title: French general practitioners' attitudes and prescription patterns toward buprenorphine maintenance treatment: does doctor shopping reflect buprenorphine misuse?
abstract: This study investigated attitudes toward buprenorphine maintenance treatment (BMT) among general practitioners (GPs) and their maintained patients' propensity to turn to several prescribers (doctor shopping), among a sample of 345 GPs prescribing BMT in South-Eastern France. Survey data were anonymously matched to administrative data that provided information about GPs' patients. A simultaneous equation model suggests that GPs' attitude influenced doctor shopping, not the reverse. Doctor shopping was lower among GPs who reported inducting BMT with 8 mg of buprenorphine per day or more, and was higher for GPs endorsing a stringent attitude toward patients. Thus doctor shopping should not be understood exclusively as a deviant behaviour. It is partially physician-driven, and further research is needed to assess whether it reflects patients' dissatisfaction toward inappropriate care supply and the difficulty to establish a good therapeutic relationship between an opiate-dependent patient and a general practitioner.
authors.affiliation: Regional Centre for Disease Control of South-Eastern France (ORS PACA) and INSERM Research Unit 379, Social Sciences Applied to Medical Innovation, Institut Paoli Calmettes, Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Feroni
authors.forename: Patrick
authors.initials: P
authors.lastname: Peretti-Watel
authors.forename: Alain
authors.initials: A
authors.lastname: Paraponaris
authors.forename: Alain
authors.initials: A
authors.lastname: Masut
authors.forename: Eleonore
authors.initials: E
authors.lastname: Ronfle
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Mabriez
authors.forename: Yolande
authors.initials: Y
authors.lastname: Obadia
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002047:Buprenorphine / Q000627:therapeutic use; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine