Opioid Patient Support and Reduction Programme

Crimond Medical Centre, Fraserburgh

The problem:

As is the case right across the UK, practices are finding it challenging to support patients with chronic pain; in particular, those who have been prescribed opioids with the aim of improving their quality of life. This is showing a significant increase over the last few years with issues such as increasing waiting times for the pain clinic in secondary care, to patients taking responsibility for their own health. More and more patients are presenting with pain issues and looking to an opiate to alleviate it. Previously, like all other GPs, our doctors would prescribe mild painkillers which would eventually lead to the patient being on an opiate. This would then spiral to increases in dosage with patients soon nearing maximum agreed dose.

The Bright Idea:

Since the beginning of February 2019 as a practice team we decided to take control of the list of patients in our practice who are prescribed opiates and seen with chronic pain issues. Our practice pharmacist did multiple searches on our clinical system to find all patients being prescribed an opiate, then we looked at those that were on more than the clinically recommended dose and instead of just sending out an impersonal letter to them advising them of any reduction programme, we have gone to extra lengths and have conducted two multidisciplinary meetings each week with these patients. 

Those involved in these meetings are the lead doctor, practice pharmacist, practice manager and the patient (sometimes with a patient representative). The multidisciplinary team (MDT) meetings are normally an hour long. In these meetings we include the patient in their future care, explain to them all the issues around the opiates they are on and look at ways of supporting them to reduce their opiate use. This support can come in the referral to the substance misuse team, physiotherapy, referral to the pain clinic in secondary care and self-help.

These meetings are, we feel, crucial for these patients in helping them to manage their chronic pain condition. It gives them a chance to speak about the challenges they face and issues they have at home which they see as barriers to them making any changes, thereby including them in their care and giving them ownership over their own health.

These meetings in themself can be challenging as we have found that many patients do not seek help, do not want to admit they have a drug misuse problem, or simply just want an opiate and not to take responsibility for their own health and wellbeing. This is the reason we have a diverse group at the meeting. The doctor and pharmacist can look at the situation clinically with input from the practice manager.

Normally at the end of each meeting an individual plan will be devised for the patient including what has been discussed, any barriers that could be a potential problem, any referrals that can be made to help manage their pain (e.g. physio, pain clinic, third sector) and an agreement of how many weeks the reduction programme will be done over. Each plan is tailored to each patient and also includes phone support by the practice pharmacist on a weekly basis, if required. Follow-up MDTs are provided to help support the patient, and these can include family members, where the patient requires additional support.

The impact:

  • Patients: Patients being more actively involved for their own health. Patients having a better understanding of their chronic pain. The health and wellbeing of patients being improved over time due to their opiate usage coming down. The patients feeling informed about what their problem is and how best to tackle it, and that drugs is not always the best option for the best outcome. Patients feeling better supported by the clinical team
  • Staff: GPs feeling better supported with chronic pain patients. Often a patient would come in for a consultation and would not be happy leaving without some form of painkiller. By having a multi-disciplinary meeting with with the patient the doctor and other staff members can feel supported by one another to get the patient to engage with the reduction programme being proposed to them.
  • Practice: Cost savings. Our practice was a high prescriber of opiates, we had a couple of patients pass away due to opiate usage, both due to overdose of the medication, so we felt a huge personal involvement in trying to make this situation better for all concerned. Patients feel more supported with the new system that is in place and included in their care.

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