Pharmacist-led management of chronic pain in primary care: patient expectations, attitudes and concerns

Hanne Bruhn, Mags Watson, Annie Blyth, Annie, Christine M Bond, Pharmacy-Led Management of Chronic Pain Study Team

Research output: Contribution to conferencePaper

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Abstract

Bruhn H, Watson M, Blyth A, Bond CM, and on behalf of Pharmacy-Led Management of Chronic Pain Study Team. Pharmacist-led management of chronic pain in primary care: patient expectations, attitudes and concerns. IJPP 2010;18(Supplement 1):23.

Background
Chronic pain affects approximately half the population.1 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. A small randomised controlled trial (RCT) is ongoing to compare: (i).pharmacist medication review of patients with chronic pain with recommended changes implemented by a general practitioner with (ii) pharmacist prescribing for patients with chronic pain. The MRC framework for development and evaluation of complex interventions2 emphasises the importance of identifying key components of an intervention and the feasibility of delivery before undertaking the RCT. In line with this, focus groups were conducted to explore patients’ beliefs and concerns about the proposed service before finalising the intervention.

Methods
This study was reviewed and approved by North of Scotland Research Ethics Committee. Patients with chronic pain were identified using a previously used computerised search strategy of pain-related prescription records3 in two Grampian general practices. A random sample of 60 patients from each practice was screened by a GP and eligible patients were invited to participate by a letter mailed by the GP. Two focus groups were conducted, one in each practice. The focus group schedule explored: (i) Patients’ previous consultations with pharmacists; (ii) Methods of managing pain other than medication; (iii) Importance of medication; (iv) Views on consulting a pharmacist in the general practice for pain; (v) What should happen in a consultation with a pharmacist; (vi) How a pharmacist would be able to help manage pain; (vii) What patients hoped to derive from treatment. The focus groups were audiotaped, transcribed verbatim, and analysed thematically, independently, by two researchers.

Results
Of 108 patients invited to participate, 13 agreed and 11 attended.
Group one (n=7) consisted of two males and five females aged 20 – 73 years. Group two (n=4) consisted of one male and three females aged 66 – 80 years. Patients in group two knew each other.
Most patients expressed positive views about the proposed intervention; pharmacists’ specialist training and knowledge were acknowledged. Patients expressed an expectation that pharmacists would have more time and be better equipped to monitor and educate about medicines and their use. Concerns were expressed about seeing the pharmacist in the practice that this risked being viewed as another ‘layer’ in their care. A pharmacist-led service might be used as a ‘quick track’ option instead of seeing a GP, not as an addition to seeing a GP. The current sample in both focus groups also expressed a preference for an acute service located in a community-pharmacy.

Conclusion
The opinions of these participants may not be generalisable to a wider population, and are about a service they have not yet experienced. Nevertheless, the results show that patients would accept pharmacist-led pain related medication management and prescribing, as this is the area of their expertise. Implications of the findings will be discussed in relation to development of a pharmacist-led management of chronic pain service.
497 words

References
1 Elliot, A,M,, Smith, B.H., Penny, K.I., Smith, W.C., Chambers, W.A. The epidemiology of chronic pain in the community. Lancet 1999; 354: 1248-1252
2 Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655
3 McDermott, E., Smith, B., Elliott. A.., Bond, C.M., Hannaford, P.C., Chambers, W.A., The use of medication for chronic pain in primary care, and the potential for intervention by a practice-based pharmacist. Family Practice 2006;23: 46-52
Original languageEnglish
Pages23-24
Number of pages2
Publication statusPublished - 2010
EventHealth Services Research and Pharmacy Practice Conference (2010) - Manchester, United Kingdom
Duration: 12 Apr 201013 Apr 2010

Conference

ConferenceHealth Services Research and Pharmacy Practice Conference (2010)
CountryUnited Kingdom
CityManchester
Period12/04/1013/04/10

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    Bruhn, H., Watson, M., Blyth, Annie, A., Bond, C. M., & Pharmacy-Led Management of Chronic Pain Study Team (2010). Pharmacist-led management of chronic pain in primary care: patient expectations, attitudes and concerns. 23-24. Paper presented at Health Services Research and Pharmacy Practice Conference (2010), Manchester, United Kingdom.