Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing
Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing
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DOI：
10.3399/bjgp20x711737
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发表时间：
2020-08-01
影响因子：
5.9
通讯作者：
Sharp, Lisa K.
中科院分区：
文献类型：
--
作者：
Saffore, Christopher D.;Tilton, Sarette T.;Sharp, Lisa K.
背景：在处方阿片类药物滥用流行的情况下，了解初级保健中安全开具阿片类药物处方的障碍至关重要。滥用。以及在美国过量服用。教育拓展策略，如学术细节（AD）。提供一个论坛，以确定障碍和促进战略。初级保健中的安全阿片类药物处方。目的通过AD确定初级保健提供者（pcp）安全开具阿片类药物处方的障碍。设计和设置通过现有的AD干预措施收集数据进行定性分析，以改善初级保健中阿片类药物的安全处方。从2018年6月到2018年8月，在芝加哥大都会地区的一个大型独立卫生系统内，向有执照的pcp提供了AD干预措施。方法AD干预包括由训练有素的详细记录员对pcp进行访问，并同时通过现场记录记录每次访问的详细信息。采用定性分析。对现场记录进行了分析，以确定与阿片类药物处方障碍有关的反复出现的主题。结果对186例就诊的pcp患者的详细记录进行了分析。销售阿片类药物处方的障碍分为六个主题：1)知识差距；2)缺乏处方监测规划（IPMP）的使用；3)患者开具阿片类药物的压力；4)保险范围政策；5)提供者信念；6)卫生系统疼痛管理实践。结论：通过对这一大群pcp的AD访问，确定了初级保健中阿片类药物安全处方的障碍，支持需要继续努力加强疼痛管理教育，最大限度地利用PMP，增加非阿片类药物治疗的可及性和可负担性。
BackgroundUnderstanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse. misuse. and overdose in the US. Educational outreach strategies, such as academic detailing (AD). provide a forum for identification of barriers to, and strategies to facilitate. safe opioid prescribing in primary care.AimTo identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD.Design and settingQualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area.MethodThe AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis. field notes were analysed to identify recurring themes related to opioid prescribing barriers.ResultsDetailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to sale opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme IPMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices.ConclusionBarriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.