General practice responses to opioid prescribing feedback: a qualitative process evaluation

Su Wood, Robbie Foy, Thomas A Willis, Paul Carder, Stella Johnson, Sarah Alderson, Su Wood, Robbie Foy, Thomas A Willis, Paul Carder, Stella Johnson, Sarah Alderson

Abstract

Background: The rise in opioid prescribing in primary care represents a significant public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. An evidence-based bimonthly feedback intervention to reduce opioid prescribing was developed and implemented, targeting 316 general practices in West Yorkshire over 1 year.

Aim: To understand how general practice staff received and responded to the feedback intervention.

Design and setting: Qualitative process evaluation involving semi-structured interviews, guided by Normalisation Process Theory (NPT), of primary care healthcare professionals targeted by feedback.

Method: Participants were purposively recruited according to baseline opioid prescribing levels and degree of change following feedback. Interview data were coded to NPT constructs, and thematically analysed.

Results: Interviews were conducted with 21 staff from 20 practices. Reducing opioid prescribing was recognised as a priority. While high achievers had clear structures for quality improvement, feedback encouraged some less structured practices to embed changes. The non-prescriptive nature of the feedback reports allowed practices to develop strategies consistent with their own ways of working and existing resources. Practice concerns were allayed by the credibility of the reports and positive experiences of reducing opioid prescribing. The scale, frequency, and duration of feedback may have ensured a good overall level of practice population reach.

Conclusion: The intervention engaged general practice staff in change by targeting an issue of emerging concern, and allowing adaption to different ways of working. Practice efforts to reduce opioid prescribing were reinforced by regular feedback, credible comparative data showing progress, and shared experiences of patient benefit.

Keywords: Normalisation Process Theory; analgesics, opioid; feedback; general practice; prescribing; process evaluation; qualitative research; quality and safety.

© The Authors.

