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We all know the issues surrounding opioid and gabapentinoid overprescribing in chronic pain. Many of us are rising to the challenge of tackling deprescribing. However, due to the knowledge gap of available support and alternatives to medication, it is proving to be a huge task. In Carlisle Rural Primary Care Network we wanted to support people to live well with their pain. We wanted to find alternative ways in which to support these patients. But how?
The First Contact Physio (FCP) (Carrieann Kirkup) and the pharmacy team began talking to each other. During this conversation we realised we had a common goal- to support these patients while reducing their opioids or gabapentinoids. Leading from this initial conversation we developed a system of referral to and from the pharmacy team and the FCP. We continue to communicate to ensure the patient has the highest standard of care leading to a common goal of medication no longer being the focus of treatment. From this collaboration we have included other roles in our referral process, mental health practitioner, care coordinator and health and wellbeing coaches to produce a professional support network close to the patient’s home.
This collaboration is producing enhanced patient care due to evolving knowledge of each others professions and encouraging people to self-care. Our way of working has had a positive impact on our opioid and gabapentinoid prescribing.
Our initial outcome measures show (random sample of 22 patients) that we have saved 40 appointments, reduced 714mg morphine (equivalent dose), 1100mg pregabalin, 2700mg gabapentin and saved £3,256.24 a year from the prescribing expenditure.
This process has given us the ability to use shared decision making in our conversations with patients and promote personalised care.
What is there not to like about collaborative working! Knock on that door, tell others the great work that you are doing, be professionally visible and you never know where that conversation will take you. It may even enhance patient care!
Our aspirations for the future;
• joint appointments in the surgeries as a one-stop shop.
• Using this collaboration at the beginning of the persons journey while the pain is still acute.
We hope that the patients’ positive experience will enhance their ability to continue self-care and reduce their reliance on medication.
