- Title
- Management of patients experiencing chronic non-cancer pain in Australian primary care
- Creator
- White, Ruth
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Chronic non-cancer pain (CNCP) is a widespread condition that places substantial burden on the person experiencing pain, health services and the economy more widely, particularly when people are treated with long-term prescription opioid analgesics. Despite the availability of effective tertiary-based treatments for this population, few patients access this mode of treatment, with many remaining on long-term opioids. In 2010, an Australian Pain Summit called for the development and evaluation of patient-centred service delivery and funding models for multidisciplinary assessment and support in primary care settings for people experiencing chronic pain. The program of research reported in this thesis examines key issues related to the potential to deprescribe and switch to alternate behavioural interventions in primary care. The original research and systematic review in this thesis by publication comprises of five inter-related papers with the following overarching objectives: To systematically review the feasibility and acceptability of patient focused behavioural interventions to support adult patients experiencing chronic non-cancer pain during opioid tapering (Paper 1); To describe the influences on opioid prescribing for general practitioners (GPs) throughout the Hunter New England Central Coast Primary Health Network (Paper 2); To describe the availability of y on therapeutic alternatives to support GPs to deprescribe opioids for the treatment of chronic pain throughout the Hunter New England Central Coast Primary Health Network (Paper 3); To identify attitudinal change following a multi-faceted provider training package designed to align attitudes with a community based guideline promoting opioid deprescribing (Paper 4); To develop and assess the feasibility and acceptability of an integrated primary healthcare-based opioid tapering pilot intervention called Assess, Inform, Manage, Monitor (AIMM) (Paper 5). Results: The reviewed studies’ findings (paper 1) were mixed and indicated that multidisciplinary behaviourally-focussed approaches to supporting opioid deprescribing are variable in terms of acceptability and feasibility. Data from the cross-sectional survey (paper 2 & 3) also suggested a mixed picture, revealing that whilst the majority of GPs’ attitudes agreed with local guidance that opioids are a non-superior treatment, a sizeable minority were at odds with that guidance. A lack of geographical access to multidisciplinary healthcare providers did not appear to be a major barrier to opioid deprescribing, however access to specialist support and alternate interventions were important influences on decision making. Paper 4 demonstrated that providers largely achieved guideline congruent attitudes following the training workshops implying attitudinal barriers to guideline uptake appear to be potentially modifiable. The pilot-test of a multidisciplinary pain management intervention in primary care (AIMM) (paper 5), whilst acceptable to the providers and patients who participated, faced feasibility challenges. Post-intervention surveys (Appendix 4) highlighted GP and practice nurse support was valued. The discussion describes the implications of these data for future practice and proposes an alternate approach for supporting deprescribing in primary care. Conclusion: This research has delved into the complexity and challenge of providing CNCP management, incorporating deprescribing within an existing policy framework in Australian primary care. Important aspects of patient and provider behaviour have been uncovered including attitudinal barriers, patient recruitment and adherence issues suggesting the current form of the AIMM model is not ready for implementation. Future similarly detailed research underpinned by an evidence based behaviour theory is required into developing alternate multidisciplinary care interventions for patients experiencing CNCP in the primary care setting. By focusing on addressing the remaining problematic perceptions among GPs and patients, acceptable and feasible models can be tested and evaluated. By following this implementation pathway, an effective pain management intervention, including deprescribing, can ultimately be embedded into routine clinical practice and in turn, lead to improved outcomes for patients experiencing CNCP.
- Subject
- pain; primary care; chronic pain; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1421947
- Identifier
- uon:37786
- Rights
- Copyright 2020 Ruth White
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 501 KB | Adobe Acrobat PDF | View Details Download |