Title: General practitioners´ challenges in reducing long-term opioid therapy (LTOT) in patients with chronic non-cancer pain (CNCP) and their wishes to cooperate with the secondary healthcare sector in this regard.
Authors: Karen Yde Hove and Randi Eltved
Supervisor: Main supervisor: Henrik Bjarke Vægter and co-supervisor: Mette Terp Højby
Background: Patients with CNCP are often treated with long-term opioid therapy (LTOT) despite professional non-recommendations. LTOT can cause a wide range of side effects leading to reduced functional level and poor quality of life. It is well documented that LTOT increases costs in both health care system and social services. The Regional Council of the Central Region of Denmark (RM) has allocated Smerteklinik Silkeborg funds for the development and operation of an opioid downsizing clinic. In our master´s project, we have tried to uncover the general practitioners´ challenges and wishes for collaboration on the patient group with CNCP in LTOT. The results from the master project will be used in the development of the opioid downsizing clinic.
Purpose: We want to uncover what challenges general practitioners encounter when phasing out LTOT in patients with CNCP and the wishes general practitioners have for collaboration with the secondary healthcare sector regarding tapering opioids in patients with CNCP in opioid LTOT.
Methods: We have used mixed methods design with triangulation. In the qualitative part we conducted semi-structed interviews with eight general practitioners in RM found by convenience sampling. In the quantitative part we have performed an observational descriptive cross-sectional study via a survey sent to all general practitioners I RM.
Results: The physicians we interviewed are not representative of physicians in RM as they all come from group practices. We have interviewed more men than women. In our survey, we achieved a response rate of 19% with a predominance of younger women. Given the consistent data we have collected, we assume that this does not skew the results significantly. The survey data are analyzed with descriptive statistics. The results from the two arms of our study converge in relation to the description of the challenges that general practitioners face in the treatment of patients with CNCP in LTOT. Doctors are met with reluctancy and a lack of motivation amongst patients. There are professional difficulties with the treatment of withdrawal symptoms and the management of comorbidity. Doctors are concerned that patients may develop addiction to and side effects from opioids. The doctors have implemented workflows so that they avoid sanctions from the Danish Patient Safety Authority (STPS). We find the challenges stated by the physicians in line with the literature. In addition, we find that the doctors want help with the task of opioid tapering via a tapering clinic and expresses a desire to refer the patients to such a clinic. They also describe a desire for further development of competence among doctors and staff.
Conclusions: Physicians are challenged in terms of knowledge of strategies for downsizing. They are pressured by regulatory demands and lack of time. The patient-provider interaction is often burdened by the physician´s sense of powerlessness. The doctors´ primary wish is to be able to delegate the task of opioid downsizing to the secondary healthcare sector. They are also interested in competence development of both doctors and practice staff through education.