In summary, a treatment agreement can be considered as the conversation about the interaction between patients and doctors, the rules of the street. Informed Consent recognizes the risks and makes it clear that a patient is aware of the possible consequences. Both are decisive steps towards a useful patient-physician relationship. In addition, both from a regulatory and cost-related perspective, both parties become a necessary component of medical documentation. Based on previous literature, we have developed a thematic guide to study patients` experience and perceptions of the administration, content and effectiveness of AAPs (Table 1). [8,11,15–18] Similarly, the thematic guides for prescribers contained questions about the management, content, effectiveness and usefulness of AAEs (Table 2). Patients and prescribers agreed that the AAE takes into account the severity of opioid medications and that expectations are behaviours. Prescribers suggested that the AAE show the patient that “someone takes care and help,” while allowing them to take responsibility for their pain management. Nevertheless, patients and prescribers indicated that increased office visits and drug testing made the AAE longer to administer and comply with for some patients. One GP said, “If they have objections or questions, it becomes a 15- or 20-minute ordeal, other patients who are waiting take time.” Physicians also expressed concern about the increased financial burden on patients due to increased office visits and drug testing. General practitioners reported more frequent complaints about the use of AAE, particularly in long-term patients, for whom AAE was seen as a sign of lack of confidence. One doctor reported: “Many times that will cause a breakdown in the relationship.” They also found that AAEs were the least effective in these patients. Instead, pain specialists indicated that the AAE improved the doctor-patient relationship by providing a platform for discussion and education, while assuring the patient that he was being helped.
One pain specialist noted: ” (PPA) offer a valid and safe mechanism for prescribing medications for good reasons.” Compliance with the AAE is a time charge for both prescribers and patients. Several physicians indicated that it could take more than 10 minutes to explain an AAE and answer questions. For a general practitioner, this valuable time could be spent discussing the patient`s health problems. This role could be transferred to a nurse or pharmacist. Many patients reported that a nurse explained the AAE to them. For patients, increasing the frequency of office visits and drug testing means more time and effort. Given the current state of evidence of the effectiveness of AAEs in reducing opioid abuse and diversion, consideration should be given to reducing some of the most distressing aspects of the AAE. [10,15] Scenarios in which an AEA could be used varied and highlighted a lack of guidelines or recommendations for prescribers regarding the administration of AAEs.