Reluctant to train, reluctant to prescribe: barriers to general practitioner prescribing of opioid substitution therapy
Christine Longman A E , Meredith Temple-Smith B , Gail Gilchrist C and Nicholas Lintzeris DA Department of General Practice and Primary Health Care Academic Centre, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
B Primary Care Research Unit, Department of General Practice and Primary Health Care Academic Centre, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
C Centre for Applied Social Research, School of Health and Social Care, The University of Greenwich, Avenuery Hill Campus, Avery Hill Road, London SE9 2UG, UK.
D The Langton Centre, Director, Drug and Alcohol Services, South East Sydney and Illawarra Health Services, 591 South Dowling Street, Surry Hills, NSW 2010, Australia.
E Corresponding author. Email: chrislongman22@gmail.com
Australian Journal of Primary Health 18(4) 346-351 https://doi.org/10.1071/PY11100
Submitted: 17 August 2011 Accepted: 13 December 2011 Published: 1 February 2012
Abstract
Opioid substitution therapy (OST) is a well-recognised, evidence-based treatment for opioid dependence. Since the early 1990s, Australia has used a community-based general practitioner (GP) model of prescribing, particularly within the state of Victoria, where over 85% of OST prescribing is undertaken by GPs in community settings. Yet the majority of GPs invited to complete the required OST training decline the offer, while of those who complete training, the majority prescribe to few or no patients. This study aimed to determine the reasons for this. Twenty-two in-depth interviews were conducted with Victorian GPs exploring the reasons why the majority declined training, and for trained GPs, why they prescribed to few or no patients in the first 12 months after training. General practitioners who declined to train were predominantly influenced by negative experiences with drug-seeking patients, although other secondary reasons also affected their decision. Some GPs who completed the training were prevented from prescribing by several structural and operational barriers, many of which could be addressed. Fear of deskilling with time became a further impediment. General practitioners who became regular prescribers were highly committed with lengthy general practice experience. Concerns exist about the recruitment process for OST prescriber training, where nearly all GPs decline the offer of training, and the barriers that prevent GPs prescribing after training. Action is needed to address barriers to GP OST training and prescribing, and further research is necessary to ascertain measures required to facilitate long-term prescribing.
Additional keywords: facilitators, training.
References
Abouyanni GS, Harris L, Wickes M, Ramakrishna W, Ta S, Knowlden E (2000) GP attitudes to managing drug- and alcohol-dependent patients: a reluctant role. Drug and Alcohol Review 19, 165–170.| GP attitudes to managing drug- and alcohol-dependent patients: a reluctant role.Crossref | GoogleScholarGoogle Scholar |
Australian Institute of Health and Welfare (2011) National Opioid Pharmacotherapy Statistics Annual Data collection: 2010 report. Cat. no. HSE 109. (AIHW: Canberra)
Family Medicine Research Centre (2010) The Beach Project: bettering the evaluation of care and health. Available at www.fmrc.org.au/beach.htm#.4 [Verified May 2010]
Jacka D, Clode D, Patterson S, Wyman K (1999) Attitudes and practices of general practitioners training to work with drug using patients. Drug and Alcohol Review 18, 287–291.
| Attitudes and practices of general practitioners training to work with drug using patients.Crossref | GoogleScholarGoogle Scholar |
Longman C, Lintzeris N, Temple-Smith M, Gilchrist G (2011) Methadone and buprenorphine prescribing patterns of Victorian general practitioners: their first 5 years after authorisation. Drug and Alcohol Review 30, 355–359.
| Methadone and buprenorphine prescribing patterns of Victorian general practitioners: their first 5 years after authorisation.Crossref | GoogleScholarGoogle Scholar | 21355929PubMed |
Mattick RP, Ali R, Lintzeris N (eds) (2009) Pharmacotherapies for the treatment of opioid dependence: efficacy, cost-effectiveness, and implementation. (Informa Healthcare: New York)
McGillion J, Wanigaratne S, Feinmann C, Godden T, Byrne A (2000) GPs’ attitudes towards the treatment of drug misusers. The British Journal of General Practice 50, 385–386.
McKeown A, Matheson C, Bond C (2003) A qualitative study of GPs’ attitudes to drug misusers and drug misuse services in primary care. Family Practice 20, 120–125.
| A qualitative study of GPs’ attitudes to drug misusers and drug misuse services in primary care.Crossref | GoogleScholarGoogle Scholar | 12651783PubMed |
McMurphy S, Shea J, Switzer J, Turner BJ (2006) Clinic-based treatment for opioid dependence: a qualitative inquiry. American Journal of Health Behavior 30, 544–554.
Prescription Opioid Policy (2009) Improving management of chronic non-malignant pain and prevention of problems associated with prescription opioid use. (Royal Australian College of Physicians: Sydney)
Ritter A, Chalmers J (2009) ‘Polygon: the many sides to the Australian opioid pharmacotherapy maintenance system.’ ANCD research paper #18. (Australian National Council on Drugs: Canberra)
