What are the self-reported opioid prescribing practices of Australian GPs? A nationwide survey.

Problem

Reducing opioid-related harm is a public health priority for many western nations including Australia, USA and the UK. Australian general practitioners (GPs) prescribe approximately half of the country’s opioids. Despite up-to-date opioid prescribing guidelines and other initiatives, prescribing rates continue to increase. Understanding the self-reported practices of GPs may help engagement with provider-targeted opioid prescribing interventions. Furthermore, recognising GP demographic factors associated with possible unsafe prescribing may guide intervention delivery to specific subgroups of the GP population and help close the evidence-practice gap in this complex clinical area. Therefore, this study aimed to survey Australian GPs about their opioid prescribing practices, their attitudes and beliefs towards pain management, their perceptions of opioid prescribing interventions, their readiness for changing prescribing behaviours, and to identify demographic factors associated with evidence-based GP prescribing.

Approach

A de-identified paper-based survey was posted to a nationally representative sample of 4000 GPs across Australia in 2019, with reminders sent 4-weeks later. The 29-item survey collected demographic information and data around five primary questions exploring prescribing practices and included a hypothetical case study of an elderly woman with low back pain. Univariate and multivariate logistic regression, parametric tests and predictor modelling examined the association between GP demographic factors and higher confidence in prescribing, use of opioid risk reduction strategies, and attitudes towards changing current practices.

Findings

A total 482 surveys were completed (response rate of 12%). Cronbach’s Alpha was 0.7. Most GPs (73%; n= 222/305) felt they did not need to change their current opioid prescribing practices. However, 57% (n= 272/478) of respondents stated they would likely or definitely change their practices with increased pain management education and training. Best predictors of confidence in opioid prescribing were: being male (95% CI 0.114 to 0.310) and aged over 55 years (95% CI 0.084 to 0.156). The best predictors of opioid prescribing risk reduction strategies were: being female (95% CI -0.233 to -0.017) and overseas trained (95% CI 0.051 to 0.282). Pain not controlled by simple analgesia (74.1%) and patient quality of life (67.9%) were the most commonly reported factors influencing the decision to prescribe opioids. Guidelines were the least commonly reported factor influencing prescribing practices (21.8%).

Consequences

This is the first Australian study to report GPs’ confidence in various aspects of opioid prescribing, use of risk reduction strategies, and attitudes towards prescribing interventions. The majority of participants demonstrated low readiness for change- highlighting a major barrier to prescribing interventions including limited availability or use of guidelines. Interventions to improve knowledge also need to specifically improve GPs’ confidence in opioid prescribing.