Opioid Prescribing

Introduction:The emerging evidence in recent studies shows that Opioid use and abuse have continued to grow at a significant rate, with fatal consequences. The evidence also indicates palpable apprehension and concern over the increasing opiate/ opioid prescription numbers by General Practitioners (GPs). This present study aims to explore the opioid prescribing practices of General Practitioners (GPs) in West and South Essex. The objectives are to answer the following questions: is an opiate prescription based on any available guideline? Is opioid prescribed primarily for pain management? How many times do the GPs prescribe opioids? How long are patients on pain prescription medications? Has the GPs attended training on the use of opioid for pain management? How many years has the GPs spent working as a practitioner? Finally, these researchers believe that answers to these question will add to the knowledge base towards improving the risk-benefit balance of prescribed opiates. Methods:A short self-questionnaire was sent to all GP practices in the South and West of Essex (n=25). There was a response rate of 80 per cent (20/25). Qualitative data from the questions were analysed using thematic analysis. In addition, nominal data were analysed using descriptive statistics to summarise the results. Results:The study found that most of the GPs who participated in the survey are experienced GPs, yet the majority are not complying with prescribing guidelineand thus, overprescribes opioid for pain management. Conclusion:The overprescribing practices of opioids by GPs are affected by an absence of robust guideline on managing chronic pain. Thus, we recommendcompliance with existing guideline and consultation on managing chronic pain over 16s to producea guideline on adult pain management.

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Opioid prescribing practices of members of the national dental practice based research network

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2015.07.396 ◽

2015 ◽

Vol 156 ◽

pp. e145

Author(s):

Jenna L. McCauley ◽

Valeria V. Gordan ◽

Joseph L. Riley ◽

Roger B. Fillingim ◽

Sonia K. Makhija ◽

...

Keyword(s):

Research Network ◽

Dental Practice ◽

Prescribing Practices ◽

Opioid Prescribing ◽

Practice Based Research

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Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

Gynecologic and Obstetric Investigation ◽

10.1159/000519517 ◽

2021 ◽

pp. 1-9

Author(s):

Aakriti R. Carrubba ◽

Amy E. Glasgow ◽

Elizabeth B. Habermann ◽

Amanda P. Stanton ◽

Megan N. Wasson ◽

...

Keyword(s):

Statistical Analysis ◽

Cohort Analysis ◽

Oral Morphine ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Opioid Use ◽

Prescribing Practices ◽

Opioid Prescribing ◽

Before And After ◽

Legislative Changes

Objectives: This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. Design: This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. Methods: Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum t tests for OMEs and χ2 t tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results: In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (p < 0.0001). The opioid refill rate remained unchanged at 7.4% (p = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (p < 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; p = 0.739). Limitations: Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. Conclusions: Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

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Postoperative Opioid Prescribing Practices and Evidence-Based Guidelines in Bariatric Surgery

Obesity Surgery ◽

10.1007/s11695-019-03821-8 ◽

2019 ◽

Vol 29 (7) ◽

pp. 2030-2036 ◽

Cited By ~ 6

Author(s):

Danielle T. Friedman ◽

Saber Ghiassi ◽

Matthew O. Hubbard ◽

Andrew J. Duffy

Keyword(s):

Bariatric Surgery ◽

Evidence Based ◽

Prescribing Practices ◽

Opioid Prescribing ◽

Evidence Based Guidelines

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P113: Examining emergency physicians’ self-reported opioid prescribing practices for the treatment of acute pain: A Newfoundland perspective

CJEM ◽

10.1017/cem.2020.319 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S105-S106

Author(s):

P. Doran ◽

G. Sheppard ◽

B. Metcalfe

Keyword(s):

Emergency Department ◽

Acute Pain ◽

Oral Morphine ◽

Prescribing Patterns ◽

Evidence Based ◽

Emergency Physicians ◽

Prescribing Practices ◽

Opioid Prescribing ◽

Ensure Patient Safety ◽

Evidence Based Guidelines

Introduction: Canadians are the second largest consumers of prescription opioids per capita in the world. Emergency physicians tend to prescribe stronger and larger quantities of opioids, while family physicians write the most opioid prescriptions overall. These practices have been shown to precipitate future dependence, toxicity and the need for hospitalization. Despite this emerging evidence, there is a paucity of research on emergency physicians’ opioid prescribing practices in Canada. The objectives of this study were to describe our local emergency physicians’ opioid prescribing patterns both in the emergency department and upon discharge, and to explore factors that impact their prescribing decisions. Methods: Emergency physicians from two urban, adult emergency departments in St. John's, Newfoundland were anonymously surveyed using a web-based survey tool. All 42 physicians were invited to participate via email during the six-week study period and reminders were sent at weeks two and four. Results: A total of 21 participants responded to the survey. Over half of respondents (57.14%) reported that they “often” prescribe opioids for the treatment of acute pain in the emergency department, and an equal number of respondents reported doing so “sometimes” at discharge. Eighty-five percent of respondents reported most commonly prescribing intravenous morphine for acute pain in the emergency department, and over thirty-five percent reported most commonly prescribing oral morphine upon discharge. Patient age and risk of misuse were the most frequently cited factors that influenced respondents’ prescribing decisions. Only 4 of the 22 respondents reported using evidence-based guidelines to tailor their opioid prescribing practices, while an overwhelming majority (80.95%) believe there is a need for evidence-based opioid prescribing guidelines for the treatment of acute pain. Sixty percent of respondents completed additional training in safe opioid prescribing, yet less than half of respondents (42.86%) felt they could help to mitigate the opioid crisis by prescribing fewer opioids in the emergency department. Conclusion: Emergency physicians frequently prescribe opioids for the treatment of acute pain and new evidence suggests that this practice can lead to significant morbidity. While further research is needed to better understand emergency physicians’ opioid prescribing practices, our findings support the need for evidence-based guidelines for the treatment of acute pain to ensure patient safety.

