Sabrina Brinkmöller, Regina Poß-Doering, Alexandra Balzer, Cinara Paul, Viktoria S Wurmbach, Marco R Zugaj, Michel Wensing, Cornelia Straßner
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引用次数: 0
Abstract
Background: Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy. General practitioners write approximately 87% of all opioid prescriptions. The guideline "Long-term use of opioids for chronic non-cancer pain" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear.
Objective: This study investigates how general practitioners apply LONTS guideline recommendations and identifies barriers to implementation.
Methods: A mixed-methods study was conducted, including an online questionnaire to detect deviations from LONTS recommendations, followed by semi-structured telephone interviews to explore barriers for guideline adherence.
Results: A total of 131 questionnaires and 21 interviews with general practitioners were analyzed. 45% of questionnaire participants were unfamiliar with the LONTS guideline. Four key gaps were identified: (i) Nearly 40% of general practitioners rarely or never set individualized treatment goals for chronic pain patients; (ii) 49% preferred combining long-acting opioids at fixed intervals with short-acting opioids on demand; (iii) 17% used short-acting opioid monotherapy, considered a treatment error; (iv) 44% did not discuss opioid reduction or discontinuation after 6 months of effective pain relief. Qualitative analysis identified key barriers: lack of integration into daily routines, anticipating patients' fear of pain recurrence, and preference for personal experience over evidence.
Conclusion: General practitioners in Germany may struggle to implement LONTS recommendations for opioid use in chronic non-cancer pain. Targeted strategies are needed to promote and improve the adoption of these guidelines in primary care.
期刊介绍:
Family Practice is an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care in both developed and developing countries.
Family Practice offers its readership an international view of the problems and preoccupations in the field, while providing a medium of instruction and exploration.
The journal''s range and content covers such areas as health care delivery, epidemiology, public health, and clinical case studies. The journal aims to be interdisciplinary and contributions from other disciplines of medicine and social science are always welcomed.