Development of practice-based pharmacist-led management of chronic pain in primary care for evaluation by a RCT
Lead Research Organisation:
University of Aberdeen
Department Name: Biomedical Sciences
Abstract
Many people with chronic pain use prescribed medicines. It is important that the correct medicines are prescribed to ensure effective pain management. For some people, changing the medicines they take might improve their pain management. We believe that regular review of medication could be beneficial for patients with chronic pain.
Pharmacists have the knowledge and training to review patients’ medicines and identify changes that could lead to better pain control. Until recently, changes to prescriptions recommended by a pharmacist had to be made by a doctor. However many pharmacists are now registered to write prescriptions.
We want to assess the benefits of pharmacist review of pain medicines and prescribing. We will compare three types of care: 1) pharmacist medicine review (using patient notes) and pharmacist prescribing, with face-to-face patient consultations; 2) pharmacist medicine review (using patient notes) with recommendations to GP; 3) standard care.
Patients with chronic pain from six GP practices will be identified and divided into three groups. Practice pharmacists will review pain medication for groups 1) and 2) and compare this with best practice, recommending changes if necessary. Afterwards we will compare the groups for any differences in the way people feel their pain is affecting them.
Pharmacists have the knowledge and training to review patients’ medicines and identify changes that could lead to better pain control. Until recently, changes to prescriptions recommended by a pharmacist had to be made by a doctor. However many pharmacists are now registered to write prescriptions.
We want to assess the benefits of pharmacist review of pain medicines and prescribing. We will compare three types of care: 1) pharmacist medicine review (using patient notes) and pharmacist prescribing, with face-to-face patient consultations; 2) pharmacist medicine review (using patient notes) with recommendations to GP; 3) standard care.
Patients with chronic pain from six GP practices will be identified and divided into three groups. Practice pharmacists will review pain medication for groups 1) and 2) and compare this with best practice, recommending changes if necessary. Afterwards we will compare the groups for any differences in the way people feel their pain is affecting them.
Technical Summary
Chronic pain affects approximately half the population, recovery is rare and management often unsatisfactory. Most people are managed with prescribed analgesics, but sub-optimal prescribing, imperfect monitoring of repeat prescriptions and concomitant use of non-prescription medicines means that treatment is often ineffective or inefficient. Recent NHS changes have supported medication review by pharmacists, but research studies have shown conflicting results. Possible reasons for this include the use of inappropriate outcomes; failure to use an iterative development process; failure to adhere to the intervention; and, reliance upon a third party to implement prescribing changes.
Our long term aim is to conduct a definitive Phase III trial in patients with chronic pain to compare standard care with pharmacist review of a patient?s medication where recommendations are implemented by the doctor with pharmacist review of a patient?s medication where recommendations are implemented by the pharmacist at a face-to-face consultation. Our Phase I work has shown that a single pharmacist in one general practice can identify and recommend changes to patients? analgesic regimes which are accepted by GPs. We still have to test the generalisability of these findings beyond a single practice, test the feasibility, and quantify the value, of pharmacist prescribing, and assess effect on clinical outcomes. This proposal is for further Phase I work and a Phase II exploratory trial to inform a definitive RCT.
The setting will be six general practices (three English and three Scottish) and will involve their GPs and practice pharmacists. Thirty-six patients with chronic pain, identified from medication records using a computerised search strategy, will be recruited from each practice and randomised to one of the three groups. Outcomes (including quality of life, pain, depression, health care utilisation including drug costs, pharmacist costs and patient costs) will be compared across the three groups at three and six months by postal questionnaire .
We will: develop and test a training package for the pharmacists to ensure standardisation of the intervention; test recruitment methods; estimate consent and participation rates; calculate response rates and quantify and compare the effect sizes to inform future sample size calculations; confirm the most appropriate outcome measures and unit of randomisation; interview pharmacists and GPs to ascertain feasibility and acceptability and gain feedback for modifications; and determine the acceptability of the proposed intervention to participants. Findings from the work will be used to optimise the intervention for a definitive Phase III RCT.
Our long term aim is to conduct a definitive Phase III trial in patients with chronic pain to compare standard care with pharmacist review of a patient?s medication where recommendations are implemented by the doctor with pharmacist review of a patient?s medication where recommendations are implemented by the pharmacist at a face-to-face consultation. Our Phase I work has shown that a single pharmacist in one general practice can identify and recommend changes to patients? analgesic regimes which are accepted by GPs. We still have to test the generalisability of these findings beyond a single practice, test the feasibility, and quantify the value, of pharmacist prescribing, and assess effect on clinical outcomes. This proposal is for further Phase I work and a Phase II exploratory trial to inform a definitive RCT.
The setting will be six general practices (three English and three Scottish) and will involve their GPs and practice pharmacists. Thirty-six patients with chronic pain, identified from medication records using a computerised search strategy, will be recruited from each practice and randomised to one of the three groups. Outcomes (including quality of life, pain, depression, health care utilisation including drug costs, pharmacist costs and patient costs) will be compared across the three groups at three and six months by postal questionnaire .
We will: develop and test a training package for the pharmacists to ensure standardisation of the intervention; test recruitment methods; estimate consent and participation rates; calculate response rates and quantify and compare the effect sizes to inform future sample size calculations; confirm the most appropriate outcome measures and unit of randomisation; interview pharmacists and GPs to ascertain feasibility and acceptability and gain feedback for modifications; and determine the acceptability of the proposed intervention to participants. Findings from the work will be used to optimise the intervention for a definitive Phase III RCT.
