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Realities of opioid and gabapentinoid deprescribing in socioeconomically disadvantaged communities: qualitative evaluation

Lookup NU author(s): Dr Charlotte Parbery-Clark, Dr Jen Portice, Dr Sarah SowdenORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Background Opioid and gabapentinoid prescribing has increased substantially in recent years despite having limited effectiveness in treating chronic primary pain. This is concerning with the prescribing rates and adverse effects of these medications being higher in more socioeconomically disadvantaged groups. Guidance for prescribing and deprescribing these medications exists but the understanding of how deprescribing is operationalised especially in areas of socio-economic disadvantage is limited.Aim To explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid and gabapentinoid prescribing.Design & setting A qualitative evaluation, using participant observation and semi-structured interviews with primary healthcare professionals working in practices serving areas of substantial socio-economic disadvantage.Method Interviewees were purposively recruited with subsequent snowballing with participant observation of the peer-support meetings. Interviews transcripts and notes from the participant observation were inductively coded and thematically analysed.Result Thirteen healthcare professionals from five practices were interviewed. Person-centred care with shared decision-making was strived for which was time consuming due to the complexity of the problem and patients. Where shared-decision making was not possible due to patient refusal or non-engagement, risk was used to determine the appropriate action. This work involved an emotional toll on staff and patients but was at times conversely easier and more rewarding than expected. Ultimately, demedicalising pain with a culture change is required to ensure patients are not prescribed these medications for inappropriate reasons or doses.Conclusion This study demonstrates key operational aspects to consider when undertaking opioid and gabapentinoid deprescribing in primary care.


Publication metadata

Author(s): Parbery-Clark C, Portice JS, Sowden S

Publication type: Article

Publication status: Published

Journal: BJGP Open

Year: 2024

Pages: epub ahead of print

Online publication date: 25/07/2024

Acceptance date: 15/07/2024

Date deposited: 04/10/2024

ISSN (electronic): 2398-3795

Publisher: Royal College of General Practitioners

URL: https://doi.org/10.3399/BJGPO.2024.0160

DOI: 10.3399/BJGPO.2024.0160

PubMed id: 39054299


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Funding

Funder referenceFunder name
National Institute for Health and Care Research
National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC)
NENC Deep End network
NHS NENC Integrated Care System (ICS)
NIHR200173

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