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Integrated Primary Healthcare Opioid Tapering Interventions: A Mixed-Methods Study of Feasibility and Acceptability in Two General Practices in New South Wales, Australia.

ABSTRACT: Introduction:Integrated team-based primary healthcare is well positioned to support opioid tapering for patients experiencing chronic pain. This paper describes the development, implementation and acceptability of a primary healthcare opioid tapering intervention 'Assess Inform Manage Monitor' (AIMM) at two sites. Methods:AIMM involved GP advice; nurse monitoring and potential engagement with: community pharmacist; psychologist; dietitian and exercise physiologist. Individuals receiving 90 days or more of prescription opioids were eligible. Patient and provider surveys and qualitative interviews were completed. Results:Of 140 eligible patients, 37 attended during the study period and were invited to participate. Patient post-intervention surveys (n = 8) and interviews (n = 6) indicated the intervention was acceptable, although the perceived value of some of the integrated team was low. GP and practice nurse support was valued. Providers (n = 4) valued team integration. Low weaning readiness was a barrier to engagement by patients and providers. Key lessons and conclusions:The intervention, whilst conceptually acceptable, was not feasible in its current form. Future efforts to transition patients towards integrated care should retain the practice nurse and place more focus on understanding and reinforcing patients' readiness to wean. Greater inter-professional collaboration may also be needed. Such refinements may advance the cause of opioid reduction in primary care.

SUBMITTER: White R

PROVIDER: S-EPMC7583216 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Integrated Primary Healthcare Opioid Tapering Interventions: A Mixed-Methods Study of Feasibility and Acceptability in Two General Practices in New South Wales, Australia.

White Ruth R Hayes Chris C Boyes Allison W AW Paul Christine L CL

International journal of integrated care 20201022 4

<h4>Introduction</h4>Integrated team-based primary healthcare is well positioned to support opioid tapering for patients experiencing chronic pain. This paper describes the development, implementation and acceptability of a primary healthcare opioid tapering intervention 'Assess Inform Manage Monitor' (AIMM) at two sites.<h4>Methods</h4>AIMM involved GP advice; nurse monitoring and potential engagement with: community pharmacist; psychologist; dietitian and exercise physiologist. Individuals rec ...[more]

PMID: 33132791

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Project description:To evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices.Mixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews.General practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group's area approximately 6?months after implementing webGP (February-July 2016).Six practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed.Attitudes and experiences of practice staff and patients regarding webGP.WebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices.GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients.81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them.From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems.There is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload.

Project description:IntroductionSocial distancing requirements during COVID-19 pose a challenge to conducting traditional academic detailing, which typically involves in-person peer education visits to improve patient outcomes. The main alternative is to conduct virtual academic detailing delivered through web-based technology, but this approach is fraught with many challenges. This study aimed to examine the feasibility and acceptability of a virtual academic detailing program implemented among health care providers.MethodsThe academic detailing program focused on appropriate opioid prescribing and chronic non-cancer pain management among a sample of providers. An initial in-person visit was followed by a virtual visit up to 8 weeks later. Videoconferencing was used to conduct the virtual visit with telephone as a backup. Feasibility was assessed whether the virtual visits could happen, and acceptability was assessed by provider satisfaction. Validated measures of Provider Satisfaction with Academic Detailing (PSAD) and Detailer Assessment of Visit Effectiveness (DAVE) with a 5-point Likert-type scale were used. Higher scores corresponded to higher satisfaction and greater perceived effectiveness. Non-parametric and parametric statistical tests were used to compare instrument summary scores across visits and between groups. Pairwise analyses across visits only included instrument responses for providers who participated in both visits and completed both surveys in their entirety.ResultsThere were 127 (90 %) initial in-person visits completed out of 141 visits scheduled, with a survey response rate of 96 %. Out of 120 virtual follow-up visits scheduled, 92 (77 %) were conducted, and 56 surveys (61 %) were collected. There was a high level of satisfaction with the initial and follow up virtual academic detailing visits, though, among providers who participated in both visits and had completed surveys (n = 50), initial visits had slightly higher scores (mean difference = -2.94 [95 % Confidence intervals: -4.38, -1.50], p < 0.001). There was no significant difference in detailer perception across the two visits as seen in the scale summary score (0.05 [-0.56, 0.66], p = 0.86) and two individually reported items related to feasibility (0.07 [-0.29, 0.42], p = 0.72) and conversation (-0.05 [-0.28, 0.17], p = 0.63). Forty-one (44.6 %) virtual visits were conducted using WebEx, where video and screen sharing of visit content was possible, while the remaining 51 (55.4 %) were conducted using a telephone. There was no significant difference in provider satisfaction between WebEx vs. telephone visits (-1.47 [-4.99, 2.05], p = 0.82). Provider satisfaction was also not impacted by any technical difficulties as reported by the detailer (-0.04 [-3.30, 3.38], p = 0.98).ConclusionThe results slightly favor in-person visits and suggest that virtual detailing visits need to incorporate strategies that minimize technical difficulties and prevent participants from defaulting to less favorable technology. Future research opportunities include evaluating the effectiveness of a virtual versus in-person delivery of AD program on outcomes such as providers' opioid prescribing behavior.