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How Hands-On Pain Skills Intensive Trainings Complement ECHO Pain and Opioid Management Programs: A Program Evaluation with the Indian Health Service

Pain Medicine ◽

10.1093/pm/pnaa151 ◽

2020 ◽

Vol 21 (9) ◽

pp. 1769-1778

Author(s):

Joanna G Katzman ◽

Kathleen Gygi ◽

Robin Swift ◽

George Comerci ◽

Snehal Bhatt ◽

...

Keyword(s):

Chronic Pain ◽

Health Service ◽

Focus Groups ◽

Indian Health Service ◽

Opioid Use ◽

Prescribing Practices ◽

Indian Health ◽

Hands On ◽

The Impact

Abstract Objective To evaluate the impact of Pain Skills Intensive trainings (PSIs) as a complement to the Indian Health Service (IHS) and the Chronic Pain and Opioid Management TeleECHO Program (ECHO Pain) collaboration. Design On-site PSIs conducted over two to three days were added to complement ECHO Pain at various IHS areas to enhance pain skills proficiency among primary care teams and to expand the reach of ECHO collaboration to ECHO nonparticipants. Setting This evaluation focuses on two PSI trainings offered to IHS clinicians in Albuquerque, New Mexico, and Spokane, Washington, in 2017. Methods The mixed-methods design comprises CME surveys and focus groups at the end of training and 12 to 18 months later. Quality of training and perceived competence were evaluated. Results Thirty-eight participants attended the two PSI workshops. All provided CME survey results, and 28 consented to use of their postsession focus group results. Nine clinicians participated in the virtual follow-up focus groups. IHS clinicians rated the PSIs highly, noting their hands-on and interdisciplinary nature. They reported above-average confidence in their skills. Follow-up focus groups indicated they were pursuing expanded options for their patients, consulting other clinicians, serving as pain consultants to their peers, and changing prescribing practices clinic-wide. However, rurality significantly limits access to ancillary and complementary services for many. Clinicians reported the need for additional training in integrating behavioral health into their practice. Conclusions Hands-on pain skills and information on medication-assisted treatment (MAT) are critical to the successful treatment of chronic pain and opioid use disorder. The PSIs provide clinicians with critical competencies in assessment and screening, pain management, and communication skills, complementing required IHS training and telementoring from ECHO Pain.

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Implementation of an Evidence-Based Protocol Significantly Reduces Opioid Prescribing After Ventral Hernia Repair

The American Surgeon ◽

10.1177/0003134820942207 ◽

2020 ◽

Vol 86 (11) ◽

pp. 1602-1606

Author(s):

Diana E. Peterman ◽

Bryan P. Knoedler ◽

Joseph A. Ewing ◽

Alfredo M. Carbonell ◽

William S. Cobb ◽

...

Keyword(s):

South Carolina ◽

Hernia Repair ◽

Ventral Hernia ◽

Program Analysis ◽

Ventral Hernia Repair ◽

Monitoring Program ◽

Trend Test ◽

Evidence Based ◽

Opioid Use ◽

Opioid Prescribing

Background Increased recognition of the dangers of opioid analgesia has led to significant focus on strategies for reducing use through multimodal analgesia, enhanced recovery protocols, and standardized guidelines for prescribing. Our institution implemented a standard protocol for prescribing analgesics at discharge after ventral hernia repair (VHR). We hypothesize that this strategy significantly reduces opioid use. Methods A standardized protocol for discharge prescribing was implemented in March 2018. Patients were prescribed ibuprofen, acetaminophen, and opioids based on milligram morphine equivalent (MME) use the 24 hours prior to discharge. We retrospectively reviewed prescriptions of opioids for two 6-month periods—July-December 2017 (PRE) and July-December 2018 (POST)—for comparison using EPIC report and the South Carolina Prescription Monitoring Program. Analysis performed included Mann-Kendall linear trend test and Student’s t-test for continuous variables. Results VHR was performed in 105 patients in the PRE and 75 patients in the POST group. Total MME prescribed decreased significantly from mean 322.7 + 261.3/median 225 (IQR 150-400) MME to 141.6 + 150.4/median 100 (50-184) MME ( P < .001). This represents a 57% reduction in mean opioid MME prescriptions. Acetaminophen prescribing increased from 10% to 65%, and ibuprofen from 7.6% to 61.3%. Refills were prescribed in 21 patients (20%) during the PRE period, which decreased to 10.7% during the POST group ( P = .141). Implementation of an evidence-based protocol significantly reduces opioid prescribing after VHR. Discussion A multimodal approach to postoperative pain management decreases the need for opioids. The additional implementation of an evidence-based prescribing protocol results in significant reduction of opioid use following VHR.

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