References

    1. Hamunen K, Paakkari P, Kalso E. Trends in opioid consumption in the Nordic countries 2002–2006. Eur J Pain. 2009;13(9):954–962.
    1. Fischer B, Jones W, Rehm J. Trends and changes in prescription opioid analgesic dispensing in Canada 2005–2012: an update with a focus on recent interventions. BMC Health Serv Res. 2014;14(1):90.
    1. Ruscitto A, Smith B, Guthrie B. Changes in opioid and other analgesic use 1995–2010: repeated cross–sectional analysis of dispensed prescribing for a large geographical population in Scotland. Eur J Pain. 2015;19(1):59–66.
    1. Stannard C. Opioids in the UK: what’s the problem? BMJ. 2013;347:f5108.
    1. Ballantyne JC, Shin NS. Efficacy of opioids for chronic pain: a review of the evidence. Clin J Pain. 2008;24(6):469–478.
    1. Reid MC, Henderson CR, Papaleontiou M, et al. Characteristics of older adults receiving opioids in primary care: treatment duration and outcomes. Pain Med. 2010;11(7):1063–1071.
    1. Solomon DH, Rassen JA, Glynn RJ, et al. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med. 2010;170(22):1968–1978.
    1. Foy R, Leaman B, McCrorie C, et al. Prescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristics. BMJ Open. 2016;6(5):e010276.
    1. Curtis HJ, Croker R, Walker AJ, et al. Opioid prescribing trends and geographical variation in England, 1998–2018: a retrospective database study. Lancet Psychiatry. 2019;6(2):140–150.
    1. Connelly D, Cotterell M. Opioids in England: crisis averted? Pharm J. 2019;302(7926) doi: 10.1211/PJ.2019.20206735..
    1. Mordecai L, Reynolds C, Donaldson LJ, Williams AC, de C. Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study. Br J Gen Pract. 2018 doi: 10.3399/bjgp18X695057.
    1. McCrorie C, Closs SJ, House A, et al. Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study. BMC Fam Prac. 2015;16(1):121.
    1. Alderson SL, Farragher TM, Willis TA, et al. The effects of an evidence and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care: a controlled interrupted time series analysis. PLOS Medicine
    1. Ivers NM, Grimshaw JM, Jamtvedt G, et al. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. J Gen Intern Med. 2014;29(11):1534–1541.
    1. Windmill J, Fisher E, Eccleston C, et al. Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane Database Syst Rev. 2013;(9):CD010323.
    1. Office for National Statistics Estimates of the population for the UK, England and Wales, Scotland and Northern Ireland Mid-2014 edition. 2021 (accessed 12 Jul 2021).
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357.
    1. Glidewell L, Willis TA, Petty D, et al. To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis. Implement Sci. 2018;13(1):32.
    1. May C. A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res. 2006;6(1):86.
    1. May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalisation process theory. Sociology. 2009;43(3):535–554.
    1. May CR, Cummings A, Girling M, et al. Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review. Implement Sci. 2018;13(1):80.
    1. Francis JJ, Johnston M, Robertson C, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–1245.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
    1. Gray-Burrows KA, Willis TA, Foy R, et al. Role of patient and public involvement in implementation research: a consensus study. BMJ Qual Saf. 2018;27(10):858–864.
    1. Royal College of Anaesthetists Opioids aware. 2015 Faculty of Pain Medicine, (accessed 12 Jul 2021).
    1. Moore P, Cole F. The pain toolkit. 2018 (accessed 12 Jul 2021).
    1. Langford AV, Gnjidic D, Lin CW, et al. Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis. BMJ Qual Saf. 2020;30(2):133–140.
    1. Grol R, Dalhuijsen J, Thomas S, et al. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ. 1998;317(7162):858–861.
    1. MacBride-Stewart S, Marwick C, Houston N, et al. Evaluation of a complex intervention to improve primary care prescribing: a phase IV segmented regression interrupted time series analysis. Br J Gen Pract. 2017 doi: 10.3399/bjgp17X690437.
    1. Hallsworth M, Chadborn T, Sallis A, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016;387(10029):1743–1752.
    1. Elouafkaoui P, Young L, Newlands R, et al. An audit and feedback intervention for reducing antibiotic prescribing in general dental practice: the RAPiD cluster randomised controlled trial. PLoS Med. 2016;13(8):p.e1002115.
    1. Brehaut JC, Colquhoun HL, Eva KW, et al. Practice feedback interventions: 15 suggestions for optimizing effectiveness. Ann Intern Med. 2016;164(6):435–441.
    1. Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;(6):CD000259.
    1. Willis TA, Collinson M, Glidewell L, et al. An adaptable implementation package targeting evidence-based indicators in primary care: a pragmatic cluster-randomised evaluation. PLoS Med. 2020;17(2):e1003045.
    1. Foy R, Willis T, Glidewell L, et al. Developing and evaluating packages to support implementation of quality indicators in general practice: the ASPIRE research programme, including two cluster RCTs. Programme Grants Appl Res. 2020;8(4) doi: 10.3310/pgfar08040..
    1. Guthrie B, Kavanagh K, Robertson C, et al. Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial. BMJ. 2016;354:i4079.
    1. Brown B, Gude WT, Blakeman T, et al. Clinical performance feedback intervention theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research. Implement Sci. 2019;14(1):40.
    1. Grant AM, Guthrie B, Dreischulte T. Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study. BMJ Open. 2014;4(1):e004153.
    1. Grant A, Dreischulte T, Guthrie B. Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing. BMJ Open. 2017;7(3):e015281.
    1. Walker AJ, Pretis F, Powell-Smith A, Goldacre B. Variation in responsiveness to warranted behaviour change among NHS clinicians: novel implementation of change detection methods in longitudinal prescribing data. BMJ. 2019;367:l5205.
    1. Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6(2):107–112.
    1. Dowding D, Randell R, Gardner P, et al. Dashboards for improving patient care: review of the literature. Int J Med Inform. 2015;84(2):87–100.
    1. Ivers NM, Grimshaw JM. Reducing research waste with implementation laboratories. Lancet. 2016;388(10044):547–548.

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