scholarly journals General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing

2019 ◽  
Vol Volume 12 ◽  
pp. 467-475 ◽  
Author(s):  
Ruth White ◽  
Chris Hayes ◽  
Allison W Boyes ◽  
Simon Chiu ◽  
Christine L Paul
Keyword(s):  
General Practitioners ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

scholarly journals Gender Differences in Depression and Sex Hormones among Patients Receiving Long-Term Opioid Treatment for Chronic Noncancer Pain in Taiwan—A Multicenter Cross-Sectional Study

2021 ◽  
Vol 18 (15) ◽  
pp. 7837
Author(s):  
Shung-Tai Ho ◽  
Tso-Chou Lin ◽  
Chun-Chang Yeh ◽  
Kuang-I Cheng ◽  
Wei-Zen Sun ◽  
...  
Keyword(s):  
Sexual Function ◽  
Sex Hormones ◽  
Sex Hormone ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Depression Diagnosis ◽  
Opioid Treatment ◽  
Hormone Levels ◽  
Noncancer Pain

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.

scholarly journals Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jason W. Busse ◽  
Joyce Douglas ◽  
Tara S. Chauhan ◽  
Bilal Kobeissi ◽  
Jeff Blackmer
Keyword(s):  
Online Survey ◽  
Preliminary Evidence ◽  
Opioid Therapy ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Opioid Tapering ◽  
Noncancer Pain

Background. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results. We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion. There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

scholarly journals Stockpiled personal protective equipment and knowledge of pandemic plans as predictors of perceived pandemic preparedness among German general practitioners

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255986
Author(s):  
Arno Stöcker ◽  
Ibrahim Demirer ◽  
Sophie Gunkel ◽  
Jan Hoffmann ◽  
Laura Mause ◽  
...  
Keyword(s):  
General Practitioners ◽  
Personal Protective Equipment ◽  
Explanatory Power ◽  
Vital Role ◽  
Protective Equipment ◽  
Linear Regression Models ◽  
Pandemic Preparedness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Determining Factor

Background The COVID-19 pandemic significantly changed the work of general practitioners (GPs). At the onset of the pandemic in March 2020, German outpatient practices had to adapt quickly. Pandemic preparedness (PP) of GPs may play a vital role in their management of a pandemic. Objectives The study aimed to examine the association in the stock of seven personal protective equipment (PPE) items and knowledge of pandemic plans on perceived PP among GPs. Methods Three multivariable linear regression models were developed based on an online cross-sectional survey for the period March–April 2020 (the onset of the pandemic in Germany). Data were collected using self-developed items on self-assessed PP and knowledge of a pandemic plan and its utility. The stock of seven PPE items was queried. For PPE items, three different PPE scores were compared. Control variables for all models were gender and age. Results In total, 508 GPs were included in the study; 65.16% believed that they were very poorly or poorly prepared. Furthermore, 13.83% of GPs were aware of a pandemic plan; 40% rated those plans as beneficial. The stock of FFP-2/3 masks, protective suits, face shields, safety glasses, and medical face masks were mostly considered completely insufficient or insufficient, whereas disposable gloves and disinfectants were considered sufficient or completely sufficient. The stock of PPE was significantly positively associated with PP and had the largest effect on PP; the association of the knowledge of a pandemic plan was significant but small. PPE scores did not vary considerably in their explanatory power. The assessment of a pandemic plan as beneficial did not significantly affect PP. Conclusion The stock of PPE seems to be the determining factor for PP among German GPs; for COVID-19, sufficient masks are the determining factor. Knowledge of a pandemic plans play a secondary role in PP.

scholarly journals Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

2021 ◽  
Vol 22 ◽  
Author(s):  
Peter P. Groenewegen ◽  
Wienke G. W. Boerma ◽  
Peter Spreeuwenberg ◽  
Bohumil Seifert ◽  
Willemijn Schäfer ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Professional Training ◽  
Institutional Development ◽  
Task Shifting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Independent Variables ◽  
Nurse Prescribing ◽  
Number Of Patients

Abstract Aim: To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable ‘task shifting’ is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. Findings: Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.

