Abstract
Background: In many countries, the consumption of opioid medicines is too low to meet population needs. Discussions within the Access To Opioid Medication in Europe project indicated that there may be significant differences in the perception of barriers for their adequate use, depending on the stakeholders. Aim: The aim of this study was to examine the perception of barriers and their impact concerning opioid medicines, comparing policy makers, healthcare professionals working in the field of pain management, palliative care or harm reduction and other stakeholders. Design: Data were collected using a questionnaire partially constructed from existing surveys, reviewed for content validity by four experts and pilot-tested in Latvia. Setting/participants: Participants of the Access to Opioid Medication in Europe national conferences were invited to complete the questionnaire. Stakeholder groups were compared using non-parametric rank-sum tests. Results: In total, 199 participants (54%) in seven countries completed the questionnaire. Most frequently rated major barriers included lack of financial resources and inadequate knowledge, skills and training among policy makers (55%–66%). Overall, policy makers perceived issues less often as major barriers or having major impact (29% barrier, 32% impact) compared to other stakeholders (36%–42% barrier, 39%–51% impact). Significant differences were seen on several aspects. For example, excessive regulation or bureaucracy for prescribing was rated as having major impact by 55%–57% of healthcare professionals in contrast to only 20% of the policy makers (p = 0.002). Conclusion: Multiple barriers may play an important role, partly depending on the perspective of the stakeholder involved. Hence, when addressing perceived barriers, it is important to include all relevant stakeholder groups. Only then, effective and widely supported solutions can be implemented.
Original language | English |
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Pages (from-to) | 493-503 |
Number of pages | 11 |
Journal | Palliative Medicine |
Volume | 34 |
Issue number | 4 |
DOIs | |
Publication status | Published - 1 Apr 2020 |
Funding
The authors would like to express their gratitude to all Access To Opioid Medication in Europe (ATOME) country team members for their contribution to the ATOME project. The authors would also like to thank Prof. Dr H.G.M. Leufkens for his contribution to this study and the Institutional Review Board of the Utrecht Institute for Pharmaceutical Sciences, Utrecht University, The Netherlands for reviewing the study protocol and questionnaire. This paper was prepared on behalf of the ATOME consortium which was composed of 10 partners from the fields of palliative care (Department of Palliative Medicine, University of Bonn, Germany; Hospice Casa Sperantei, Brasov, Romania; Help the Hospices, London, UK; International Observatory on End of Life Care, Lancaster University, UK; European Association for Palliative Care, Milan, Italy); law/health policy (World Health Organization, Geneva, Switzerland; Utrecht University, Utrecht, The Netherlands) and harm reduction (Eurasian Harm reduction Network, Vilnius, Lithuania; National Anti-Drug Agency, Bucharest, Romania; Harm Reduction International, London, UK). Together, this group consisted of national, Europewide and international organizations with long-standing experience in opioid medicine issues; the 10 ATOME partners worked with the country teams, including government officials and public health and medicines experts, to carry out legislative and policy reviews, leading to recommendations that aimed to facilitate access for all patients requiring treatment with medicines controlled under international drug conventions. Core scientific group/work package leaders: Lukas Radbruch, University of Bonn/Malteser Krankenhaus Bonn/Rhein-Sieg, Germany; Willem Scholten, Consultant – Medicines and Controlled Substances, The Netherlands; Sheila Payne, Lancaster University, UK; Sergey Votyagov, Eurasian Harm Reduction Association, Lithuania; Daniela Mosoiu, Hospice Casa Sperantei, Romania; Paula Frusinoiu, National Anti-Drug Agency, Romania; David Praill, Help the Hospices, UK; Rick Lines, Harm Reduction International, UK; Marie-Hélène Schutjens, Utrecht University, The Netherlands; Sheila Payne, European Association for Palliative Care, Italy. Academic Advisory Board: Snezana Bosnjak, Institute for Oncology and Radiology, Serbia; David Clark, University of Glasgow, UK; Ambros Uchtenhagen, Institut für Sucht- und Gesundheitsforschung Zürich, Switzerland; John Lisman, Lisman Legal Life Sciences, the Netherlands; Stein Kaasa, The Norwegian University of Science and Technology (NTNU), Norway; Per Sjøgren, Rigshospitalet, Copenhagen, Denmark. Project management: Lukas Radbruch (project coordinator); Saskia Jünger (project executive officer); Willem Scholten (scientific coordinator) and Sheila Payne. The Division of Pharma-coepidemiology and Clinical Pharmacology of Utrecht University is designated as a WHO Collaborating Centre for Pharmaceutical and Regulation. The WHO Collaborating Centre for Pharma-ceutical Policy and Regulation receives no direct funding or donations from private parties, including pharma industry. Research funding from public–private partnerships, for example, IMI, TI Pharma ( www.tipharma.nl ), is accepted under the condition that no company-specific product or company-related study is conducted. The Centre has received unrestricted research funding from public sources, for example, Netherlands Organization for Health Research and Development (ZonMW), the Dutch Healthcare Insurance Board (ZIN), European Union Seventh Framework Programme (FP7), the Dutch Medicines Evaluation Board (MEB), and the Dutch Ministry of Health, Welfare and Sport. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007–2013, Grant No. 222994), with the overall aim to improve the access to opioid medication in Europe.
Keywords
- Access
- barriers
- healthcare professionals
- opioid analgesics
- opioids
- perception
- policy makers
- questionnaire