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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    Bruhn, H., Bond, C. M., Elliott, A. M., Hannaford, P. C., Lee, A. J., McNamee, P., Smith, B. H., Watson, M. C., Holland, R., & Wright, D. (2013). Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open, 3(4). https://doi.org/10.1136/bmjopen-2012-002361