A qualitative exploration of dentists' opioid prescribing decisions within U.S. veterans affairs facilities.
A qualitative exploration of dentists' opioid prescribing decisions within U.S. veterans affairs facilities.
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DOI：
10.1097/j.pain.0000000000002759
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发表时间：
2023-04-01
期刊：
影响因子：
7.4
通讯作者：
中科院分区：
文献类型：
--
作者：
补充数字内容在文本中可用。与牙医的定性访谈提供了可能的干预目标，以扩大在退伍军人事务部内实施安全的阿片类药物处方用于急性牙痛管理。美国退伍军人事务部（VA）是美国最大的综合医疗保健系统，每年为大约50万退伍军人提供牙科护理。为了应对阿片类药物危机，VA发布了几项阿片类药物风险缓解策略。虽然退伍军人事务部牙医的阿片类药物处方总体上有所减少，但牙医一级的实施经验仍不清楚。我们的目标是探讨影响VA牙医管理急性牙痛的阿片类药物决策的障碍和促进因素。招募了在具有最高和最低阿片类药物处方量的VA设施中执业的牙医。标准化的电话定性访谈遵循一个半结构化的指南，围绕能力（C），机会（O），动机（M）和行为（B）模型设计。使用NVivo转录并独立双重编码录音，以确定未来基于指南的阿片类药物干预的潜在目标。在395名合格的普通和专业牙医中，90名（24.8%）代表33家VA机构完成了采访。处方阿片类药物的机会包括：1）完成与急性牙痛相关的牙科手术，2）照顾患有现有牙痛的患者，3）回应患者阿片类药物的请求。能力包括使用资源（例如，电子病历），临床判断（例如，包括药物使用在内的病史评价），沟通技巧和筛选阿片类药物滥用的能力。动机主题集中在减轻患者的急性牙痛。阿片类药物处方的障碍和促进因素因设施而异。研究结果可以为持续的阿片类药物风险缓解工作提供干预目标。
Supplemental Digital Content is Available in the Text. Qualitative interviews with dentists offered possible intervention targets to expand implementation of safe opioid prescribing for acute dental pain management within the Veterans Affairs. The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and provides dental care to approximately one-half million veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. Although opioid prescribing by VA dentists has decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that affect opioid decision making for management of acute dental pain among VA dentists. Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semistructured guide designed around the Capability (C), Opportunity (O), Motivation (M), and Behaviour (B) model. Audio recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (eg, electronic medical records), clinical judgement (eg, evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. The results can offer intervention targets for continued opioid risk mitigation efforts.
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影响因子：
13.8
作者：
Suda, Katie J.;Durkin, Michael J.;Thornhill, Martin H.
通讯作者：
Thornhill, Martin H.
DOI：
10.1186/s13012-017-0605-9
发表时间：
2017-06-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Atkins L;Francis J;Islam R;O'Connor D;Patey A;Ivers N;Foy R;Duncan EM;Colquhoun H;Grimshaw JM;Lawton R;Michie S
通讯作者：
Michie S
影响因子：
3.1
作者：
Mastarone, Ginnifer L.;Wyse, Jessica J.;Carlson, Kathleen F.
通讯作者：
Carlson, Kathleen F.
影响因子：
3.4
作者：
Carlson, Kathleen F.;Gilbert, Tess A.;Cook, Lawrence J.
通讯作者：
Cook, Lawrence J.
影响因子：
2.3
作者：
Oliva, Elizabeth M.;Bowe, Thomas;Trafton, Jodie A.
通讯作者：
Trafton, Jodie A.