Evaluation of Physicians' Knowledge, Attitudes and Hesitations in Opioid Prescribing; A Cross-sectional Study
Öz
Introduction: Opioid analgesics are very important in pain management. Doctors may be reluctant to prescribe these drugs to patients with severe pain, resulting in different types of pain management. This study evaluates physicians' knowledge levels, attitudes, and hesitations about opioid prescribing.
Method: Three hundred-eight physicians working at University of Health Sciences Izmir Tepecik Training and Research Hospital participated in this descriptive and cross-sectional study. Study data were collected through a questionnaire form between March 2021 and May 2021 and analyzed using SPSS 26. Normally distributed data were analyzed with Chi-square and student T-test, and non-normally distributed data were analyzed with Mann Whitney U and Kruskal Wallis tests. P values <0.05 were considered significant.
Results: 51.6% of the participants were male, the mean age was 32.73±7.57 (24-65), 51.9% were working in internal medicine, 63.3% were resident physicians, and 50.6% had ≤5 years of professional experience. 63.6% of the participants said they were previously trained in pain treatment. 72.7% of the participants thought many pain patients would benefit from opioids, and 22.7% relied on their clinical skills when prescribing. The average correct answer rate of participants to questions about opioids was 65.9%. Physicians who had prescribed opioids previously were found to have higher average correct answer rate to questions about opioids than those who did not. It was determined that male physicians, those with >5 years of experience in their profession, surgeons, specialists, those who had prescribed opioids before, and those who were trained in pain management before, had more confidence in their knowledge and clinical skills while prescribing the opioids. The potential for opioids to be abused (85.1%), addiction (84.1%), adverse effects (67.9%), tolerance (62%), and physicians' lack of knowledge about opioids (47.4%) were the main reasons for participants' hesitancy to prescribe the opioids.
Conclusion: In this study, knowledge levels, attitudes, and hesitations about opioid prescribing among physicians’ working in an training and research hospital was evaluated. Although most physicians accept the importance of opioids in pain management, it has been observed that they avoid prescribing opioids for various reasons, especially the addiction potential of opioids and lack of knowledge. Considering the large number of patients suffering from chronic pain today, the primary goal should be to eliminate hesitations about prescribing opioid analgesics for all physicians, especially family physicians. To address these barriers and improve pain management service delivery, it may be beneficial to increase theoretical and practical training on opioids, pain management and addiction in graduate and postgraduate curriculum.
Anahtar Kelimeler
Pain management education opioid analgesics opiophobia physicians
Kaynakça
- 1. Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Research and Management. 2011;16(6):445-450.
- 2. Yentür EA. Opioid kullanımında engeller. Klinik Gelişim Dergisi. 2007;20(3):155-158.
- 3. Alattas IM. Opiophobia: A barrier to pain management. JKAU Med Sci. 2016;23(3):1-7.
- 4. Webster F, Bremner S, Oosenbrug E, Durant S, McCartney CJ, Katz J. From Opiophobia to Overprescribing: A Critical Scoping Review of Medical Education Training for Chronic Pain. Pain Med. 2017;18(8):1467-1475.
- 5. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013 Aug 29;2013(8):CD006146.
- 6. Wolfert MZ, Gilson AM, Dahl JL, Cleary JF. Opioid analgesics for pain control: wisconsin physicians' knowledge, beliefs, attitudes, and prescribing practices. Pain Med. 2010;11(3):425-34.
- 7. Seo MS, Shim JY, Choi YS, Kim DY, Hwang IG, Baek SK, Shin JY, Lee J, Lee CG. Physician’s Attitude toward Treating Breakthrough Cancer Pain in Korea. J Hosp Palliat Care. 2017;20:18-25.
- 8. Furlan AD, Diaz S, Carol A, MacDougall P, Allen M. Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: An Updated Survey of Canadian Family Physicians. Journal of clinical medicine. 2020;9(10):3304.
- 9. Devi BC, Tang TS, Corbex M. What doctors know about cancer pain management: an exploratory study in Sarawak, Malaysia. Journal of pain & palliative care pharmacotherapy. 2006;20(2):15-22.
- 10. Lechowicz K, Karolak I, Drożdżal S, Żukowski M, Szylińska A, Białecka M, et al. Acute and chronic pain learning and teaching in Medical School—An observational cross-sectional study regarding preparation and self-confidence of clinical and pre-clinical medical students. Medicina. 2019;55(9):533.
- 11. Baldemir R, Akçaboy EY, Çelik Ş, Noyan Ö, Akçaboy ZN, Baydar M. Doktorların opioid kullanımı ve opiofobiye yaklaşımlarının değerlendirilmesi: Bir eğitim ve araştırma hastanesinden anket sonuçları. Ağrı. 2019;31(1):23-31.
