Abstract
BackgroundThe Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes.MethodsA working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes.ResultsFive outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient’s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient’s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases.ConclusionMeasuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.
Highlights
The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP)
Development of the 2010 COG was undertaken by the National Opioid Use Guideline Group (NOUGG) [5] working under the auspices of Federation of Medical Regulatory Authorities of Canada (FMRAC) [6]
For Step 1, the Evaluation Working Group (EWG) consulted with the Canadian Hypertension Education Program (CHEP), known as Hypertension Canada, which has extensive experience in guideline evaluation [11, 12]
Summary
The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain [1] (COG) was initially released in April 2010 and an updated and revised version was published in 2017 [2]. Development of the 2010 COG was undertaken by the National Opioid Use Guideline Group (NOUGG) [5] working under the auspices of FMRAC [6]. The National Faculty consists of professionals with expertise in pain management, addiction medicine, primary care, knowledge translation, and epidemiology and patient advocates and representatives, who are further divided into working groups of experts to ensure the ongoing dissemination, evaluation and revision of the COG. This included establishing important outcomes to measure and determining where and how to obtain necessary data for guideline evaluation
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