Project description:BackgroundNumerous studies of dental antibiotic prescribing show that overprescribing is a worldwide occurrence. The aim of this study was to assess prescribing practices of general dentists in Australia for antibiotics, analgesics and anxiolytics and to determine the extent to which prescribing is in accordance with current guidelines.MethodsA structured questionnaire was sent to 1468 dentists in Victoria and Queensland in July-August 2018. The questionnaire covered demographics, clinical conditions where dentists prescribe antibiotics, non-clinical factors which influence prescribing, and medicines for anxiolysis and pain relief. Responses were scored using a system based on the current Australian therapeutic guidelines. Logistic regression was used to determine the relative importance of independent variables on inappropriate prescribing.ResultsThree hundred eighty-two responses were received. Overall, 55% of overprescribing of antibiotics was detected, with a range of 13-88% on a routine or occasional basis depending on the scenario. Between 16 and 27% of respondents inappropriately preferenced analgesics over anti-inflammatories for dental pain; 46% of those who prescribed anxiolytic medicines did so inappropriately, with varying regimens and choices outside the guidelines. Years of practice was the main demographic factor influencing prescribing, with recent graduates (0-5 years) generally scoring better than their colleagues for antibiotic prescribing (p < 0.05).ConclusionsFuture interventions could be directed towards the appropriate role and use of antibiotics, shortfalls in knowledge and appropriate choices of medicines for pain relief and anxiolysis. Given that the most overprescribing occurred for localised swellings (88%), this area could be focused on in continuing education as well as ensuring it is addressed in undergraduate teaching. Continuing education on the appropriate use of medicines can be targeted at more experienced dentists as well as patients, especially those who expect antibiotics instead of treatment.Trial registrationUniversity of Melbourne Human Ethics Sub-Committee; ID: 1750768.1 .

Project description:BackgroundNaturopathy forms an increasingly significant part of the Australian healthcare setting, with high utilisation of naturopaths by the Australian public and a large therapeutic footprint in rural and regional Australia. However, despite these circumstances, there has been little exploration of the interface between naturopathy providers and conventional primary health care practitioners in rural and regional Australia. The study reported here examined the referral practices and factors that underlie referral to naturopaths amongst a sample of rural and regional Australian general practitioners (GPs).MethodsA 27-item questionnaire was sent to all 1,486 GPs currently practising in rural and regional Divisions of General Practice in New South Wales, Australia.ResultsA total of 585 GPs responded to the questionnaire, with 49 questionnaires returned as "no longer at this address" (response rate: 40.7%). One-quarter of GPs (25.8%) referred to a naturopath at least a few times per year while nearly half (48.8%) stated that they would not refer to a naturopath under any circumstances. GPs were more likely to refer to a naturopath if the GP: was not initially from a rural area (OR=1.78; 95% CI: 0.95, 3.33); believes in the efficacy of naturopathy (OR=5.62; 95% CI: 2.42, 11.36); has seen positive results from naturopathy previously (OR=2.61; 95% CI: 1.35, 5.05); perceives a lack of other treatment options for their patient (OR=5.25; 95% CI: 2.42; 11.36); uses peer-reviewed literature as their major source of CAM information (OR=3.03; 95% CI: 1.65, 5.55); uses CAM practitioners as a major source of CAM information (OR=6.09; 95% CI: 2.91, 12.72); and does not have an existing relationship with any CAM provider (OR=3.03; 95% CI: 1.53, 6.25).ConclusionsThere is little interaction (both via referrals as well as the development of professional relationships) between the naturopathic and GP communities in rural and regional Australia, with significant levels of both support and opposition for naturopathic referral amongst GPs. The significant presence and high utilisation of naturopathy in rural primary health care, which appears to work in parallel to conventional medical care rather than in conjunction with it, should serve as an impetus for increased research into naturopathy practice, policy and regulation in rural and regional health.

Project description:BackgroundPatients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia.MethodsThis research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs' role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed.ResultsBCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients' felt need for and acceptance of BCNs' services, recruitment of BCNs from the patient community, as well as BCNs' training and motivation for their role. Major barriers for patients to access BCNs' services included lack of awareness of the BCNs' roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project.ConclusionBCNs' placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups.

Dataset Information

Integrated Primary Healthcare Opioid Tapering Interventions: A Mixed-Methods Study of Feasibility and Acceptability in Two General Practices in New South Wales, Australia.

Publications

Integrated Primary Healthcare Opioid Tapering Interventions: A Mixed-Methods Study of Feasibility and Acceptability in Two General Practices in New South Wales, Australia.

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