Emergency Department Provider Perspectives on Benzodiazepine-Opioid Coprescribing: A Qualitative Study
Emergency Department Provider Perspectives on Benzodiazepine-Opioid Coprescribing: A Qualitative Study
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DOI：
10.1111/acem.13273
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发表时间：
2018-01-01
影响因子：
4.4
通讯作者：
Lambert, Bruce L.
中科院分区：
文献类型：
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作者：
Kim, Howard S.;McCarthy, Danielle M.;Lambert, Bruce L.
目的：苯二氮卓类药物和阿片类药物同时处方（即，“coprescribed”），尽管指南建议反对这种做法，越来越多的证据表明，同时使用这两种药物会增加过量的风险。本研究旨在描述的背景下，苯二氮卓类阿片coprescribing发生和供应商的原因coprescribing.Methods：我们进行了重点小组与急诊科（艾德）供应商（居民和主治医生，先进的实践提供商，和药剂师）从三家医院使用半结构化访谈，以引起苯二氮卓类阿片coprescribing的观点。对讨论进行了录音和文字记录。我们进行了定性的内容分析，所得到的成绩单使用一个共识的定性研究方法，旨在确定优先类别，描述的现象，苯二氮卓类阿片类药物coprescribing.Results：与会者承认coprescribing很少和不情愿，并经常提供具体的出院指示时coprescribing。共同描述的决定是多因素的，通常与特定的临床和情境环境（例如，下背痛，失败的单独阿片类药物治疗），并受到提供者对联合治疗疗效的信念的强烈影响。共同处方的决定进一步受到自我施加的压力的影响，以加强护理或避免住院。当考虑潜在的干预措施，以减少coprescribing的发生率，与会者反对计算机警报，但支持药剂师辅助干预。许多供应商发现参与同行讨论处方habitues.Conclusions的过程是有益的：在这个定性研究的艾德供应商，我们发现，苯二氮卓类阿片类coprescribing发生在特定的临床和情境的情况下，如治疗腰痛或失败的单独阿片类药物治疗。共同书写的决定受到提供者的信念和自我施加的压力的强烈影响，以升级护理或避免入院。
Objective: Benzodiazepines and opioids are prescribed simultaneously (i.e., " coprescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepineopioid coprescribing occurs and providers' reasons for coprescribing.Methods: We conducted focus groups with emergency department (ED) providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semistructured interviews to elicit perspectives on benzodiazepine-opioid coprescribing. Discussions were audio-recorded and transcribed. We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach, aiming to identify priority categories that describe the phenomenon of benzodiazepine-opioid coprescribing.Results: Participants acknowledged coprescribing rarely and reluctantly and often provided specific discharge instructions when coprescribing. The decision to coprescribe is multifactorial, often isolated to specific clinical and situational contexts (e.g., low back pain, failed solitary opioid therapy) and strongly influenced by a provider's beliefs about the efficacy of combination therapy. The decision to coprescribe is further influenced by a selfimposed pressure to escalate care or avoid hospital admission. When considering potential interventions to reduce the incidence of coprescribing, participants opposed computerized alerts but were supportive of a pharmacist-assisted intervention. Many providers found the process of participating in peer discussions on prescribing habits to be beneficial.Conclusions: In this qualitative study of ED providers, we found that benzodiazepine-opioid coprescribing occurs in specific clinical and situational contexts, such as the treatment of low back pain or failed solitary opioid therapy. The decision to coprescribe is strongly influenced by a provider's beliefs and by self-imposed pressure to escalate care or avoid admission.