Self-reported practices in opioid management of chronic noncancer pain: A survey of Canadian family physicians

被引:30
作者
Allen, Michael J. M. [1 ]
Asbridge, Mark M. [2 ,3 ]
MacDougall, Peter C. [4 ]
Furlan, Andrea D. [5 ,6 ]
Tugalev, Oleg [7 ]
机构
[1] Dalhousie Univ, Halifax, NS B3H 4R2, Canada
[2] Dalhousie Univ, Dept Community Hlth & Epidemiol, Halifax, NS B3H 4R2, Canada
[3] Dalhousie Univ, Dept Emergency Med, Halifax, NS B3H 4R2, Canada
[4] Dalhousie Univ, Dept Anesthesia, Halifax, NS B3H 4R2, Canada
[5] Univ Toronto, Toronto Rehabil Inst, Inst Work & Hlth, Toronto, ON, Canada
[6] Univ Toronto, Dept Med, Toronto, ON, Canada
[7] Woodstock Gen Hosp, Rehabil Serv, Woodstock, ON, Canada
关键词
Chronic noncancer pain; Guidelines; Opioids; Pain management; Primary care surveys; CHRONIC NONMALIGNANT PAIN; PRIMARY-CARE PHYSICIANS; ANALGESICS; ATTITUDES; TRENDS; CONSUMPTION; GUIDELINE;
D O I
10.1155/2013/528645
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians' (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated. OBJECTIVES: To determine FPs' practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP. METHODS: An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges. RESULTS: A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the 'watchful dose' of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient's opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse. CONCLUSIONS: While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.
引用
收藏
页码:177 / 184
页数:8
相关论文
共 26 条
[1]  
[Anonymous], DRUG CLASS REV LONG
[2]  
[Anonymous], 2010, OP CHRON NONC PAIN 2
[3]   Chronic pain in Canada: Have we improved our management of chronic noncancer pain? [J].
Boulanger, Aline ;
Clark, Alexander J. ;
Squire, Pamela ;
Cui, Edward ;
Horbay, G. L. A. .
PAIN RESEARCH & MANAGEMENT, 2007, 12 (01) :39-47
[4]  
College of Family Physicians of Canada. National Physician Survey, 2007, NAT PHYS SURV 2007 R
[5]   Continuing education, guideline implementation, and the emerging transdisciplinary field of knowledge translation [J].
Davis, D .
JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 2006, 26 (01) :5-12
[6]   Trends in the consumption of opioid analgesics in Spain. Higher increases as fentanyl replaces morphine [J].
del Pozo, Javier Garcia ;
Carvajal, Alfonso ;
Viloria, Jose Maria ;
Velasco, Alfonso ;
del Pozo, Victorina Garcia .
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 2008, 64 (04) :411-415
[7]   Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone [J].
Dhalla, Irfan A. ;
Mamdani, Muhammad M. ;
Sivilotti, Marco L. A. ;
Kopp, Alex ;
Qureshi, Omar ;
Juurlink, David N. .
CANADIAN MEDICAL ASSOCIATION JOURNAL, 2009, 181 (12) :891-896
[8]   Non-medical use of prescription opioids and public health in Canada - An urgent call for research and interventions development [J].
Fischer, Benedikt ;
Rehm, Juergen ;
Goldman, Brian ;
Popova, Svetlana .
CANADIAN JOURNAL OF PUBLIC HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE, 2008, 99 (03) :182-184
[9]   Changes in illicit opioid use across Canada [J].
Fischer, Benedikt ;
Rehm, Juergen ;
Patra, Jayadeep ;
Cruz, Michelle Firestone .
CANADIAN MEDICAL ASSOCIATION JOURNAL, 2006, 175 (11) :1385-1387
[10]   Differences and over-time changes in levels of prescription opioid analgesic dispensing from retail pharmacies in Canada, 2005-2010 [J].
Fischer, Benedikt ;
Jones, Wayne ;
Krahn, Murray ;
Rehm, Juergen .
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2011, 20 (12) :1269-1277