title: An examination of the influences on New South Wales general practitioners regarding the provision of opioid substitution therapy.
abstract: BACKGROUND
  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.
  
  
  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.
authors.affiliation: Albert St Medical Centre, Taree, Australia; Drug and Alcohol Clinical Services, Hunter New England Health, Taree, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Holliday
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
authors.forename: Christopher
authors.initials: C
authors.lastname: Oldmeadow
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Janet
authors.initials: J
authors.lastname: Dunbabin
authors.forename: Julie-Marie
authors.initials: JM
authors.lastname: Henry
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.forename: Susan
authors.initials: S
authors.lastname: Goode
authors.forename: Adrian
authors.initials: A
authors.lastname: Dunlop
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D058850:Opiate Substitution Treatment / Q000523:psychology* / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: dependency; general practitioners; motivating factors; opioid substitution therapy; pain