ABSTRACT
OBJETIVO: Conocer los patrones de prescripción de opioides fuertes en dolor crónico no oncológico por parte de médicos de familia. MATERIAL Y MÉTODOS: diseño: estudio descriptivo mediante cuestionario autoadministrado por correo electrónico. EMPLAZAMIENTO: todos los centros de salud de Cataluña. PARTICIPANTES: 3.602 médicos de familia socios de la Sociedad Catalana de Medicina Familiar y Comunitaria. INTERVENCIONES: administración de la encuesta por correo electrónico a los médicos de familia catalanes. MEDICIONES PRINCIPALESs: datos demográficos, número de pacientes que consultan por dolor crónico no oncológico tratados con opioides fuertes, opioides utilizados e indicación, patrones de prescripción, relación con la Unidad del Dolor. RESULTADOS: se obtuvieron 551 respuestas de 3.602 cuestionarios enviados (tasa de respuesta del 15,3%): 480 facultativos (87%) prescriben opioides fuertes para dolor músculo-esquelético; 268 (48,6%) prescriben fentanilo ultrarrápido; 434 (78,7%) disminuyen las dosis de benzodiacepinas al prescribir opioides fuertes. Los efectos adversos más habituales son estreñimiento y náuseas. Las principales dificultades observadas en la prescripción son su manejo (341, 71%) y la resistencia de pacientes y profesionales (87, 18,1%). La valoración de la interrelación con las Unidades de Dolor fue 2+/-1 (escala 1 al 5), siendo los problemas en la comunicación (271, 52,2%) y en la accesibilidad (141, 27,1%) los principales puntos de mejora. CONCLUSIONES: los patrones de prescripción se adecuan mayoritariamente a las guías clínicas en algunos aspectos (disminución de benzodiacepinas o titulación de dosis). Sin embargo, existen áreas de mejora como son el poco uso de laxantes o el uso de opioides ultrarrápidos para indicaciones no autorizadas y sin tratamiento opioide de base. Los médicos de familia demandan formación, perciben resistencias en su prescripción y creen necesario mejorar la relación con las Unidades del Dolor
OBJECTIVE: To identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. MATERIALS AND METHODS: Design A descriptive study based on a self-administered email questionnaire. LOCATION: All primary health care centres in Catalonia. PARTICIPANTS: 3,602 family doctors, all members of the Catalan Society of Family and Community Medicine. INTERVENTIONS: Email survey of Catalan family doctors. MAIN MEASUREMENTS: Demographic data, number of patients treated with potent opioids for chronic non-cancer pain, type of opioid used and indications, prescribing patterns and relationship with the Pain Management Unit. RESULTS: A total of 551 answers were obtained from 3,602 questionnaires sent (response rate of 15.3%), in which 480 physicians (87%) prescribed strong opioids for musculoskeletal pain, 268 (48.6%) prescribed ultra-rapid fentanyl and 434 (78.7%) reduced benzodiazepines dosage when prescribing potent opioids. The most common adverse effects were constipation and nausea. The main problems related with opioid prescription were improper use (341, 71%) and patient and/or practitioner reluctance (87, 18.1%). The assessment of the relationship with Pain Management Units was 2+/-1 (on a 1 to 5 scale), with communication (271, 52.2%) and accessibility (141, 27.1%) being the areas most in need of improvement. CONCLUSIONS: Opioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units
Subject(s)
Humans , Male , Female , Middle Aged , Analgesics, Non-Narcotic/administration & dosage , Chronic Pain/drug therapy , Physicians, Family , Drug Prescriptions , Analgesics, Non-Narcotic/adverse effects , Surveys and Questionnaires , Epidemiology, Descriptive , Musculoskeletal Pain/drug therapy , Chronic Pain/classification , Pain Management , Visual Analog Scale , SpainABSTRACT
OBJECTIVE: To identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. MATERIALS AND METHODS: Design A descriptive study based on a self-administered email questionnaire. LOCATION: All primary health care centres in Catalonia. PARTICIPANTS: 3,602 family doctors, all members of the Catalan Society of Family and Community Medicine. INTERVENTIONS: Email survey of Catalan family doctors. MAIN MEASUREMENTS: Demographic data, number of patients treated with potent opioids for chronic non-cancer pain, type of opioid used and indications, prescribing patterns and relationship with the Pain Management Unit. RESULTS: A total of 551 answers were obtained from 3,602 questionnaires sent (response rate of 15.3%), in which 480 physicians (87%) prescribed strong opioids for musculoskeletal pain, 268 (48.6%) prescribed ultra-rapid fentanyl and 434 (78.7%) reduced benzodiazepines dosage when prescribing potent opioids. The most common adverse effects were constipation and nausea. The main problems related with opioid prescription were improper use (341, 71%) and patient and/or practitioner reluctance (87, 18.1%). The assessment of the relationship with Pain Management Units was 2±1 (on a 1 to 5 scale), with communication (271, 52.2%) and accessibility (141, 27.1%) being the areas most in need of improvement. CONCLUSIONS: Opioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units.
