Understanding long-term opioid prescribing for non- XXXX @entity158 in primary care: a qualitative study.

@entity5 @entity1 @entity1118 @entity158
BACKGROUND: The place of opioids in the management of chronic, non- @entity5 @entity158 is limited. Even so their use is escalating, leading to concerns that @entity1 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- @entity5 @entity158 . METHODS: We held semi-structured interviews with @entity1 and focus groups with general practitioners (GPs). @entity1 included 23 @entity1 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: @entity1 are driven by the needs for @entity158 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 @entity1118 , especially when facing diagnostic uncertainty or when their own approach is at odds with the @entity1 's wishes. Four features of the resulting transaction between @entity1 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- @entity1 relationship; and mutuality and trust. CONCLUSIONS: Problematic prescribing occurs when @entity1 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 @entity1 .
