Abstract
BackgroundThe rise in opioid prescribing in primary care represents a significant public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. An evidence-based bimonthly feedback intervention to reduce opioid prescribing was developed and implemented, targeting 316 general practices in West Yorkshire over 1 year.AimTo understand how general practice staff received and responded to the feedback intervention.Design and settingQualitative process evaluation involving semi-structured interviews, guided by Normalisation Process Theory (NPT), of primary care healthcare professionals targeted by feedback.MethodParticipants were purposively recruited according to baseline opioid prescribing levels and degree of change following feedback. Interview data were coded to NPT constructs, and thematically analysed.ResultsInterviews were conducted with 21 staff from 20 practices. Reducing opioid prescribing was recognised as a priority. While high achievers had clear structures for quality improvement, feedback encouraged some less structured practices to embed changes. The non-prescriptive nature of the feedback reports allowed practices to develop strategies consistent with their own ways of working and existing resources. Practice concerns were allayed by the credibility of the reports and positive experiences of reducing opioid prescribing. The scale, frequency, and duration of feedback may have ensured a good overall level of practice population reach.ConclusionThe intervention engaged general practice staff in change by targeting an issue of emerging concern, and allowing adaption to different ways of working. Practice efforts to reduce opioid prescribing were reinforced by regular feedback, credible comparative data showing progress, and shared experiences of patient benefit.
Highlights
Healthcare systems internationally are attempting to counter rises in opioid prescribing.[1,2,3] Such rises are largely attributed to prescribing for chronic noncancer pain,[4] where opioids are of limited effectiveness and can cause dependence.[5]
Reducing opioid prescribing was recognised as a priority
Practice concerns were allayed by the credibility of the reports and positive experiences of reducing opioid prescribing
Summary
Healthcare systems internationally are attempting to counter rises in opioid prescribing.[1,2,3] Such rises are largely attributed to prescribing for chronic noncancer pain,[4] where opioids are of limited effectiveness and can cause dependence.[5] Prescribed opioids — even weaker opioids such as codeine — are associated with increased psychosocial problems, hospitalisation, and mortality.[6,7]. GPs recognise the shortcomings of prescribing and negotiating alternative approaches to treatment, but have limited access to alternative sources of support.[12] Given accumulating evidence of harm, reducing opioid prescribing for chronic pain would deliver substantial population benefit. The rise in opioid prescribing in primary care represents a significant public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. An evidence-based bimonthly feedback intervention to reduce opioid prescribing was developed and implemented, targeting 316 general practices in West Yorkshire over 1 year
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