Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: a qualitative study to inform intervention development
Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: a qualitative study to inform intervention development
Introduction: regular review of patients prescribed opioids for persistent non-cancer pain (PCNP) is recommended but not routinely undertaken. The PROMPPT (Proactive clinical Review of patients taking Opioid Medicines long-term for persistent Pain led by clinical Pharmacists in primary care Teams) research programme aims to develop and test a pharmacist-led pain review (PROMPPT) to reduce inappropriate opioid use for persistent pain in primary care. This study explored the acceptability of the proposed PROMPPT review to inform early intervention development.
Methods: interviews (n = 15) and an online discussion forum (n = 31) with patients prescribed opioids for PCNP and interviews with pharmacists (n = 13), explored acceptability of a proposed PROMPPT review. A prototype PROMPPT review was then tested and refined through 3 iterative cycles of in-practice testing (IPT) (n = 3 practices, n = 3 practice pharmacists, n = 13 patients). Drawing on the Theoretical Framework of Acceptability (TFA), a framework was generated (including a priori TFA constructs) allowing for deductive and inductive thematic analysis to identify aspects of prospective and experienced acceptability.
Results: patients felt uncertain about practice pharmacists delivering the proposed PROMPPT review leading to development of content for the invitation letter for IPT (introducing the pharmacist and outlining the aim of the review). After IPT, patients felt that pharmacists were suited to the role as they were knowledgeable and qualified. Pharmacists felt that the proposed reviews would be challenging. Although challenges were experienced during delivery of PROMPPT reviews, pharmacists found that they became easier to deliver with time, practise and experience. Recommendations for optimisations after IPT included development of the training to include examples of challenging consultations.
Conclusions: uptake of new healthcare interventions is influenced by perceptions of acceptability. Exploring prospective and experienced acceptability at multiple time points during early intervention development, led to mini-optimisations of the prototype PROMPPT review ahead of a non-randomised feasibility study.
Chronic pain, acceptability, opioids, pain management, pharmacists, primary care
Cornwall, Nicola
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Woodcock, Charlotte
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Ashworth, Julie
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Harrisson, Sarah A.
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Dikomitis, Lisa
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White, Simon
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Helliwell, Toby
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Hodgson, Eleanor
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Knaggs, Roger
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Pincus, Tamar
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Santer, Miriam
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Mallen, Christian D.
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Jinks, Clare
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Cornwall, Nicola
093db397-e7d3-4cb3-9f23-1641e2bde18b
Woodcock, Charlotte
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Ashworth, Julie
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Harrisson, Sarah A.
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Dikomitis, Lisa
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White, Simon
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Helliwell, Toby
718369b9-65b4-4fe8-bb38-42e45262e2fb
Hodgson, Eleanor
1a85c2ad-eb09-457c-821a-f6578b6113ea
Knaggs, Roger
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Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Mallen, Christian D.
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Jinks, Clare
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Cornwall, Nicola, Woodcock, Charlotte, Ashworth, Julie, Harrisson, Sarah A., Dikomitis, Lisa, White, Simon, Helliwell, Toby, Hodgson, Eleanor, Knaggs, Roger, Pincus, Tamar, Santer, Miriam, Mallen, Christian D. and Jinks, Clare
,
the PROMPPT team
(2023)
Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: a qualitative study to inform intervention development.
British Journal of Pain.
(doi:10.1177/20494637231221688).
Abstract
Introduction: regular review of patients prescribed opioids for persistent non-cancer pain (PCNP) is recommended but not routinely undertaken. The PROMPPT (Proactive clinical Review of patients taking Opioid Medicines long-term for persistent Pain led by clinical Pharmacists in primary care Teams) research programme aims to develop and test a pharmacist-led pain review (PROMPPT) to reduce inappropriate opioid use for persistent pain in primary care. This study explored the acceptability of the proposed PROMPPT review to inform early intervention development.
Methods: interviews (n = 15) and an online discussion forum (n = 31) with patients prescribed opioids for PCNP and interviews with pharmacists (n = 13), explored acceptability of a proposed PROMPPT review. A prototype PROMPPT review was then tested and refined through 3 iterative cycles of in-practice testing (IPT) (n = 3 practices, n = 3 practice pharmacists, n = 13 patients). Drawing on the Theoretical Framework of Acceptability (TFA), a framework was generated (including a priori TFA constructs) allowing for deductive and inductive thematic analysis to identify aspects of prospective and experienced acceptability.
Results: patients felt uncertain about practice pharmacists delivering the proposed PROMPPT review leading to development of content for the invitation letter for IPT (introducing the pharmacist and outlining the aim of the review). After IPT, patients felt that pharmacists were suited to the role as they were knowledgeable and qualified. Pharmacists felt that the proposed reviews would be challenging. Although challenges were experienced during delivery of PROMPPT reviews, pharmacists found that they became easier to deliver with time, practise and experience. Recommendations for optimisations after IPT included development of the training to include examples of challenging consultations.
Conclusions: uptake of new healthcare interventions is influenced by perceptions of acceptability. Exploring prospective and experienced acceptability at multiple time points during early intervention development, led to mini-optimisations of the prototype PROMPPT review ahead of a non-randomised feasibility study.
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More information
Accepted/In Press date: 28 November 2023
e-pub ahead of print date: 19 December 2023
Additional Information:
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the NIHR Programme Grant for Applied Research under Grant number RP-PG-0617-20005. CM, CJ and CW are part funded by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands. CM is also funded by the National Institute for Health Research (NIHR) School for Primary Care Research and the School of Medicine have received funding from BMS to support a non-pharmacological Atrial Fibrillation Screening Trial.
Publisher Copyright:
© The Author(s) 2023.
Keywords:
Chronic pain, acceptability, opioids, pain management, pharmacists, primary care
Identifiers
Local EPrints ID: 486069
URI: http://eprints.soton.ac.uk/id/eprint/486069
ISSN: 2049-4637
PURE UUID: ff7ec4e3-a4da-4dfb-adbe-4913b408913d
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Date deposited: 08 Jan 2024 17:42
Last modified: 18 Mar 2024 04:05
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Contributors
Author:
Nicola Cornwall
Author:
Charlotte Woodcock
Author:
Julie Ashworth
Author:
Sarah A. Harrisson
Author:
Lisa Dikomitis
Author:
Simon White
Author:
Toby Helliwell
Author:
Eleanor Hodgson
Author:
Roger Knaggs
Author:
Tamar Pincus
Author:
Christian D. Mallen
Author:
Clare Jinks
Corporate Author: the PROMPPT team
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