Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: A qualitative study to inform intervention development

Nicola Cornwall; Charlotte Woodcock; Julie Ashworth; Sarah A Harrisson; Lisa Dikomitis; Simon White; Toby Helliwell; Eleanor Hodgson; Roger Knaggs; Tamar Pincus; Miriam Santer; Christian D Mallen; Clare Jinks; PROMPPT team

doi:10.1177/20494637231221688

Acceptability of a proposed practice pharmacist-led review for opioid-treated patients with persistent pain: A qualitative study to inform intervention development

Br J Pain. 2024 Jun;18(3):274-291. doi: 10.1177/20494637231221688. Epub 2023 Dec 19.

Authors

Nicola Cornwall¹, Charlotte Woodcock¹, Julie Ashworth^{1

2}, Sarah A Harrisson^{1

2}, Lisa Dikomitis³, Simon White⁴, Toby Helliwell^{1

2}, Eleanor Hodgson⁵, Roger Knaggs^{6

7

8}, Tamar Pincus⁹, Miriam Santer¹⁰, Christian D Mallen^{1

2}, Clare Jinks¹; PROMPPT team

Affiliations

¹ School of Medicine, Keele University, Keele, UK.
² Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke on Trent, UK.
³ Centre for Health Services Studies and Kent and Medway Medical School, University of Kent, Canterbury, UK.
⁴ School of Pharmacy and Bioengineering, Keele University, Keele, Staffordshire, UK.
⁵ Leek Health Centre, Leek, UK.
⁶ Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK.
⁷ Pain Centre Versus Arthritis, Clinical Sciences Building, City Hospital, Nottingham, UK.
⁸ UK & Primary Integrated Community Services, Nottingham, UK.
⁹ Department of Psychology, University of Southampton, Southampton, UK.
¹⁰ Primary Care Research Centre, University of Southampton, Southampton, UK.

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.

Keywords: Chronic pain; acceptability; opioids; pain management; pharmacists; primary care.