- 12. Rash JA, Buckley N, Busse JW, Campbell TS, Corace K, Cooper L, et al. Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review. Systematic reviews. 2018;7(1):1-9.
- 13. Roy É, Côté RJ, Hamel D, Dubé PA, Langlois É, Labesse ME, Thibault C, Boulanger A. Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain. Pain Res Manag. 2017;2017:1365910.
- 14. Nwokeji ED, Rascati KL, Brown CM, Eisenberg A. Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain. Clin Ther. 2007;29:2589-602.
- 15. Blake H, Leighton P, van der Walt G, Ravenscroft A. Prescribing opioid analgesics for chronic non-malignant pain in general practice–a survey of attitudes and practice. British Journal of Pain. 2015;9(4):225-32.
- 16. Keller CE, Ashrafioun L, Neumann AM, Van Klein J, Fox CH, Blondell RD. Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain. Substance Abuse. 2012;33(2):103-13.
- 17. Hsu YC, Lin SL, Sung CS, Ger LP, Liou HH, Lin TC, et al. Knowledge, attitude, and barriers regarding prescribing long-term opioids among Taiwan physicians treating officially registered patients with chronic noncancer pain. Journal of the Chinese Medical Association. 2021;84(2):227-32.
- 18. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015 Apr;156(4):569-576.
Hekimlerin Opioid Reçetelemede Bilgi Düzeyi, Tutum ve Tereddütlerinin Değerlendirilmesi; Kesitsel Bir Çalışma
Öz
Giriş: Yaşlanan nüfusla beraber kronik ağrı nedeniyle sağlık hizmeti alan hasta sayıları gün geçtikçe artmaktadır. Ağrı yönetiminde opioid analjezikler çok önemlidir. Doktorların, şiddetli ağrısı olan hastalara bu ilaçları reçete etme konusundaki bilgi ve tutumları, ağrı yönetimini çok farklı şekilde etkileyebilir. Bu çalışmanın amacı, hekimlerin opioid reçeteleme konusundaki bilgi düzeyleri, tutum ve tereddütlerini değerlendirmektir.
Yöntem: Tanımlayıcı ve kesitsel tipteki bu çalışmaya Sağlık Bilimleri Üniversitesi İzmir Tepecik Eğitim ve Araştırma Hastanesi'nde görev yapan 308 hekim katılmıştır. Çalışma verileri Mart 2021 – Mayıs 2021 tarihleri arasında anket formu aracılığıyla toplanmış ve SPSS 26 kullanılarak analiz edilmiştir. Normal dağılım gösteren veriler Ki-kare ve Student T-testi ile normal dağılım göstermeyen veriler Mann Whitney U ve Kruskal Wallis testi ile analiz edilmiştir. p< 0,05 değerleri anlamlı kabul edilmiştir.
Bulgular: Katılımcıların %51,6'sı erkek, yaş ortalaması 32,73±7,57 (24-65) yıl ve %51,9'u dahili bilimlerde çalışmaktaydı, %63,3'ü asistan hekimdi ve %50,6'sı ≤5 yıl mesleki deneyime sahipti. Katılımcıların %63,6'sı daha önce ağrı tedavisi eğitimi aldığını beyan etti. Katılımcıların %72,7'si birçok ağrı hastasının opioidlerden fayda göreceğini düşünmekteydi, %22,7'si reçete yazarken klinik becerilerine güvenmekteydi. Katılımcıların opioidlerle ilgili bilgi sorularına verdikleri ortalama doğru cevap oranı %65,9 idi. Daha önce opioid reçetelemiş olan hekimlerin, reçetelememiş olanlara göre opioidlerle ilgili bilgi sorularına verdikleri doğru cevap oranı daha yüksek bulundu. Erkeklerin, meslekte >5yıl tecrübesi olanların, cerrahi branştakilerin, uzmanların, daha önce opioid reçetelemiş olanların ve daha önce ağrı yönetimi eğitimi alanların opioid reçetelemede kendi bilgi düzeyleri ve klinik becerilerine daha çok güvendikleri saptandı. Opiodlerin suistimal edilme (%85,1), bağımlılık yapma (%84,1), yan etki görülme (%67,9), tolerans geliştirme potansiyeli (%62) ve hekimlerin opioidler hakkındaki bilgi eksikliği (%47,4) nedeniyle opioid reçeteleme konusunda hekimlerin tereddüt ettiği saptandı.
