scholarly journals Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study

2021 ◽  
Vol 41 (6) ◽  
pp. 182-189
Author(s):  
Joshua Goodwin ◽  
Susan Kirkland
Keyword(s):  
Qualitative Study ◽  
Cancer Pain ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Barriers And Facilitators ◽  
Health Concern ◽  
Prescription Opioid ◽  
Monitoring And Control ◽  
Structured Interviews ◽  
Physician Patient Relationship

Introduction Harms caused by prescription opioid analgesics (POAs) have been identified as a major international public health concern. Recent statistics show rising numbers of opioid-related deaths across Canada. However, Canadian family physicians appear to have inadequate resources to safely and effectively prescribe opioid analgesics to treat chronic non-cancer pain (CNCP). Methods We completed a qualitative study of the barriers and facilitators to safe and effective prescribing of opioid analgesics for CNCP through semi-structured interviews with eight family physicians in Nova Scotia. Thematic analysis was used to identify the barriers and facilitators. Results Family physicians identified challenges in prescribing opioid analgesics for CNCP: the complexity of CNCP management, addictions risks and prescribing tools, physician training, the physician–patient relationship, prescription monitoring and control, and systemic factors. Conclusion Family physicians described themselves as inadequately supported in their prescribing of opioid analgesics for CNCP and could benefit from an integrated and coordinated approach to prescriber support.

scholarly journals Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 215-228 ◽  
Author(s):  
Mark J. Elzey
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Opioid Analgesics ◽  
Risk Indicators ◽  
Phase Iii ◽  
Health Concern ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Mortality And Morbidity ◽  
Societal Burden

Background: Opioid overdose continues to be a significant and growing cause of preventable mortality and morbidity. Studies suggest that unintentional, non-fatal overdose from prescription opioid analgesics constitutes a large portion of total overdose events. The societal burden associated with these events is a frequently overlooked public health concern. Objectives: To evaluate unintentional, non-fatal prescription opioid overdoses, including the identification of risk factors, societal burden, and knowledge gaps where further study is warranted. Study Design: Systematic review of the literature for unintentional, non-fatal opioid overdose. Methods: Preferred reporting items for systematic reviews and meta-analyses guidelines were used in constructing this systematic review. To determine the scope of the existing literature, a systematic search was conducted using the MEDLINE, CINAHL, PsycINFO, and Web of Science databases. Results: This systematic review analyzes 24 articles (21 retrospective descriptive analyses, 2 prospective analyses, one phase III trial, and one meta-analysis). Articles were reviewed by authors and relevant data examined. Results show that opioid overdose morbidity is significantly more prevalent than mortality and sequelae of non-fatal events should be studied in more detail. Limitations: The limitations of this systematic review include the range of study populations and opioids discussed and the broad and variable definitions of “opioid overdose” in the literature. Conclusion(s): Opioid overdose morbidity and mortality is seen across the entire spectrum of inpatient and outpatient use with significant numbers of adverse events occurring in population segments not identified by high risk indicators. Increased physician awareness and a multi-modal approach could help mitigate the overdose epidemic while maintaining effective pain control for patients. Key words: Prescription, opioid, accidental drug overdose, unintentional overdose, drug poisoning, fentanyl, oxycodone, hydrocodone, methadone, oxymorphone, hydromorphone

scholarly journals Exploring the Prescribing Process of Domperidone for Low Milk Supply: A Qualitative Study Among Mothers, IBCLCs, and Family Doctors

2020 ◽  
pp. 089033442096407
Author(s):  
Lara A. Tauritz Bakker ◽  
Liset van Dijk ◽  
Patricia M. L. A. van den Bemt
Keyword(s):  
Qualitative Study ◽  
Family Physicians ◽  
Milk Supply ◽  
Clinical Protocol ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Family Doctors ◽  
Provider Perspectives ◽  
Lactation Consultants ◽  
Dutch Family

Background When mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians’ journal to support Dutch family physicians in prescribing domperidone to stimulate lactation. Research aim To explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol. Methods A cross-sectional qualitative study was performed using semi-structured interviews ( N = 40) based on a topic list covering the prescribing process. Participants were mothers ( n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants ( n = 9), and their family physicians ( n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics. Results In the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented. Conclusions Though the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone.

scholarly journals The anticipated and the lived experience of home and in-centre haemodialysis: Is there a disconnect?

