Acceptability of a primary care-based opioid and pain review service: a mixed-methods evaluation in England

Abstract

BackgroundPrimary care opioid prescribing to treat chronic non-cancer pain (CNCP) has progressively increased despite a lack of evidence for long-term safety and effectiveness. Developing primary care interventions to reduce opioid dependence in patients with CNCP is a public health priority.AimTo report the acceptability of the South Gloucestershire pain and opioid review service for patients with CNCP, which aimed to help patients understand their relationship with prescribed opioids and support non-drug-based pain management strategies.Design and settingA mixed-methods evaluation was performed on the service, which was based in two GP practices in South Gloucestershire, England, and delivered by project workers.MethodDescriptive data were collected on delivered-within-service and community-based interventions. Twenty-five semi-structured interviews (n = 18 patients, n = 7 service providers) explored experiences of the service.ResultsThe enrolment process, person-centred primary care-based delivery, and service content focused on psychological issues underlying CNCP were found to be acceptable to patients and service providers. Patients welcomed having time to discuss their pain, its management, and related psychological issues. Maintaining a long-term approach was desired as CNCP is a complex issue that takes time to address. GPs recommended that funding was needed to ensure they have dedicated time to support a similar service and to ensure that project workers received adequate clinical supervision.ConclusionThis service model was acceptable and may be a useful means to manage patients with CNCP who develop opioid dependence after long-term use of opioids. A randomised controlled trial is needed to formally test the effectiveness of the service.

Інформаційне Забезпечення Доказового Ведення Пацієнтів З Ураженнями Кістково-М’язової Системи В Первинній Ланці Охорони Здоров’я

“…Nowadays, a category search is unavailable in the TRIP. Evidence may be found either by search terms that match the PICO components (Patient, Intervention, Comparison, [19]; 2) a double blind phase IIb/III RCT of using fasinumab for osteoarthritic pain, reported by Dakin P. et al [20]; 3) «a mixed methods study protocol» as to effectiveness, cost-utility, and benefit of a multicomponent therapy to improve the quality of life of patients with FM in primary care, by Caballol Angelats R. et al [21]; 4) a mixed method evaluation of a primary care-based opioid's acceptability for chronic non-cancer pain, conducted by Kesten J. et al [22]. We are reporting the obtained results, taking into account their novelty.…”

“…The other two documents of the «Primary care» TRIP category on MSDs (as shown by the content-analysis results of the titles) are study protocols of «effectiveness, cost-utility, and benefit of a multicomponent therapy to improve the quality of life of patients with FM» in the primary care settings in Spain [21], and assessment of the British experience on the eligibility of such a PHC service as managing chronic non-cancer pain based on both non-pharmacologic support and use of opioids [22].…”

Evaluation of a primary care-based opioid and pain review service: a mixed-methods evaluation in two GP practices in England

“…The main strength of this study was the use of mixed methods to evaluate the service and to understand the potential impact of the intervention on the target group. 33,34 Factors to consider for future service development are discussed in the authors' linked article by Kesten et al 24 There are four main limitations. First, the sample size was small, and quantitative follow-up data were not available for some service users (particularly those who dropped out early).…”

“…Second, because of the service users' close relationship with the project workers, 24 they may have been reluctant to provide negative outcomes relating to the service during interviews. However, the findings reflect a range of positive and negative experiences suggesting that service users felt free to express negative experiences.…”

“…Additionally, GPs reported more informed opioid prescribing with greater consideration of the appropriateness of opioid prescribing, as well as increased confidence in explaining the benefits and harms for this patient cohort. Though the results of the study are promising, further development of the service is required, 24 followed by a more robust evaluation of the intervention, ideally an RCT.…”