Sonuç: Bu çalışma ile bir eğitim araştırma hastanesinde çalışan hekimlerin opioidler hakkındaki bilgi düzeyleri, reçeteleme konusundaki tutum ve tereddütleri ortaya koyulmuştur. Hekimlerin çoğunun opioidlerin ağrı yönetimindeki önemini kabul etmelerine rağmen opioidlerin bağımlılık potansiyeli ve bilgi eksikliği başta olmak üzere çeşitli nedenlerle opioid reçetelemeden kaçındıkları görülmüştür. Günümüzde kronik ağrıdan muzdarip hasta sayısının çokluğu göz önüne alındığında aile hekimleri başta olmak üzere tüm hekimlerin opioid analjezikleri reçeteleme konusundaki tereddütlerin ortadan kaldırılması öncelikli hedef olmalıdır. Bu engelleri aşmak ve ağrı yönetimi hizmet sunumunu iyileştirmek için lisans ve lisansüstü müfredatta opioidler, ağrı yönetimi ve bağımlılık konularında teorik ve uygulamalı eğitimlerin arttırılması faydalı olabilir.
Anahtar Kelimeler
Kaynakça
- 1. Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Research and Management. 2011;16(6):445-450.
- 2. Yentür EA. Opioid kullanımında engeller. Klinik Gelişim Dergisi. 2007;20(3):155-158.
- 3. Alattas IM. Opiophobia: A barrier to pain management. JKAU Med Sci. 2016;23(3):1-7.
- 4. Webster F, Bremner S, Oosenbrug E, Durant S, McCartney CJ, Katz J. From Opiophobia to Overprescribing: A Critical Scoping Review of Medical Education Training for Chronic Pain. Pain Med. 2017;18(8):1467-1475.
- 5. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013 Aug 29;2013(8):CD006146.
- 6. Wolfert MZ, Gilson AM, Dahl JL, Cleary JF. Opioid analgesics for pain control: wisconsin physicians' knowledge, beliefs, attitudes, and prescribing practices. Pain Med. 2010;11(3):425-34.
- 7. Seo MS, Shim JY, Choi YS, Kim DY, Hwang IG, Baek SK, Shin JY, Lee J, Lee CG. Physician’s Attitude toward Treating Breakthrough Cancer Pain in Korea. J Hosp Palliat Care. 2017;20:18-25.
- 8. Furlan AD, Diaz S, Carol A, MacDougall P, Allen M. Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: An Updated Survey of Canadian Family Physicians. Journal of clinical medicine. 2020;9(10):3304.
- 9. Devi BC, Tang TS, Corbex M. What doctors know about cancer pain management: an exploratory study in Sarawak, Malaysia. Journal of pain & palliative care pharmacotherapy. 2006;20(2):15-22.
- 10. Lechowicz K, Karolak I, Drożdżal S, Żukowski M, Szylińska A, Białecka M, et al. Acute and chronic pain learning and teaching in Medical School—An observational cross-sectional study regarding preparation and self-confidence of clinical and pre-clinical medical students. Medicina. 2019;55(9):533.
- 11. Baldemir R, Akçaboy EY, Çelik Ş, Noyan Ö, Akçaboy ZN, Baydar M. Doktorların opioid kullanımı ve opiofobiye yaklaşımlarının değerlendirilmesi: Bir eğitim ve araştırma hastanesinden anket sonuçları. Ağrı. 2019;31(1):23-31.
- 12. Rash JA, Buckley N, Busse JW, Campbell TS, Corace K, Cooper L, et al. Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review. Systematic reviews. 2018;7(1):1-9.
- 13. Roy É, Côté RJ, Hamel D, Dubé PA, Langlois É, Labesse ME, Thibault C, Boulanger A. Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain. Pain Res Manag. 2017;2017:1365910.
- 14. Nwokeji ED, Rascati KL, Brown CM, Eisenberg A. Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain. Clin Ther. 2007;29:2589-602.
- 15. Blake H, Leighton P, van der Walt G, Ravenscroft A. Prescribing opioid analgesics for chronic non-malignant pain in general practice–a survey of attitudes and practice. British Journal of Pain. 2015;9(4):225-32.
- 16. Keller CE, Ashrafioun L, Neumann AM, Van Klein J, Fox CH, Blondell RD. Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain. Substance Abuse. 2012;33(2):103-13.
- 17. Hsu YC, Lin SL, Sung CS, Ger LP, Liou HH, Lin TC, et al. Knowledge, attitude, and barriers regarding prescribing long-term opioids among Taiwan physicians treating officially registered patients with chronic noncancer pain. Journal of the Chinese Medical Association. 2021;84(2):227-32.
- 18. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015 Apr;156(4):569-576.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Aile Hekimliği |
| Bölüm | Orijinal Makaleler |
| Yazarlar | |
| Erken Görünüm Tarihi | 5 Mart 2024 |
| Yayımlanma Tarihi | 12 Mart 2024 |
| Gönderilme Tarihi | 17 Ağustos 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 18 Sayı: 1 |
Sağlığın ve birinci basamak bakımın anlaşılmasına ve geliştirilmesine katkıda bulunacak yeni bilgilere sahip yazarların İngilizce veya Türkçe makaleleri memnuniyetle karşılanmaktadır.