“ Overall, I'm Feeling More Confident Than I Was ” General Practitioner Intention to Diagnose and Manage Prescription Opioid Dependence for Patients Prescribed Opioids for Chronic Pain, NSW, Australia 2021–2023: A Longitudinal Qualitative Study Frame

In Australia, oral opioids have increasingly been prescribed for chronic pain with limited effectiveness, attendant side effects and risks including the development of opioid dependence. In primary care, opioid dependence in chronic pain patients prescribed opioids is underrecognised, underdiagnosed and as a consequence undertreated. This may lead to sometimes severe adverse health outcomes. This longitudinal qualitative study analysed two waves of semi-structured interviews undertaken with 24 general practitioners (GPs) working in community general practice in New South Wales (NSW), Australia, between 2021 and 2023. The theory of planned behaviour (TPB) framed these interviews. TPB has three factors: attitudes, social norms and perceived behavioural controls. The positive and negative valences of these factors may impact intention to undertake a specific behaviour. In this case, the intention of participants to diagnose and manage opioid dependence in their patients’ prescribed opioids for chronic pain. Over the study period, some participants reported changing social norms, with patients increasingly flagging concerns regarding their opioid use. This led to fruitful conversations about opioid dependence between participants and their patients and positive experiences diagnosing and managing opioid dependence, including commencing treatment with methadone or buprenorphine. This led to more positive attitudes and strengthened intention for participants. Behavioural controls, including supportive workplace and colleagues, change in role, increased knowledge, expanded skills and easy access to specialist support, also strengthened intention. Participants were enthusiastic about the benefits of a newly introduced real-time prescription monitoring tool; however, this did not appear to change their approach to the diagnosis or management of opioid dependence. Overarching these experiences were the impact of the coronavirus pandemic and an exodus of participants from Medicare supported general practice work. To improve GPs' intention to undertake the diagnosis and management of opioid dependence for patients prescribed opioids for chronic pain, a raft of changes need to be implemented.