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An examination of the influences on New South Wales general practitioners regarding the provision of opioid substitution therapy

Authors


  • Simon Holliday BMed, FAChAM, FRACGP, FACRRM, DA, DipRACOG, GradDipA&DSt, General Practitioner & Staff Specialist, Parker Magin PhD, FRACGP, Conjoint Professor, Medical Educator, Christopher Oldmeadow B.Math. (Hons.), PhD, John Attia PhD, FRCPC, FRACP, Professor, Academic Director, Research Fellow, Janet Dunbabin BAgSc, PhD, Senior Project Officer, Julie-Marie Henry Diploma of Applied Science (Nursing), Registered Nurse, Nicholas Lintzeris PhD, FAChAM, Director, Clinical A/Professor, Susan Goode B.Sc. (Hons.), Dip. Management, Research Manager, Adrian Dunlop PhD, FAChAM, GradDipEpi&Biostat, Area Director & Senior Staff Specialist, Conjoint Associate Professor.

Correspondence to: Dr Simon Holliday, Albert St Medical Centre, 78 Albert Street, Taree, NSW 2430, Australia. Tel: + 61 2 6552 5533; Fax: + 61 2 6552 4249; E-mail: simon.holliday@albertstmc.com

Abstract

Introduction.

Few general practitioners (GP) prescribe opioid substitution therapy. Our aim was to analyse their previously identified motivating factors by describing their frequency and demographic associations.

Methods.

An anonymous, cross-sectional questionnaire-based survey on opioid prescribing in pain and dependency was distributed across five New South Wales Divisions of GPs. Questions elicited opinions on 11 barriers and five facilitators previously described in qualitative literature. Data were analysed against demographic variables, including opioid substitution therapy prescriber (OSTP) status and postgraduate training status. ‘Profiles’ of non-OSTPs were then constructed using latent class analysis.

Results.

Of the 1735 surveys posted, there were 404 responses (23.3%), with 16% respondents being OSTPs. Frequently reported barriers included: ‘negative experiences with the opioid dependent’ (72%), ‘heavy workload’ (60%) and ‘lack of specialist support’ (58%), with most barriers less frequent among OSTPs. Facilitating factors included: ‘more accessible specialist support’ (75%), ‘more accessible training’ (67%) and ‘better evidence of safety and efficacy’ (64%), with the latter two significantly less frequently among OSTPs. Latent class analysis of the non-OSTPs revealed three distinct clusters. The smallest (‘class 3’) had the least barriers and resembled OSTPs demographically.

Discussion and Conclusions.

The pattern of motivating factors towards the psychological, social and behavioural challenges of the management of dependency has a predominantly negative bias. However, this lessens with postgraduate training and OSTP experience. Structural and logistical options are identified to promote OSTP recruitment and retention. GPs resembling class 3 may be more amenable to becoming OSTPs and may be worth targeting for recruitment. [Holliday S, Magin P, Oldmeadow C, Dunbabin J, Henry J-M, Lintzeris N, Attia J, Goode S, Dunlop A. An examination of the influences on New South Wales general practitioners regarding the provision of opioid substitution therapy. Drug Alcohol Rev 2013;32:495–503]

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