Kennedy, M-C orcid.org/0000-0002-3835-2736, Pallotti, P, Dickinson, R et al. (1 more author) (2019) ‘If you can’t see a dilemma in this situation you should probably regard it as a warning’: a metasynthesis and theoretical modelling of general practitioners’ opioid prescription experiences in primary care. British Journal of Pain, 13 (3). pp. 159-176. ISSN 2049-4637
Abstract
Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care.
Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions.
Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription.
Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The British Pain Society 2018. This is an author produced version of an article published in British Journal of Pain. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Chronic pain; family medicine; general practitioner; opioid; prescribing metasynthesis |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Healthcare (Leeds) > Nursing Adult (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Healthcare (Leeds) > Pharmacy (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 11 Sep 2018 10:28 |
Last Modified: | 12 Jul 2019 09:18 |
Status: | Published |
Publisher: | SAGE Publications |
Identification Number: | 10.1177/2049463718804572 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:135548 |