2016 ◽  
Vol 22 (12) ◽  
pp. 1524-1533 ◽  
Author(s):  
Rabiya Majeed-Ariss ◽  
A Jayanti ◽  
T Schulz ◽  
A Wearden ◽  
S Mitra
Keyword(s):  
Qualitative Study ◽  
Lived Experience ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Patient Factors ◽  
Home Haemodialysis ◽  
Advantages And Disadvantages ◽  
Patients Experience

This qualitative study aimed to explore home haemodialysis and in-centre haemodialysis patients’ experience, to illuminate barriers and facilitators in the uptake and maintenance of home haemodialysis. Thirty-two semi-structured interviews with patients receiving home haemodialysis or in-centre haemodialysis were analysed using framework analysis. Four themes emerged: ‘perceptions of self’; ‘impact of haemodialysis on family’; ‘perceived advantages and disadvantages of home haemodialysis and in-centre haemodialysis’ and ‘practical issues and negotiating haemodialysis’. The lived experience of home haemodialysis was in contrast to the lived experience of in-centre haemodialysis and to the anticipated experience of home haemodialysis, highlighting patient factors that contributed to under-usage of home haemodialysis.

Physicians’ empathy levels in a primary care setting: perceptions of patients and their physicians, a qualitative study

2020 ◽  
Vol 37 (6) ◽  
pp. 834-838
Author(s):  
Khairat Al-Habbal ◽  
Thalia Arawi
Keyword(s):  
Qualitative Study ◽  
Subjective Experience ◽  
Middle Eastern ◽  
Tertiary Care ◽  
Chief Complaint ◽  
Patient Relationship ◽  
Structured Interviews ◽  
Physician Patient Relationship ◽  
Tertiary Care Centre ◽  
Physician Patient

Abstract Background The physician–patient relationship is a crucial element in successful medical care. Empathy is the ability to understand an individual’s subjective experience yet remain as an observer. It plays a major role in establishing a good physician–patient relationship. Objective The aim of this study was to evaluate the perspectives of patients and their corresponding emergency physicians regarding physicians’ empathy levels and to extract themes that both patients and their doctors considered as important for an empathic encounter. Methods This is a qualitative study conducted at a Middle Eastern tertiary care centre Emergency Department (ED) using in-depth semi-structured interviews administered to each participating patient and his/her corresponding ED physician. Empathy-related themes were identified using inductive thematic analysis. Results This study shows that both patients and physicians believe in the importance of empathy in the ED based on four major themes: emotions, interpersonal skills, time and chief complaint. Time and the chief complaint were perceived as barriers by physicians, but not by their patients. Conclusions A gap lies in the expressive communication phase of empathy between the two groups. The four major themes retrieved could form the basis of an empathy measure in the medical encounter in Lebanese and similar settings.

scholarly journals Barriers and facilitators to the management of mental health complications after mild traumatic brain injury

Concussion ◽  
2021 ◽  
pp. CNC92
Author(s):  
Noah D Silverberg ◽  
Thalia Otamendi ◽  
Amanda Dulai ◽  
Ripenjot Rai ◽  
Jason Chhina ◽  
...  
Keyword(s):  
Mental Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Theoretical Domains Framework ◽  
Family Physicians ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Early Management ◽  
Health Complications

Background: Clinical practice guidelines for mild traumatic brain injury (mTBI) management call on family physicians to proactively screen and initiate treatment for mental health complications, but evidence suggests that this does not happen consistently. The authors aimed to identify physician-perceived barriers and facilitators to early management of mental health complications following mTBI. Methods & results: Semi-structured interviews based on the Theoretical Domains Framework (TDF) were conducted with 11 family physicians. Interview transcripts were analyzed using directed content analysis. Factors influencing management of mental health post-mTBI were identified along five TDF domains. Conclusion: Family physicians could benefit from accessible and easily implemented resources to manage post-mTBI mental health conditions, having a better defined role in this process, and formalization of referrals to mental health specialists.

scholarly journals Barriers and Facilitators for Return to Work from the Perspective of Workers with Common Mental Disorders with Short, Medium and Long-Term Sickness Absence: A Longitudinal Qualitative Study

2021 ◽  
Author(s):  
Margot C. W. Joosen ◽  
Marjolein Lugtenberg ◽  
Iris Arends ◽  
Hanneke J. A. W. M. van Gestel ◽  
Benedikte Schaapveld ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Qualitative Study ◽  
Return To Work ◽  
Sickness Absence ◽  
Common Mental Disorders ◽  
Coping Behavior ◽  
Work Conditions ◽  
Barriers And Facilitators ◽  
Structured Interviews

