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Ruth White
Senior Physiotherapist, Hunter Integrated Pain Service, NSW, Australia​

Acceptability of Integrated Primary Healthcare Opioid Tapering:
​a Mixed-Methods Study

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Authors List:
Ruth White1,2 B App Sc (Phty), M. Sc. Med (PMgt) Chris Hayes1 FFPMANZCA, M. Med Allison W Boyes2,3 BA (Psych), MPH, PhD Christine L Paul2 BA (Hons), PhD  1Hunter Integrated Pain Service, Hunter New England Health, Newcastle, New South Wales, Australia  2School of Medicine and Public Health, University of Newcastle, NSW, Australia 3 Hunter Medical Research Institute, Newcastle, NSW, Australia
 
Background: Integrated team-based primary healthcare can support opioid tapering for patients experiencing chronic pain.

Objective(s) To describe patient and provider perspectives regarding the acceptability of the primary healthcare opioid tapering intervention ‘Assess Inform Manage Monitor’.

Methods: The intervention was delivered at two primary-care practices, involving general practitioner advice; nurse monitoring and potential engagement with: community pharmacist; psychologist; dietitian and exercise physiologist. Individuals receiving 90 days or more of prescription opioids were eligible. Patient and provider surveys and qualitative interviews were completed.

Results: Of 140 eligible patients, 37 attended during the study period and were invited to participate, and 18 enrolled. Patient post-intervention surveys (n=8) and interviews (n=6) indicated the intervention was acceptable, although the perceived value of some members of the integrated team was low. General practitioner and practice nurse support was valued. Providers (n=4) valued team collaboration. Low weaning readiness was a reported barrier to engagement by patients and providers.

Conclusions: The intervention was conceptually acceptable, although engagement was low. Improved approaches should retain the practice nurse and focus more strongly on understanding patients’ readiness to wean and supporting their transition to integrated care. Greater inter-professional collaboration may also be needed. Such refinements may better address the challenge of primary-healthcare-based opioid reduction.

Key words: integrated-care, opioids; chronic-pain, tapering, primary healthcare, deprescribing

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