Leek Moorlands Hospital

BACKGROUND: Opioids are frequently prescribed for persistent non-cancer pain despite limited evidence of long-term effectiveness and risk of harm. Evidence-based interventions to address inappropriate opioid prescribing are lacking. AIM: To explore perspectives of people living with persistent pain to understand barriers and facilitators in reducing opioids in the context of a pharmacist-led primary care review, and identify review components and features for optimal delivery. DESIGN & SETTING: A multi-method qualitative study undertaken in the primary care setting in the UK. METHOD: = 31). The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis, involving deductive analysis to TDF domains, inductive analysis within domains to generate sub-themes, and sub-theme comparison to form across-domain overarching themes. The behaviour change technique taxonomy (v1) and motivational behaviour change technique classification system were used to systematically map themes to behaviour change techniques to identify potential review components and delivery features. RESULTS: Thirty-two facilitator and barrier sub-themes for patients reducing opioids were identified across 13 TDF domains. These combined into the following six overarching themes: learning to live with pain; opioid reduction expectations; assuming a medical model; pharmacist-delivered reviews; pharmacist-patient relationship; and patient engagement. Sub-themes mapped to 21 unique behaviour change techniques, yielding 17 components and five delivery features for the proposed PROMPPT review. CONCLUSION: This study generated theoretically informed evidence for design of a practice pharmacist-led PROMPPT review. Future research will test the feasibility and acceptability of the PROMPPT review and pharmacist training.

BACKGROUND: Often, people living with persistent non-cancer pain are prescribed opioids long term, despite a lack of evidence for their long-term effectiveness and safety. This study informed the design of a new practice pharmacist-led review (the PROMPPT review) for people prescribed opioids for persistent pain in UK primary care. AIM: To explore the perspectives of pharmacists working in UK general practice regarding the proposed PROMPPT review, and to identify barriers to and facilitators of its delivery in practice, including supporting opioid deprescribing where appropriate. DESIGN & SETTING: Multi-method qualitative study conducted with pharmacists working in primary care, who were recruited via professional networks predominantly in the East Midlands and West Midlands, UK. METHOD: = 16) to explore attitudes to, beliefs about, and experiences of the proposed PROMPPT review for people living with persistent pain. The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis. Facilitators and barriers were mapped to components of the Capability Opportunity Motivation - Behaviour (COM-B) model. RESULTS: In total, 16 facilitators and barriers relating to the delivery of the PROMPPT review were identified across 10 domains of the TDF. Factors included access to evidence-based patient-facing resources, receiving professional colleagues' peer support, and having a therapeutic alliance with patients. These mapped to the COM-B model components as follows: capability (knowledge, skills), opportunity (environmental context and resources, social influences), and motivation (social or professional role and identity, beliefs about capabilities, beliefs about consequences, intentions, goals, emotions). CONCLUSION: This study provides theoretically based evidence of factors influencing pharmacists' delivery of the proposed PROMPPT review in relation to pharmacist capability, motivation, and opportunity. This work informed the co-design of both the intervention and the pharmacist training package.