A Pharmacist-Assisted Initiative to Improve Chronic Pain Management and Reduce Opioid   Use in Primary Care

Perry, Kailene; Ferron, S.; Norquist, Nathan; Mullen, Deborah

doi:10.24926/iip.v14i1.5265

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…This intervention encompassed patient notifications, proactive outreach by pharmacists, and the establishment of a patient registry with regularly updated clinical data. 43 Additionally, a nurse-led telephone follow-up intervention for titrating or tapering opioids showed positive results. 44 …”

Section: Discussionmentioning

confidence: 99%

Patient perspectives on primary care providers role in long-term opioid therapy

Davies,

Jansen-Groot Koerkamp,

Koster

et al. 2024

Br J Gen Pract

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Introduction: Over the past decade, long-term use of prescription opioids for chronic non-cancer pain (CNCP) has risen globally despite the associated risks. The majority of opioid users receive their first prescription in primary care. Aim: To investigate the perspective of long-term opioid users in primary care regarding the role of healthcare providers (HCP) in their prolonged opioid use. Design and setting: Semi-structured interviews in Dutch primary care Methods: We recruited long-term opioid users for CNCP from seven community pharmacies in the Netherlands. In-depth, semi-structured interviews focussed on experiences with long term opioid use, access to opioids, and the guidance of their HCPs. A directed content analysis was conducted on the transcribed interviews using NVivo. Results: Participants (n=25) mentioned ways HCPs impacted their long-term use of opioids. These encompassed: 1) the initiation of treatment, 2) chronic use of opioids, 3) discontinuation of treatment. Participants stressed the need for risk counselling during initial prescriptions, ongoing medication evaluations including tapering conversations, and more support from their HCP during a tapering attempt. Conclusion: Patients’ perspective illustrates the important role of HCPs across the spectrum of opioid usage – from initiation to tapering. It underscores the importance of clear risk counselling starting at the initial prescription, continuous medication assessments throughout treatment, addressing tapering at regular intervals and strong support during tapering. These insights carry significant implications for clinical practice, emphasising the importance of informed and patient-centred care when it comes to opioid use for chronic non-cancer pain management.

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Section: Discussionmentioning

confidence: 99%

Patient perspectives on primary care providers role in long-term opioid therapy

Davies,

Jansen-Groot Koerkamp,

Koster

et al. 2024

Br J Gen Pract

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Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting

Bakhai,

Mustafa,

Cloutier

et al. 2024

BMJ Open Qual

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BackgroundImplementing guidelines for chronic opioid management during a clinic merger posed significant challenges. Our aim was to increase the percentage of chronic pain evaluations and urine toxicology tests in patients on chronic opioid therapy from the baseline rate of less than 20% to 50% within 1 year at an academic, primary care clinic.MethodsWe applied the Define, Measure, Analyze, Improve, Control (DMAIC) approach of Lean Six Sigma for this quality improvement (QI) project. The QI tools included the creation of stakeholder mapping, root cause analysis, process flow mapping and a driver diagram. Lack of patient and provider education emerged as a significant barrier. The outcome measures were percentage of chronic pain evaluations and urine drug toxicology with an increase in controlled substance agreement completion rates as our process measures. Major interventions included patient and provider education, leveraging health information technology, care coordination and implementing new clinic protocols. Data analysis was performed by monthly run charts. Descriptive statistics were used to summarise clinical variables, while χ2analyses were employed to determine statistically significant differences between preintervention and postintervention measures.ResultsWe observed an increase in completion rates of clinic visits for chronic pain, rising from 19.0% to 51.9% (p<0.001). During study period, we observed a steady increase in chronic pain evaluations with a median of 4.5. Urine toxicology completion rates increased from 19.9% to 65.8% (p<0.001) during the preintervention and postintervention periods. We observed variable changes in urine toxicology rates with a median of 5.19. Furthermore, we observed an increase in controlled substance agreement completion rates, increasing to 50% from the baseline rate of <10%.ConclusionsEducation to patients and providers, shared decision-making using a patient-centred approach, enhancement of health information technology and system-based interventions in clinic protocols and workflows contributed to the success of this QI project. The DMAIC approach may facilitate the implementation of practice guidelines for chronic opioid therapy and enhance providers’ opioid prescribing practices.

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Primary care-based interventions for secondary prevention of opioid dependence in patients with chronic non-cancer pain taking pharmaceutical opioids: a systematic review

French,

Troy,

Dawson

et al. 2024

BJGP Open

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BackgroundGlobally almost one third of adults with chronic non-cancer pain (CNCP) are prescribed opioids. Prevention of opioid dependence among these patients is a public health priority.AimSynthesise the evidence on the effectiveness of primary care-based interventions for secondary prevention of opioid dependence in CNCP patients on pharmaceutical opioids.Design & SettingSystematic review of randomised controlled trials (RCTs) and comparative non-randomised studies of interventions from high-income countries.MethodWe searched five databases for studies on non-tapering secondary prevention interventions such as tools for predicting dependence, screening tools for early recognition of dependence, prescribing/medication monitoring, and specialist support. We examined multiple outcomes, including reduction in opioid dosage. Primary analyses were restricted to RCTs with data synthesised using an effect direction plot. Risk of bias was assessed using the Cochrane risk of bias (RoB2) tool.ResultsOf 7,102 identified reports, 18 studies were eligible (8 RCTs). Most used multiple interventions/components. Of the seven RCTs at low risk of bias or ‘some concerns’, five showed a positive intervention effect on at least one relevant outcome, four of which included a nurse care manager and/or other specialist support. The remaining two RCTs showed no positive effect of automated symptom monitoring and optimised analgesic management by a nurse care manager/physician pain specialist team, or of a mobile opioid management app.ConclusionWe identify a clear need for further adequately powered high quality studies. The conclusions that can be drawn on intervention effectiveness are limited by the sparsity and inconsistency of available data.

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A Pharmacist-Assisted Initiative to Improve Chronic Pain Management and Reduce Opioid Use in Primary Care

Cited by 3 publications

References 31 publications

Patient perspectives on primary care providers role in long-term opioid therapy

Patient perspectives on primary care providers role in long-term opioid therapy

Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting

Primary care-based interventions for secondary prevention of opioid dependence in patients with chronic non-cancer pain taking pharmaceutical opioids: a systematic review

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