title: How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium.
abstract: BACKGROUND
  Opiate substitution treatment (OST) is the administration of opioids (methadone or buprenorphine) under medical supervision for opiate addiction. Several studies indicate a large unmet need for OST in general practice in Antwerp, Belgium. Some hurdles remain before GPs engage in OST prescribing.
  
  
  OBJECTIVE
  Formulate recommendations to increase engagement of GPs in OST, applicable to Belgium and beyond.
  
  
  METHODS
  In 2009, an exploratory qualitative research was performed using focus group discussions and interviews with GPs. During data collection and analysis, purposive sampling, open and axial coding was applied. The script was composed around the advantages, disadvantages and conditions of engaging in OST in general practice.
  
  
  RESULTS
  We conducted six focus groups and two interviews, with GPs experienced in prescribing OST (n = 13), inexperienced GPs (n = 13), and physicians from addiction centres (n = 5). Overall, GPs did not seem very willing to prescribe OST for opiate users. A lack of knowledge about OST and misbehaving patients creates anxiety and makes the GPs reluctant to learn more about OST. The GPs refer to a lack of collaboration with the addiction centres and a need of support (from either addiction centres or experienced GP-colleagues for advice). Important conditions for OST are acceptance of only stable opiate users and more support in emergencies.
  
  
  CONCLUSIONS
  Increasing GPs' knowledge about OST and improving collaboration with addiction centres are essential to increase the uptake of OST in general practice. Special attention could be paid to the role of more experienced colleagues who can act as advising physicians for inexperienced GPs.
authors.affiliation: a Department or Epidemiology and Social Medicine , Research Unit Medical Sociology and Health Policy, University of Antwerp , Antwerp , Belgium ;
authors.forename: Jessica
authors.initials: J
authors.lastname: Fraeyman
authors.affiliation: b Department of Primary and Interdisciplinary Care , Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium ;
authors.forename: Linda
authors.initials: L
authors.lastname: Symons
authors.affiliation: b Department of Primary and Interdisciplinary Care , Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium ;
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
authors.affiliation: a Department or Epidemiology and Social Medicine , Research Unit Medical Sociology and Health Policy, University of Antwerp , Antwerp , Belgium ;
authors.forename: Guido
authors.initials: G
authors.lastname: Van Hal
authors.affiliation: b Department of Primary and Interdisciplinary Care , Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium ;|c Department of Public Health , Faculty of Medicine, Vrije Universiteit Brussel , Brussels , Belgium ;|d Department of Nursing and Midwifery , Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp , Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Peremans
mesh_terms: D000328:Adult; D001530:Belgium; D003299:Cooperative Behavior; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
keywords: Public health; community medicine; healthcare organization; qualitative methods