title: Physicians' Knowledge of and Attitudes Toward Use of Opioids in Long-Term Care Facilities.
abstract: Insufficient pain management in vulnerable older persons living in long-term care facilities is common, and opiophobia might contribute to this. As opiophobia and its related factors have not been investigated in long-term care, this study evaluates the degree of knowledge of opioids among elderly-care physicians (ECPs) and ECP trainees, as well as their attitudes and other factors possibly influencing the clinical use of opioids in these facilities.
  
  
  
  A questionnaire was designed and distributed among ECPs and ECP trainees by email, regional symposia, and all three university training faculties for elderly-care medicine in the Netherlands.
  
  
  
  Respondents were 324 ECPs and 111 ECP trainees. Fear of addiction did not influence the prescription of opioids. Main barriers to the clinical use of opioids were patients' reluctance to take opioids (83.3%); unknown degree of pain (79.2%); and pain of unknown origin (51.4%). ECPs' average knowledge scores were sufficient: those who felt that their knowledge of opioids was poor scored lower than those who felt that their knowledge was good.
  
  
  
  Factors identified in this study may help provide better pain management for vulnerable older persons living in a long-term care facility. Also, more patient information on the pros and cons of opioid use is needed, as well as appropriate tools for better clinical assessment of pain in a long-term care population.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Griffioen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Eva G
authors.initials: EG
authors.lastname: Willems
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Kouwenhoven
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Monique A A
authors.initials: MAA
authors.lastname: Caljouw
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D005853:Geriatrics / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid
keywords: barriers; long-term care facilities; opioids; pain