scholarly journals A cross-sectional survey of awareness of human papillomavirus-associated oropharyngeal cancers among general practitioners in the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e023339 ◽  
Author(s):  
Matt Lechner ◽  
Claire Vassie ◽  
Cemal Kavasogullari ◽  
Oliver Jones ◽  
James Howard ◽  
...  
Keyword(s):  
Risk Factor ◽  
Human Papillomavirus ◽  
General Practitioners ◽  
Further Education ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Chewing Tobacco ◽  
The Uk ◽  
Epidemiological Trends

ObjectivesTo examine the level of awareness of the link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) and epidemiological trends in HPV-related OPC among general practitioners (GPs) in the UK.DesignCross-sectional survey.Participants384 GPs from England, Scotland, Wales and Northern Ireland.SettingThe survey was administered at GP training courses and via email to lists of training course attendees.Primary and secondary outcome measuresProportion of respondents aware of the link between HPV and OPC; respondents’ self-rated knowledge of OPC; proportion of participants aware of the epidemiological trends in HPV-associated OPC.Results384 questionnaires were completed with an overall response rate of 72.9%. 74.0% of participants recognised HPV as a risk factor for OPC, which was lower than knowledge about the role of smoking, chewing tobacco and alcohol consumption (all >90% recognition). Overall, 19.4% rated their knowledge of OPC as very good or good, 62.7% as average and 17.7% as poor or very poor. The majority (71.9%) were aware that rates of HPV-associated OPC have increased over the last two decades. Fewer than half (41.5%) of the participants correctly identified being male as a risk factor of HPV-associated OPC, while 58.8% were aware that patients with HPV-associated OPC tend to be younger than those with non-HPV-associated disease.ConclusionsThe association of HPV infection with OPC is a relatively recent discovery. Although the level of awareness of HPV and OPC among GPs was high, the characteristics of HPV-associated OPC were less well recognised, indicating the need for further education.

Prevalence, Characteristics, and Management of Chronic Noncancer Pain Among People Who Use Drugs: A Cross-Sectional Study

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3205-3214
Author(s):  
Jean-Luc Kaboré ◽  
Lise Dassieu ◽  
Élise Roy ◽  
Didier Jutras-Aswad ◽  
Julie Bruneau ◽  
...  
Keyword(s):  
Illicit Drugs ◽  
Cross Sectional Study ◽  
Pain Medication ◽  
Health Condition ◽  
People Who Use Drugs ◽  
Sectional Study ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Relieve Pain ◽  
Noncancer Pain

Abstract Introduction Most studies on chronic noncancer pain (CNCP) in people who use drugs (PWUD) are restricted to people attending substance use disorder treatment programs. This study assessed the prevalence of CNCP in a community-based sample of PWUD, identified factors associated with pain, and documented strategies used for pain relief. Methods This was a cross-sectional study nested in an ongoing cohort of PWUD in Montreal, Canada. Questionnaires were administered to PWUD seen between February 2017 and January 2018. CNCP was defined as pain lasting three or more months and not associated with cancer. Results A total of 417 PWUD were included (mean age = 44.6 ± 10.6 years, 84% men). The prevalence of CNCP was 44.8%, and the median pain duration (interquartile range) was 12 (5–18) years. The presence of CNCP was associated with older age (&gt;45 years old; odds ratio [OR] = 1.8, 95% CI = 1.2–2.7), male sex (OR = 2.3, 95% CI = 1.2–4.2), poor health condition (OR = 1.9, 95% CI = 1.3–3.0), moderate to severe psychological distress (OR = 2.9, 95% CI = 1.8–4.7), and less frequent cocaine use (OR = 0.5, 95% CI = 0.3–0.9). Among CNCP participants, 20.3% used pain medication from other people, whereas 22.5% used alcohol, cannabis, or illicit drugs to relieve pain. Among those who asked for pain medication (N = 24), 29.2% faced a refusal from the doctor. Conclusions CNCP was common among PWUD, and a good proportion of them used substances other than prescribed pain medication to relieve pain. Close collaboration of pain and addiction specialists as well as better pain assessment and access to nonpharmacological treatments could improve pain management in PWUD.

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