Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial

Hanne Bruhn, Christine M Bond, Alison M Elliott, Philip C Hannaford, Amanda J Lee, Paul McNamee, Blair H Smith, Margaret C Watson, Richard Holland, David Wright

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Abstract

OBJECTIVES: To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.

DESIGN: An exploratory randomised controlled trial.

SETTING: Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).

PARTICIPANTS: Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.

OUTCOME MEASURES: Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.

RESULTS: In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).

CONCLUSIONS: This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.

TRIAL REGISTRATION: www.isrctn.org/ISRCTN06131530. Medical Research Council funding.

Original languageEnglish
Number of pages12
JournalBMJ Open
Volume3
Issue number4
DOIs
Publication statusPublished - 2013
Externally publishedYes

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Pharmacists
Chronic Pain
Primary Health Care
Randomized Controlled Trials
Anxiety
Depression
General Practitioners
Therapeutics
Terminally Ill
Random Allocation
Telephone
General Practice
Biomedical Research
Patient Care
Pain
Health

Cite this

Bruhn, Hanne ; Bond, Christine M ; Elliott, Alison M ; Hannaford, Philip C ; Lee, Amanda J ; McNamee, Paul ; Smith, Blair H ; Watson, Margaret C ; Holland, Richard ; Wright, David. / Pharmacist-led management of chronic pain in primary care : results from a randomised controlled exploratory trial. In: BMJ Open. 2013 ; Vol. 3, No. 4.
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abstract = "OBJECTIVES: To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.DESIGN: An exploratory randomised controlled trial.SETTING: Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).PARTICIPANTS: Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92{\%}) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.OUTCOME MEASURES: Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.RESULTS: In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7{\%} (21/44; p=0.003) and in the review arm, 38.6{\%} (17/44; p=0.001), but not the TAU group, 31.3{\%} (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).CONCLUSIONS: This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.TRIAL REGISTRATION: www.isrctn.org/ISRCTN06131530. Medical Research Council funding.",
author = "Hanne Bruhn and Bond, {Christine M} and Elliott, {Alison M} and Hannaford, {Philip C} and Lee, {Amanda J} and Paul McNamee and Smith, {Blair H} and Watson, {Margaret C} and Richard Holland and David Wright",
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Bruhn, H, Bond, CM, Elliott, AM, Hannaford, PC, Lee, AJ, McNamee, P, Smith, BH, Watson, MC, Holland, R & Wright, D 2013, 'Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial', BMJ Open, vol. 3, no. 4. https://doi.org/10.1136/bmjopen-2012-002361

Pharmacist-led management of chronic pain in primary care : results from a randomised controlled exploratory trial. / Bruhn, Hanne; Bond, Christine M; Elliott, Alison M; Hannaford, Philip C; Lee, Amanda J; McNamee, Paul; Smith, Blair H; Watson, Margaret C; Holland, Richard; Wright, David.

In: BMJ Open, Vol. 3, No. 4, 2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pharmacist-led management of chronic pain in primary care

T2 - results from a randomised controlled exploratory trial

AU - Bruhn, Hanne

AU - Bond, Christine M

AU - Elliott, Alison M

AU - Hannaford, Philip C

AU - Lee, Amanda J

AU - McNamee, Paul

AU - Smith, Blair H

AU - Watson, Margaret C

AU - Holland, Richard

AU - Wright, David

PY - 2013

Y1 - 2013

N2 - OBJECTIVES: To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.DESIGN: An exploratory randomised controlled trial.SETTING: Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).PARTICIPANTS: Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.OUTCOME MEASURES: Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.RESULTS: In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).CONCLUSIONS: This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.TRIAL REGISTRATION: www.isrctn.org/ISRCTN06131530. Medical Research Council funding.

AB - OBJECTIVES: To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.DESIGN: An exploratory randomised controlled trial.SETTING: Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).PARTICIPANTS: Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.OUTCOME MEASURES: Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.RESULTS: In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).CONCLUSIONS: This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.TRIAL REGISTRATION: www.isrctn.org/ISRCTN06131530. Medical Research Council funding.

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DO - 10.1136/bmjopen-2012-002361

M3 - Article

C2 - 23562814

VL - 3

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 4

ER -