AbstractPurpose Although common mental disorders (CMDs) highly impact individuals and society, a knowledge gap exists on how sickness absence can be prevented in workers with CMDs. This study explores: (1) workers’ perceived causes of sickness absence; (2) perceived return to work (RTW) barriers and facilitators; and (3) differences between workers with short, medium and long-term sickness absence. Methods A longitudinal qualitative study was conducted involving 34 workers with CMDs. Semi-structured interviews were held at two time-points during their RTW process. The 68 interviews were audio-taped, transcribed and thematically analyzed to explore workers’ perspective on sickness absence causes, RTW barriers and facilitators, and compare data across the three sub-groups of workers. Results Workers reported various causes for their absence, including: (1) high work pressure; (2) poor work relationships; (3) unhelpful thoughts and feelings, e.g. lacking self-insight; and (4) ineffective coping behaviors. According to workers, RTW was facilitated by work adjustments, fulfilling relationships with supervisors, and adequate occupational health guidance. Workers with short-term leave more often reported favorable work conditions, and proactive coping behavior. In contrast, the long-term group reported reactive coping behavior and dissatisfaction with their work. Conclusion Supporting workers with CMDs in gaining self-awareness and regaining control, discussing the value of their work, and creating work conditions that enable workers to do valuable work, seem central for successful RTW and might prevent sickness absence. Supervisors play a key role in enabling workers to do valuable work and further research should focus on how supervisors can be supported in this task.

scholarly journals GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care

2019 ◽  
Vol 69 (688) ◽  
pp. e752-e759
Author(s):  
Laura Condon ◽  
Vibhore Prasad
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young People ◽  
Qualitative Study ◽  
Health Concern ◽  
Health Consequences ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Children And Young People ◽  
Being Bullied

BackgroundBullying among children and young people (CYP) is a major public health concern that can lead to physical and mental health consequences. CYP may disclose bullying, and seek help from a GP. However, there is currently little research on GPs’ views on and perceptions of their role in dealing with disclosures of bullying in primary care.AimTo explore GPs’ views about their role in dealing with CYPs’ disclosures of being bullied, especially factors that have an impact on GPs’ roles.Design and settingIn this cross-sectional qualitative study, semi-structured interviews were conducted with GPs in primary care in England from October to December 2017.MethodPurposive sampling was used to achieve variation in GP age, professional status in practice, profile of the patients served by the practice, practice size and location, and whether the GPs considered themselves to be actively in research or teaching.ResultsData from 14 semi-structured interviews revealed three main themes: remaining clinically vigilant; impact of bullying in schools; and training and guidance on dealing with bullying and cyberbullying. GPs felt that dealing with disclosures of bullying and cyberbullying came down to their clinical experience rather than guideline recommendations, which do not currently exist, and that bullying was a precipitating factor in presentations of CYPs’ mental health issues.ConclusionGPs feel they have a role to play in managing and supporting the health of CYP who disclose being bullied during consultations. However, they feel ill-equipped to deal with these disclosures because of lack of professional development opportunities, and guidance on treating and managing the health consequences of being bullied.

scholarly journals A Qualitative Study of Veterans on Long-Term Opioid Analgesics: Barriers and Facilitators to Multimodality Pain Management

Pain Medicine ◽  
2015 ◽  
Vol 16 (4) ◽  
pp. 726-732 ◽  
Author(s):  
Maureen J. Simmonds ◽  
Erin P. Finley ◽  
Shruthi Vale ◽  
Mary Jo Pugh ◽  
Barbara J. Turner
Keyword(s):  
Pain Management ◽  
Qualitative Study ◽  
Opioid Analgesics ◽  
Barriers And Facilitators

Palliative care in the emergency department: A qualitative study exploring barriers, facilitators, desired clinician qualities, and future directions

2021 ◽  
pp. 1-6
Author(s):  
Alexa Gips ◽  
Bethany-Rose Daubman ◽  
Laura A. Petrillo ◽  
Jason Bowman ◽  
Kei Ouchi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Qualitative Study ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Structured Interviews ◽  
Two Phase ◽  
Financial Model ◽  
The Future ◽  
The Impact

Abstract Objective To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED–PC, and clinicians’ perspectives on the future of ED–PC. Method This qualitative study using semi-structured interviews was conducted in June–August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED–PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED–PC currently and in the future. Results PC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED–PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED–PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED–PC. Increased primary PC education for ED staff, increased automation, and innovative ED–PC models were seen as areas for future growth. Significance of results Our findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED–PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED–PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED–PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.

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