{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:50:29Z","timestamp":1791269429490,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Foot and Ankle Research"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Australian\u2010endorsed general podiatrists and podiatric surgeons (EGPs and EPSs, respectively) operate under a fixed prescribing formulary, the National Podiatry Scheduled Medicines List (NPSML), that restricts access to opioid analgesics including tramadol and tapentadol, despite emerging evidence questioning the efficacy of available alternatives such as codeine. The impact of these restrictions on clinical practice has not been qualitatively examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive study using semi\u2010structured interviews was conducted with thirty\u2010one clinicians: ten pharmacists, seven dentists, five EGPs and nine EPSs practising across metropolitan, regional and rural Australia. Profession\u2010specific interview guides explored prescribing practices, analgesic strategies, experiences with formulary limitations and perceived impacts on patients and care systems. Interviews were audio\u2010recorded, transcribed verbatim and analysed using comparative thematic analysis with inductive coding. This study was reported in accordance with the COREQ checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes were identified: (1) Inadequacy of fixed prescribing formularies: All professional groups, including pharmacists and dentists not directly constrained by the NPSML, critiqued the static, list\u2010based prescribing model as structurally misaligned with contemporary evidence and practice. (2) Codeine as an unreliable ceiling for moderate to severe pain: Codeine was widely regarded as an unreliable analgesic because of variable metabolism, with clinicians describing cases of treatment failure necessitating emergency department referral. (3) Fragmented care pathways and cascading patient impact: Prescribing restrictions were perceived to generate disjointed care pathways, delayed pain relief, increased healthcare utilisation and disproportionately affected patients in rural settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Australia's NPSML is perceived by clinicians to be structurally misaligned with current pharmacological evidence, professional competencies and equitable care principles. These findings support the transition to a dynamic, scope\u2010of\u2010practice\u2010based prescribing model that can respond to emerging evidence and meet the analgesic needs of diverse patient populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jfa2.70202","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:13:08Z","timestamp":1787199188000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinician Perspectives on Prescribing Restrictions and Opioid Pain Management in Australian Podiatric Practice: A Qualitative Study"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1215-0710","authenticated-orcid":false,"given":"Lachlan","family":"Aquilina","sequence":"first","affiliation":[{"name":"School of Health and Clinical Sciences The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mischa","family":"Kronenberg","sequence":"additional","affiliation":[{"name":"Department of Podiatry and High Risk Foot Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4883-6793","authenticated-orcid":false,"given":"Estie","family":"Kruger","sequence":"additional","affiliation":[{"name":"School of Health and Clinical Sciences The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Tennant","sequence":"additional","affiliation":[{"name":"School of Health and Clinical Sciences The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2052-558X","authenticated-orcid":false,"given":"Joon Soo","family":"Park","sequence":"additional","affiliation":[{"name":"School of Health and Clinical Sciences The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010022\u201000515\u2010w"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2014.01.005"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.313.7053.321"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.16265"},{"issue":"4","key":"e_1_2_11_6_1","first-page":"17","article-title":"Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants","volume":"6","author":"Sansone R. A.","year":"2009","journal-title":"Psychiatry"},{"issue":"3","key":"e_1_2_11_7_1","first-page":"401","article-title":"Tramadol Extended\u2010Release in the Management of Chronic Pain","volume":"3","author":"McCarberg B.","year":"2007","journal-title":"Therapeutics and Clinical Risk Management"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000001683"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.15255"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2013\/16\/27"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.06.024"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2013.05.010"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1310\/hpj5104\u2010320"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232076"},{"key":"e_1_2_11_15_1","volume-title":"Unleashing the Potential of Our Health Workforce\u2014Scope of Practice Review Final Report","author":"Australian Government","year":"2024"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/23333936251356349"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2011.287"},{"key":"e_1_2_11_18_1","article-title":"Tramadol Versus Placebo for Chronic Pain: A Systematic Review With Meta\u2010Analysis and Trial Sequential Analysis","author":"Barakji J. 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