A marketing campaign that urged GPs to ‘think-twice’ earlier than placing a affected person on opioid medicines is efficient in decreasing opioid prescribing in main care, in response to the findings of a serious examine.
Though the discount within the variety of opioid prescriptions issued by particular person GPs was small, when aggregated collectively they’d a big impact.
The marketing campaign was trialled in West Yorkshire and the researchers say over a 12 months, it resulted in 15,000 fewer sufferers being given opioids – and a internet saving to the NHS of £700,000. If it had been replicated throughout the UK, it may result in 406,000 fewer sufferers taking opioid drugs.
This examine, led by researchers from the College of Leeds and revealed within the journal PLoS Medication, concerned a ‘suggestions’ intervention that continued for a 12 months, the place GPs got two-monthly updates on the variety of individuals at their observe being prescribed opioids.
Opioids are morphine-based medicines that can lead to habit, dependency and an elevated threat of falls and early demise.
They’re typically given as painkillers, however the Royal School of Anaesthetists says there’s little proof they assist with long-term persistent ache – though they work for acute ache and end-of-life care.
In early April, NICE, the Nationwide Institute for Well being and Care Excellence, issued steerage on how one can help sufferers who expertise persistent or persistent ache, ache that exists for 3 or extra months. NICE mentioned they shouldn’t be began on generally used medicine, together with opioids.
The variety of prescriptions issued by GPs in England for opioids elevated by 37 p.c from 1998 to 2016, with the overall amount of oral morphine given to sufferers greater than doubling – prompting claims that the UK has been within the grip of an “opioid epidemic”.
The researchers imagine “doctor prescribing habits” account for the rise in opioid prescribing, reasonably than the wants of sufferers. Within the paper, they acknowledge the challenges dealing with GPs when some sufferers have a “robust expectation” of having the ability to entry prescription ache reduction.
As a part of the suggestions marketing campaign, the medical doctors had been reminded of the necessity to “…provoke opioids with warning” and to overview whether or not sufferers ought to proceed to obtain opioids when there is no such thing as a profit.
How one GP helped a affected person to cut back dependency on opioid
One GP concerned within the examine described how the intervention helped him get a affected person off opioid medicine.
The affected person, who had a number of sclerosis, was on three totally different types of opioids. As soon as on the medicine, nobody had spoken to her about whether or not she wanted to remain on them. The GP labored together with her to steadily scale back the dosage.
The GP mentioned: “I used to be actually impressed by her progress – and it has made a distinction to her life. When she involves see me, she says ‘Look, I’m modified individual. I can now concentrate on issues and I’ve an enthusiasm for all times. Earlier than I used to be only a clean’.”
Outcomes of the intervention
The suggestions intervention – known as the Marketing campaign to Scale back Opioid Prescribing – was trialled in West Yorkshire. There have been 316 GP surgical procedures within the group that acquired suggestions – one other 130 practices had been in a management group and didn’t get any suggestions.
Each two months, the GPs within the suggestions group acquired an replace detailing what number of sufferers at their observe had acquired an opioid prescription. Sufferers with most cancers or drug dependency weren’t included.
Within the months previous to the marketing campaign beginning, the speed of opioid prescribing was rising within the intervention group by 0.18 per 1000 sufferers/month. Within the management group it was 0.36 per 1000 sufferers/month.
Throughout the intervention, the speed of prescribing within the intervention group fell by 0.11 per 1000 sufferers/month whereas it rose within the management group to 0.54 per 1000 sufferers/month
The outcomes, with the 95% confidence interval in brackets
The general distinction between the intervention and management teams was -0.65 per 1000 sufferers/month which implies throughout West Yorkshire, round 15,000 fewer individuals could have been placed on opioids over the year-long trial, which equates to a internet saving of greater than £700,000 to the NHS as soon as all prices have been accounted for.
Dr Sarah Alderson, Medical Affiliate Professor on the College of Leeds and a GP in Holmfirth, West Yorkshire, who led the examine, mentioned: “Our evaluation reveals that the intervention was notably efficient at getting GPs to cease or scale back their prescribing for these teams at excessive threat resembling older sufferers or those that additionally had a psychological well being situation.
“The examine reveals that GPs will be extremely efficient in figuring out different methods of supporting sufferers who expertise persistent ache.
“The suggestions intervention may simply be tailored and delivered elsewhere at comparatively low price.”
The results of the programme began to wane as soon as the suggestions was stopped and Dr Alderson believes the marketing campaign must be sustained over an extended time interval.
This examine is a good instance of how well being information can enhance affected person care by offering updated data to medical doctors about what number of of their sufferers are being prescribed opioids.”
Dr Tracey Farragher, Epidemiologist at The College of Manchester and analyst on the examine
The examine concerned researchers from the College of Leeds with the College of Manchester and NHS Bradford Districts Medical Commissioning Group, West Yorkshire.
Alderson, S.L., et al. (2021) The results of an proof and theory-informed suggestions intervention on opioid prescribing for non-cancer ache in main care: a managed interrupted time sequence evaluation. PLoS Medication. doi.org/10.1371/journal.pmed.1003796.
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