Abstract
BackgroundGPs are central to opioid strategy in chronic non-cancer pain (CNCP). Lack of treatment alternatives and providers are common reasons cited for not deprescribing opioids. There are limited data about availability of multidisciplinary healthcare providers (MHCPs), such as psychologists, physiotherapists, or dietitians, who can provide broader treatments.AimTo explore availability of MHCPs, and the association with GP opioid deprescribing and transition to therapeutic alternatives for CNCP.Design & settingCross-sectional survey of all practising GPs (N = 1480) in one mixed urban and regional Australian primary health network.MethodA self-report mailed questionnaire assessed the availability of MHCPs and management of their most recent patient on long-term opioids for CNCP.ResultsSix hundred and eighty-one (46%) valid responses were received. Most GPs (71%) had access to a pain specialist and MHCPs within 50 km. GPs’ previous referral for specialist support was significantly associated with access to a greater number of MHCPs (P = 0.001). Employment of a nurse increased the rate ratio of available MHCPs by 12.5% (incidence rate ratio [IRR] 1.125, 95% confidence interval [CI] = 1.001 to 1.264). Only one-third (32%) of GPs reported willingness to deprescribe and shift to broader CNCP treatments. Availability of MHCPs was not significantly associated with deprescribing decisions.ConclusionLack of geographical access to known MHCPs does not appear to be a major barrier to opioid deprescribing and shifting toward non-pharmacological treatments for CNCP. Considerable opportunity remains to encourage GPs' decision to deprescribe, with employment of a practice nurse appearing to play a role.
Highlights
Across Australian and British general practice, the reported prevalence of people experiencing cancer pain (CNCP) is 19% and 33–50% respectively, representing a substantial health burden.[1,2]Developed countries have focused on pharmacological treatments and prescribing rates have subsequently increased.[3]
Employment of a nurse increased the rate ratio of available multidisciplinary healthcare providers (MHCPs) by 12.5%
How this fits in Chronic pain, when coupled with low socioeconomic factors and high opioid utilisation, presents a difficult conundrum in the general practice setting
Summary
Across Australian and British general practice, the reported prevalence of people experiencing CNCP is 19% and 33–50% respectively, representing a substantial health burden.[1,2]Developed countries have focused on pharmacological treatments and prescribing rates have subsequently increased.[3]. In the US, the Troup study[8] identified 90 days as important when shifting towards potentially more effective treatments in primary care and reducing opioid reliance.[9,10,11,12,13] Large US healthcare groups have been working toward optimal opioid stewardship, with one group achieving a 30% reduction in high dose prescriptions by utilising MHCPs to provide exercise and cognitive behavioural therapy.[14,15] British guidance recognises the role of the patient and trained non-specialist MHCPs to implement behavioural interventions.[16] In Australia, GPs are able to create various primary care teams using government-funded general practice management plans (GPMPs) This funding supports consultations with a range of MHCPs including psychologists, physiotherapists, pharmacists, occupational therapists, exercise physiologists, social workers, and dietitians. There are limited data about availability of multidisciplinary healthcare providers (MHCPs), such as psychologists, physiotherapists, or dietitians, who can provide broader treatments
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