Ruth A White1,2, Chris Hayes3, Allison W Boyes4,5, Simon Chiu6, Christine L Paul7,8. 1. Pain Physiotherapist, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 2. Pain Physiotherapist, Hunter Integrated Pain Service, Hunter New England Health, Newcastle, Australia. 3. Director, Hunter Integrated Pain Service, Hunter New England Health, Newcastle, Australia. 4. NHMRC Early Career Fellow, Faculty of Health & Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 5. NHMRC Early Career Fellow, Hunter Medical Research Institute, Newcastle, Australia. 6. Statistician, Hunter Medical Research Institute, Newcastle, Australia. 7. Associate Dean, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 8. Co-Deputy Director, Hunter Cancer Research Alliance, Hunter Medical Research Institute, Newcastle, Australia.
Abstract
BACKGROUND: GPs are central to opioid strategy in chronic non-cancer pain (CNCP). Lack of treatment alternatives and providers are common reasons cited for not deprescribing opioids. There are limited data about availability of multidisciplinary healthcare providers (MHCPs), such as psychologists, physiotherapists, or dietitians, who can provide broader treatments. AIM: To explore availability of MHCPs, and the association with GP opioid deprescribing and transition to therapeutic alternatives for CNCP. DESIGN & SETTING: Cross-sectional survey of all practising GPs (N = 1480) in one mixed urban and regional Australian primary health network. METHOD: A self-report mailed questionnaire assessed the availability of MHCPs and management of their most recent patient on long-term opioids for CNCP. RESULTS: Six hundred and eighty-one (46%) valid responses were received. Most GPs (71%) had access to a pain specialist and MHCPs within 50 km. GPs' previous referral for specialist support was significantly associated with access to a greater number of MHCPs (P = 0.001). Employment of a nurse increased the rate ratio of available MHCPs by 12.5% (incidence rate ratio [IRR] 1.125, 95% confidence interval [CI] = 1.001 to 1.264). Only one-third (32%) of GPs reported willingness to deprescribe and shift to broader CNCP treatments. Availability of MHCPs was not significantly associated with deprescribing decisions. CONCLUSION: Lack of geographical access to known MHCPs does not appear to be a major barrier to opioid deprescribing and shifting toward non-pharmacological treatments for CNCP. Considerable opportunity remains to encourage GPs' decision to deprescribe, with employment of a practice nurse appearing to play a role.
BACKGROUND: GPs are central to opioid strategy in chronic non-cancer pain (CNCP). Lack of treatment alternatives and providers are common reasons cited for not deprescribing opioids. There are limited data about availability of multidisciplinary healthcare providers (MHCPs), such as psychologists, physiotherapists, or dietitians, who can provide broader treatments. AIM: To explore availability of MHCPs, and the association with GP opioid deprescribing and transition to therapeutic alternatives for CNCP. DESIGN & SETTING: Cross-sectional survey of all practising GPs (N = 1480) in one mixed urban and regional Australian primary health network. METHOD: A self-report mailed questionnaire assessed the availability of MHCPs and management of their most recent patient on long-term opioids for CNCP. RESULTS: Six hundred and eighty-one (46%) valid responses were received. Most GPs (71%) had access to a pain specialist and MHCPs within 50 km. GPs' previous referral for specialist support was significantly associated with access to a greater number of MHCPs (P = 0.001). Employment of a nurse increased the rate ratio of available MHCPs by 12.5% (incidence rate ratio [IRR] 1.125, 95% confidence interval [CI] = 1.001 to 1.264). Only one-third (32%) of GPs reported willingness to deprescribe and shift to broader CNCP treatments. Availability of MHCPs was not significantly associated with deprescribing decisions. CONCLUSION: Lack of geographical access to known MHCPs does not appear to be a major barrier to opioid deprescribing and shifting toward non-pharmacological treatments for CNCP. Considerable opportunity remains to encourage GPs' decision to deprescribe, with employment of a practice nurse appearing to play a role.
Authors: Andrea M Trescot; Mark V Boswell; Sairam L Atluri; Hans C Hansen; Timothy R Deer; Salahadin Abdi; Joseph F Jasper; Vijay Singh; Arthur E Jordan; Benjamin W Johnson; Roger S Cicala; Elmer E Dunbar; Standiford Helm; Kenneth G Varley; P K Suchdev; John R Swicegood; Aaron K Calodney; Bentley A Ogoke; W Stephen Minore; Laxmaiah Manchikanti Journal: Pain Physician Date: 2006-01 Impact factor: 4.965
Authors: Bradley C Martin; Ming-Yu Fan; Mark J Edlund; Andrea Devries; Jennifer Brennan Braden; Mark D Sullivan Journal: J Gen Intern Med Date: 2011-07-13 Impact factor: 5.128
Authors: Adam J Gordon; Lynn E Sullivan; Daniel P Alford; Julia H Arnsten; Marc N Gourevitch; Stefan G Kertesz; Hillary V Kunins; Joseph O Merrill; Jeffrey H Samet; David A Fiellin Journal: J Gen Intern Med Date: 2007-05-10 Impact factor: 5.128
Authors: Philip James Edwards; Ian Roberts; Mike J Clarke; Carolyn Diguiseppi; Reinhard Wentz; Irene Kwan; Rachel Cooper; Lambert M Felix; Sarah Pratap Journal: Cochrane Database Syst Rev Date: 2009-07-08