RESEARCHERS from South Australia looking into opioid prescribing in rural general practice report a marked disparity between evidencebased guidelines for chronic pain management and the reality of rural medical practice.
Opioid prescribing rates are much higher in rural and regional areas than in capital cities, which reflects both a greater burden of chronic pain as well as limited pain management alternatives.
The qualitative study involved interviews with 17 rural general practitioners who had prescribed opioids for managing chronic noncancer pain during the preceding 12 months.
Many regarded the prescribing of opioids as a "pragmatic approach", given the constraints of consultation time, which in turn was driven by the Medicare compensation model - more, but shorter appointments pay better than fewer, longer ones.
"Given the anticipated complexity of initiating a conversation about reducing opioid medication use, combined with brief appointment windows, alternative management strategies seemed impractical and overwhelming," the authors noted.
Also at issue was the lack of access in rural areas to multidisciplinary teams to provide non-pharmacological pain management.
Even where available, allied health services such as physiotherapy and dietetics, as well as private pain clinics, were also likely to be unaffordable to rural residents.
"Opioid prescription is much less expensive and easier to obtain than an allied health professional," they observed.
The GPs described difficulties in adapting guidelines developed for citybased doctors to rural practice, forcing them to "operate within a different reality than the one imagined for urbancreated clinical guidelines", creating a disconnect between evidencebased recommendations and their practical implementation.
"Rural doctors operating in a difficult context resort to prescribing opioids because of systemic inadequacies rather than lack of awareness of their limited value," the authors concluded.
"Chronic pain management in rural areas could be improved by better Medicare support for longer pain management consultations, improved access to allied health, rural areaspecific guidelines that take resource constraints into account, and improved support for general practitioners in pain management and deprescribing.
"Contextually appropriate interventions that enable rural practitioners to undertake evidencebased pain management within system constraints should be developed and evaluated."
Read the research paper HERE. KB
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