The pattern of opioid management by Australian general practice trainees

Holliday, Simon, Morgan, Simon, Tapley, Amanda, Dunlop, Adrian, Henderson, Kim, van Driel, Mieke, Spike, Neil, Mcarthur, Lawrie, Ball, Jean, Oldmeadow, Chris and Magin, Parker (2015) The pattern of opioid management by Australian general practice trainees. Pain Medicine (United States), 16 9: 1720-1731. doi:10.1111/pme.12820

Author Holliday, Simon
Morgan, Simon
Tapley, Amanda
Dunlop, Adrian
Henderson, Kim
van Driel, Mieke
Spike, Neil
Mcarthur, Lawrie
Ball, Jean
Oldmeadow, Chris
Magin, Parker
Title The pattern of opioid management by Australian general practice trainees
Journal name Pain Medicine (United States)   Check publisher's open access policy
ISSN 1526-4637
Publication date 2015-06-27
Sub-type Article (original research)
DOI 10.1111/pme.12820
Volume 16
Issue 9
Start page 1720
End page 1731
Total pages 12
Place of publication Hoboken, NJ United States
Publisher Wiley-Blackwell Publishing
Collection year 2016
Language eng
Formatted abstract
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.

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.
Keyword Opioids
Pain management
Primary care
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Early view of article. Published online 27 June 2015.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Discipline of General Practice Publications
Official 2016 Collection
School of Medicine Publications
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