Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study
Abstract Background Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-023-03213-x |
| _version_ | 1797363210065543168 |
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| author | Neetu Bansal Stephen M. Campbell Chiu-Yi Lin Darren M. Ashcroft Li-Chia Chen |
| author_facet | Neetu Bansal Stephen M. Campbell Chiu-Yi Lin Darren M. Ashcroft Li-Chia Chen |
| author_sort | Neetu Bansal |
| collection | DOAJ |
| description | Abstract Background Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain in primary care in the UK. This study aimed to identify opioid prescription scenarios for developing indicators for prescribing opioids to patients with chronic pain in primary care. Methods Scenarios of opioid prescribing indicators were identified from a literature review, guidelines, and government reports. Twenty-one indicators were identified and presented in various opioid scenarios concerning opioid-related harm and adverse effects, drug-drug interactions, and drug-disease interactions in certain disease conditions. After receiving ethics approval, two rounds of electronic Delphi panel technique surveys were conducted with 24 expert panellists from the UK (clinicians, pharmacists, and independent prescribers) from August 2020 to February 2021. Each indicator was rated on a 1–9 scale from inappropriate to appropriate. The score’s median, 30th and 70th percentiles, and disagreement index were calculated. Results The panel unanimously agreed that 15 out of the 21 opioid prescribing scenarios were inappropriate, primarily due to their potential for causing harm to patients. This consensus was reflected in the low appropriateness scores (median ranging from 1 to 3). There were no scenarios with a high consensus that prescribing was appropriate. The indicators were considered inappropriate due to drug-disease interactions (n = 8), drug-drug interactions (n = 2), adverse effects (n = 3), and prescribed dose and duration (n = 2). Examples included prescribing opioids during pregnancy, concurrently with benzodiazepines, long-term without a laxative prescription and prescribing > 120-mg morphine milligram equivalent per day or long-term duration over 3 months after surgery. Conclusions The high agreement on opioid prescribing indicators indicates that these potentially hazardous consequences are relevant and concerning to healthcare practitioners. Future research is needed to evaluate the feasibility and implementation of these indicators within primary care settings. This research will provide valuable insights and evidence to support opioid prescribing and deprescribing strategies. Moreover, the findings will be crucial in informing primary care practitioners and shaping quality outcome frameworks and other initiatives to enhance the safety and quality of care in primary care settings. |
| first_indexed | 2024-03-08T16:17:01Z |
| format | Article |
| id | doaj.art-1793badc550048fc9e07a82a4b2f0130 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-03-08T16:17:01Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-1793badc550048fc9e07a82a4b2f01302024-01-07T12:29:37ZengBMCBMC Medicine1741-70152024-01-0122111510.1186/s12916-023-03213-xDevelopment of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi studyNeetu Bansal0Stephen M. Campbell1Chiu-Yi Lin2Darren M. Ashcroft3Li-Chia Chen4Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of ManchesterDepartment of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences UniversityDivision of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, University of ManchesterDrug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of ManchesterDrug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of ManchesterAbstract Background Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain in primary care in the UK. This study aimed to identify opioid prescription scenarios for developing indicators for prescribing opioids to patients with chronic pain in primary care. Methods Scenarios of opioid prescribing indicators were identified from a literature review, guidelines, and government reports. Twenty-one indicators were identified and presented in various opioid scenarios concerning opioid-related harm and adverse effects, drug-drug interactions, and drug-disease interactions in certain disease conditions. After receiving ethics approval, two rounds of electronic Delphi panel technique surveys were conducted with 24 expert panellists from the UK (clinicians, pharmacists, and independent prescribers) from August 2020 to February 2021. Each indicator was rated on a 1–9 scale from inappropriate to appropriate. The score’s median, 30th and 70th percentiles, and disagreement index were calculated. Results The panel unanimously agreed that 15 out of the 21 opioid prescribing scenarios were inappropriate, primarily due to their potential for causing harm to patients. This consensus was reflected in the low appropriateness scores (median ranging from 1 to 3). There were no scenarios with a high consensus that prescribing was appropriate. The indicators were considered inappropriate due to drug-disease interactions (n = 8), drug-drug interactions (n = 2), adverse effects (n = 3), and prescribed dose and duration (n = 2). Examples included prescribing opioids during pregnancy, concurrently with benzodiazepines, long-term without a laxative prescription and prescribing > 120-mg morphine milligram equivalent per day or long-term duration over 3 months after surgery. Conclusions The high agreement on opioid prescribing indicators indicates that these potentially hazardous consequences are relevant and concerning to healthcare practitioners. Future research is needed to evaluate the feasibility and implementation of these indicators within primary care settings. This research will provide valuable insights and evidence to support opioid prescribing and deprescribing strategies. Moreover, the findings will be crucial in informing primary care practitioners and shaping quality outcome frameworks and other initiatives to enhance the safety and quality of care in primary care settings.https://doi.org/10.1186/s12916-023-03213-xPrimary careChronic painPrescribing quality indicatorsOpioid-related harmsPreventable medication problems |
| spellingShingle | Neetu Bansal Stephen M. Campbell Chiu-Yi Lin Darren M. Ashcroft Li-Chia Chen Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study BMC Medicine Primary care Chronic pain Prescribing quality indicators Opioid-related harms Preventable medication problems |
| title | Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study |
| title_full | Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study |
| title_fullStr | Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study |
| title_full_unstemmed | Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study |
| title_short | Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care—a modified e-Delphi study |
| title_sort | development of prescribing indicators related to opioid related harm in patients with chronic pain in primary care a modified e delphi study |
| topic | Primary care Chronic pain Prescribing quality indicators Opioid-related harms Preventable medication problems |
| url | https://doi.org/10.1186/s12916-023-03213-x |
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