title: The Pattern of Opioid Management by Australian General Practice Trainees.
abstract: OBJECTIVE
  With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation-level prevalence and associations of opioid prescribing.
  
  
  METHODS
  A cross-sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: "Registrar Clinical Encounters in Training."
  
  
  METHODS
  Four of Australia's seventeen GP Regional Training Providers, during 2010-13.
  
  
  METHODS
  GP trainees.
  
  
  METHODS
  Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time.
  
  
  RESULTS
  Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre-existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow-up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk-mitigation strategies.
  
  
  CONCLUSIONS
  Most opioids were prescribed as maintenance therapy for non-cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Holliday
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tapley
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, NSW, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Dunlop
authors.affiliation: General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Henderson
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Mieke
authors.initials: M
authors.lastname: van Driel
authors.affiliation: Department of General Practice, The University of Melbourne, Victoria, Australia.|Director of Medical Education and Training, VMA General Practice Training, Melbourne, Victoria, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Spike
authors.affiliation: Director of Medical Education and Training, Adelaide to Outback GP Training, Adelaide, South Australia.
authors.forename: Lawrie
authors.initials: L
authors.lastname: McArthur
authors.affiliation: Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Jean
authors.initials: J
authors.lastname: Ball
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Oldmeadow
authors.affiliation: School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia.|General Practice Training Valley to Coast, Mayfield, NSW, Australia.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D059408:Pain Management / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D000701:Analgesics, Opioid
keywords: Aboriginal and Torres Strait Islander; Analgesic; Opioids; Pain Management; Persistent Pain; Prescriptions; Primary Care; Quality of Health Care; Risk Factors