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The Pattern of Opioid Management by Australian General Practice Trainees

Objective With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation‐level prevalence and associations of opioid prescribing. Design A cross‐sectional seconda... Full description

Journal Title: Pain medicine (Malden Mass.), 2015, Vol.16 (9), p.1720-1731
Main Author: Holliday, Simon
Other Authors: Morgan, Simon , Tapley, Amanda , Dunlop, Adrian , Henderson, Kim , van Driel, Mieke , Spike, Neil , McArthur, Lawrie , Ball, Jean , Oldmeadow, Chris , Magin, Parker
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: Oxford University Press
ID: ISSN: 1526-2375
Link: https://www.ncbi.nlm.nih.gov/pubmed/26118466
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title: The Pattern of Opioid Management by Australian General Practice Trainees
format: Article
creator:
  • Holliday, Simon
  • Morgan, Simon
  • Tapley, Amanda
  • Dunlop, Adrian
  • Henderson, Kim
  • van Driel, Mieke
  • Spike, Neil
  • McArthur, Lawrie
  • Ball, Jean
  • Oldmeadow, Chris
  • Magin, Parker
subjects:
  • Aboriginal and Torres Strait Islander
  • Adult
  • Analgesic
  • Analgesics
  • Analgesics, Opioid - therapeutic use
  • Australia
  • Australian aborigines
  • Cross-Sectional Studies
  • Family medicine
  • Female
  • General Practitioners - statistics & numerical data
  • Humans
  • Male
  • Opioids
  • Pain Management
  • Pain Management - statistics & numerical data
  • Palliative care
  • Patients
  • Persistent Pain
  • Physicians (General practice)
  • Practice Patterns, Physicians' - statistics & numerical data
  • Prescriptions
  • Primary Care
  • Quality of Health Care
  • Risk Factors
ispartof: Pain medicine (Malden, Mass.), 2015, Vol.16 (9), p.1720-1731
description: Objective With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation‐level prevalence and associations of opioid prescribing. Design A cross‐sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: “Registrar Clinical Encounters in Training.” Setting Four of Australia's seventeen GP Regional Training Providers, during 2010‐13. Subjects GP trainees. Methods Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time. Results Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre‐existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow‐up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk‐mitigation strategies. Conclusions Most opioids were prescribed as maintenance therapy for non‐cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
language: eng
source:
identifier: ISSN: 1526-2375
fulltext: no_fulltext
issn:
  • 1526-2375
  • 1526-4637
url: Link


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titleThe Pattern of Opioid Management by Australian General Practice Trainees
creatorHolliday, Simon ; Morgan, Simon ; Tapley, Amanda ; Dunlop, Adrian ; Henderson, Kim ; van Driel, Mieke ; Spike, Neil ; McArthur, Lawrie ; Ball, Jean ; Oldmeadow, Chris ; Magin, Parker
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descriptionObjective With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation‐level prevalence and associations of opioid prescribing. Design A cross‐sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: “Registrar Clinical Encounters in Training.” Setting Four of Australia's seventeen GP Regional Training Providers, during 2010‐13. Subjects GP trainees. Methods Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time. Results Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre‐existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow‐up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk‐mitigation strategies. Conclusions Most opioids were prescribed as maintenance therapy for non‐cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
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subjectAboriginal and Torres Strait Islander ; Adult ; Analgesic ; Analgesics ; Analgesics, Opioid - therapeutic use ; Australia ; Australian aborigines ; Cross-Sectional Studies ; Family medicine ; Female ; General Practitioners - statistics & numerical data ; Humans ; Male ; Opioids ; Pain Management ; Pain Management - statistics & numerical data ; Palliative care ; Patients ; Persistent Pain ; Physicians (General practice) ; Practice Patterns, Physicians' - statistics & numerical data ; Prescriptions ; Primary Care ; Quality of Health Care ; Risk Factors
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descriptionObjective With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation‐level prevalence and associations of opioid prescribing. Design A cross‐sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: “Registrar Clinical Encounters in Training.” Setting Four of Australia's seventeen GP Regional Training Providers, during 2010‐13. Subjects GP trainees. Methods Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time. Results Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre‐existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow‐up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk‐mitigation strategies. Conclusions Most opioids were prescribed as maintenance therapy for non‐cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
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23Quality of Health Care
24Risk Factors
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titleThe Pattern of Opioid Management by Australian General Practice Trainees
authorHolliday, Simon ; Morgan, Simon ; Tapley, Amanda ; Dunlop, Adrian ; Henderson, Kim ; van Driel, Mieke ; Spike, Neil ; McArthur, Lawrie ; Ball, Jean ; Oldmeadow, Chris ; Magin, Parker
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0This study was supported by a competitive grant from the Mental Health, Drugs and Alcohol Office of the NSW Ministry of Health. The project is also funded by the participating educational organisations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, and Adelaide to Outback GP Training Program. These organisations are funded by General Practice Education and Training, an Australian Commonwealth Government initiative.
1Declaration of Conflicting Interests
2This article was published online on 27 June 2015. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected on 11 July 2015.
3Abbreviations OST = Opioid Substitution Therapy; PNCP = Persistent Non‐Cancer Pain; QUM = Quality Use of Medicines; PBS = Pharmaceutical Benefits Scheme; ReCEnT = Registrar (GP Trainee) Clinical Encounters in Training; MIMWOs = Medical Issue managed with opioids; ACSQHC = The Australian Commission on Safety and Quality in Health Care; RTPs = Regional Training Providers
abstractObjective With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation‐level prevalence and associations of opioid prescribing. Design A cross‐sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: “Registrar Clinical Encounters in Training.” Setting Four of Australia's seventeen GP Regional Training Providers, during 2010‐13. Subjects GP trainees. Methods Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time. Results Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre‐existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow‐up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk‐mitigation strategies. Conclusions Most opioids were prescribed as maintenance therapy for non‐cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
copEngland
pubOxford University Press
pmid26118466
doi10.1111/pme.12820
tpages12
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