Ashworth Julie, Cornwall Nicola, Harrisson Sarah A, Woodcock Charlotte, Nicholls Elaine, Lancaster Gillian, Wathall Simon, Laing Libby, Helliwell Toby, Jowett Sue, Kigozi Jesse, Mallen Christian D, Avery Anthony, Knaggs Roger, Pincus Tamar, White Simon, Jinks Clare
School of Medicine and Centre for Musculoskeletal Health Research, Keele University, Keele, Staffordshire, UK.
Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Stoke-On-Trent, Staffordshire, UK.
Pilot Feasibility Stud. 2025 Apr 25;11(1):53. doi: 10.1186/s40814-025-01636-2.
Given the poor long-term effectiveness of opioids for persistent non-cancer pain, and their potential for harm, evidence-based interventions to address opioid overprescribing for persistent pain are needed. This study aimed to explore the acceptability and feasibility of a primary care practice pharmacist-led intervention (PROMPPT review) for patients prescribed opioids for persistent pain and the feasibility of evaluating PROMPPT in a definitive trial.
A single-arm study, with mixed methods process evaluation, was conducted in four English primary care practices. Adults prescribed opioids for ≥ 6 months were invited to participate in the Management of Opioids and Persistent Pain (MOPP) study by completing baseline and 3-month follow-up questionnaires. Practices invited a representative sample of MOPP participants to schedule a PROMPPT review, eight of which were audio-recorded. Following the review, pharmacists completed intervention delivery templates, and participants were sent an Acceptability Questionnaire and invited to consent to an interview.
Between November 2020 and May 2021, 148 participants were recruited to the MOPP study. Of these, 123 (83%) completed 3-month follow-up. Of 88 MOPP participants invited for a PROMPPT review, 80 (91%) attended. The review was rated completely acceptable or acceptable in 90% (45/50) of acceptability questionnaires returned. Overall, participants interviewed (n = 15) perceived the review as a good idea and recommended it to others; they preferred face-to-face consultations. Prior to the review, they reported mixed feelings, including feeling 'pleased' to be invited and 'grateful' someone was taking an interest, alongside concerns about what would happen during the review, including opioids being stopped and changes being detrimental. Following the review, those with a clear plan for follow-up/access to the pharmacist felt reassured about making changes to their pain medicines, whilst those advised to arrange follow-up as needed were less satisfied and more likely to report confusion about the plan.
PROMPPT reviews appeared acceptable to patients, review uptake was high, and the study demonstrated the feasibility of a large definitive trial to evaluate PROMPPT. The review invitation, patient information, and pharmacist training were refined based on the findings ahead of a large cluster randomised controlled trial.
ISRCTN, ISRCTN87628403 , registered 31 July 2020.
鉴于阿片类药物对持续性非癌性疼痛的长期疗效不佳及其潜在危害，需要有循证干预措施来解决持续性疼痛患者阿片类药物的过度处方问题。本研究旨在探讨由初级保健机构药师主导的干预措施（PROMPT评估）对开具阿片类药物治疗持续性疼痛患者的可接受性和可行性，以及在一项确定性试验中评估PROMPT的可行性。
在四家英国初级保健机构开展了一项单臂研究，并进行混合方法过程评估。邀请开具阿片类药物≥6个月的成年人通过填写基线问卷和3个月随访问卷参与阿片类药物与持续性疼痛管理（MOPP）研究。各机构邀请了MOPP参与者的代表性样本安排一次PROMPT评估，其中8次进行了录音。评估后，药师填写干预实施模板，并向参与者发送一份可接受性问卷，邀请他们同意接受访谈。
2020年11月至2021年5月期间，148名参与者被纳入MOPP研究。其中，123名（83%）完成了3个月随访。在88名被邀请进行PROMPT评估的MOPP参与者中，80名（91%）参加了评估。在返回的可接受性问卷中，90%（45/50）的评估被评为完全可接受或可接受。总体而言，接受访谈的参与者（n = 15）认为该评估是个好主意，并向他人推荐；他们更喜欢面对面咨询。在评估前，他们表示心情复杂，既对被邀请感到“高兴”，对有人关注感到“感激”，同时又担心评估期间会发生什么，包括阿片类药物被停用以及改变会有害。评估后，那些有明确的随访计划/能联系到药师的人对更改止痛药感到放心，而那些被建议按需安排随访的人则不太满意，更有可能表示对该计划感到困惑。
PROMPT评估对患者来说似乎是可接受的，评估参与率很高，该研究证明了进行一项大型确定性试验来评估PROMPT的可行性。在一项大型整群随机对照试验之前，根据研究结果对评估邀请、患者信息和药师培训进行了完善。
ISRCTN，ISRCTN87628403，于2020年7月31日注册。
