A Systematic Review of Interventions to Improve Analgesic Use and Appropriateness in Long-Term Care Facilities

Dowd, Laura A; Cross, Amanda J.; Veal, Felicity; Ooi, Choon Ean; Bell, John

doi:10.1016/j.jamda.2021.09.024

Cited by 7 publications

(11 citation statements)

References 73 publications

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“…Four studies reported pain and opioid use separately, 8,22,27,39 while one study reported the prevalence of opioid prescribing among residents self‐reporting pain 33 . Multidisciplinary interventions that involve prescribers, nurses and pharmacists with a component of education have been demonstrated to improve analgesic use and appropriateness in RACFs 57 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…33 Multidisciplinary interventions that involve prescribers, nurses and pharmacists with a component of education have been demonstrated to improve analgesic use and appropriateness in RACFs. 57 The prevalence of opioid prescribing, dispensing and administration was highly variable. This is consistent with the Australian Commission on Safety and Quality in Health Care identifying unexplained opioid variation in the general population.…”

Section: Quality Assessmentmentioning

confidence: 99%

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A systematic review of opioid prevalence in Australian residential aged care facilities

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

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A systematic review of opioid prevalence in Australian residential aged care facilities

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“…19 Second, education is a relevant component of therapeutic management as education alone was able to change appropriate analgesic use when motivated by the possibility to earn continuing medical education (CME) credits. 21 In addition, developing further training/educational tools to address the unmet needs in pain practice stands as an educational obligation. 22,23 Since its foundation in 1934, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva, SIAARTI) has been devoted to promote the scientific and cultural development in multiple anesthesia-related fields, including pain medicine, by issuing guidelines on pain management.…”

Section: Introductionmentioning

confidence: 99%

“…First, educational interventions can be of help in limiting litigation issues as it has been recently documented that unqualified anesthesiologists may deal more likely with allegations for iatrogenic patient injuries 19 . Second, education is a relevant component of therapeutic management as education alone was able to change appropriate analgesic use when motivated by the possibility to earn continuing medical education (CME) credits 21 . In addition, developing further training/educational tools to address the unmet needs in pain practice stands as an educational obligation 22,23 …”

Section: Introductionmentioning

confidence: 99%

Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

et al. 2023

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Purpose Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self‐perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. Methods SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5‐point Likert‐type scale. Results Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31–40 years). Regarding cancer and chronic noncancer pain a positive gradient of self‐perceived competence has been observed in relation to seniority. In contrast, no gradient of self‐perceived competence was reported about musculoskeletal and low back pain. Participants self‐perceived competent in both opioid use and prevention of opioid‐related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential. Conclusion This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.

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Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

et al. 2023

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Background Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study ( N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01025-5.

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A Systematic Review of Interventions to Improve Analgesic Use and Appropriateness in Long-Term Care Facilities

Cited by 7 publications

References 73 publications

A systematic review of opioid prevalence in Australian residential aged care facilities

A systematic review of opioid prevalence in Australian residential aged care facilities

Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

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