Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study

Autor: N. Kithulegoda, Marianne Saragosa, Noah Ivers, Laura Desveaux
Rok vydání: 2019
Předmět:
Adult
Male
Canada
medicine.medical_specialty
Attitude of Health Personnel
media_common.quotation_subject
Psychological intervention
Context (language use)
Opioid
Theoretical domains framework
Opioid prescribing
03 medical and health sciences
0302 clinical medicine
Perception
Correspondence
medicine
Decision aids
Humans
030212 general & internal medicine
Practice Patterns
Physicians'
Qualitative Research
media_common
Ontario
lcsh:R5-920
business.industry
030503 health policy & services
Physicians
Family
Guideline
Middle Aged
3. Good health
Analgesics
Opioid
Prescribing
Content analysis
Family medicine
Practice Guidelines as Topic
Female
Guideline Adherence
Chronic Pain
lcsh:Medicine (General)
Qualitative
0305 other medical science
Family Practice
business
Research Article
Qualitative research
Zdroj: BMC Family Practice
BMC Family Practice, Vol 20, Iss 1, Pp 1-12 (2019)
ISSN: 1471-2296
DOI: 10.1186/s12875-019-0947-2
Popis: Background Longstanding variation in the views of family physicians (FPs) on the role of opioids seems to translate into widely varying prescribing rates. Improvement interventions are unlikely to achieve change if they do not understand and explicitly target the factors that determine physician prescribing behaviour. The aim of this work was to understand (1) the perspectives of FPs as it relates to opioid prescribing, and (2) the perceived barriers and enablers to guideline-adherent opioid prescribing and management of chronic non-cancer pain. Methods A qualitative study involving one-on-one, semi-structured interviews with a sample of FPs in Ontario, Canada. Interviews were analyzed using a directed content analysis informed by the Theoretical Domains Framework. A framework approach was used to explore interaction across behavioural determinants (factors influencing behaviour) as well as demographic sources of variation. The behaviour of interest for the current study was the prescribing of opioid medications (including initiation, renewal, and dose reduction) for patients with chronic, non-cancer pain. Associated issues in the overall management of such patients were also explored. Results Interviews were conducted with 22 FPs. Behavioural determinants interacted with one another to influence FPs prescribing behavior. The TDF domain Beliefs about Consequences played a central role in explaining physician prescribing behaviours as they related to the management of chronic non-cancer pain. Individual beliefs about prescribing consequences and patient behaviour interacted with prescriber beliefs about capabilities and perceptions of the FP’s professional role to influence prescriber behaviour. Emotion and the environmental context influenced the impact of these determinants on opioid prescribing and the management of chronic non-cancer pain. Conclusions FPs face a wide range of complex (and often interacting) challenges when prescribing opioid therapy to their patients. Solution-based strategies should target these determinants directly using evidence-based strategies that move beyond guideline dissemination and general education. Shared decision-making strategies and patient-facing decision aids are likely to decrease the tension experienced in challenging conversations. Electronic supplementary material The online version of this article (10.1186/s12875-019-0947-2) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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