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dc.contributor.authorMcCrorie, C.
dc.contributor.authorCloss, S.J.
dc.contributor.authorHouse, A.
dc.contributor.authorPetty, Duncan R.
dc.contributor.authorZiegler, L.
dc.contributor.authorGlidewell, L.
dc.contributor.authorWest, R.
dc.contributor.authorFoy, R.
dc.date.accessioned2019-11-12T09:41:12Z
dc.date.accessioned2019-11-27T14:33:49Z
dc.date.available2019-11-12T09:41:12Z
dc.date.available2019-11-27T14:33:49Z
dc.date.issued2015-09
dc.identifier.citationMcCrorie C, Closs SJ, House A et al (2015) Understanding long-term opioid prescribing for non-cancer pain in primary care: A qualitative study. BMC Family Practice. 16: 121.en_US
dc.identifier.urihttp://hdl.handle.net/10454/17517
dc.descriptionYesen_US
dc.description.abstractBackground: The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. Methods: We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. Results: Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs’ responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient’s wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. Conclusions: Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.en_US
dc.description.sponsorshipNational Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG- 1010–23041).en_US
dc.language.isoenen_US
dc.relation.isreferencedbyhttps://doi.org/10.1186/s12875-015-0335-5en_US
dc.rights© 2015 McCrorie et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en_US
dc.subjectOpioid prescribingen_US
dc.subjectNon-cancer painen_US
dc.subjectChronic painen_US
dc.subjectPrimary careen_US
dc.titleUnderstanding long-term opioid prescribing for non-cancer pain in primary care: A qualitative studyen_US
dc.status.refereedYesen_US
dc.date.Accepted2015-08-31
dc.date.application2015-09-11
dc.typeArticleen_US
dc.type.versionPublished versionen_US
dc.date.updated2019-11-12T09:41:18Z
refterms.dateFOA2019-11-27T14:34:20Z


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