Improving care for people prescribed gabapentinoids for persistent pain: building on the PROMPPT approach.

Background Opioids and gabapentinoids (gabapentin and pregabalin) are medicines with important safety concerns, which are overprescribed for patients with persistent pain. Pharmacists working in GP practices (practice pharmacists) currently conduct medication reviews with patients taking opioids and/or gabapentinoids for persistent pain, but there is a lack of specific practical training available on how to approach reviews with this population. The PROMPPT programme has developed a practice pharmacist-led review for patients prescribed opioids, and associated pharmacist training package. Findings from a feasibility study and initial interview findings from the PROMPPT main trial suggest the PROMPPT approach is well-received and acceptable to patients and pharmacists. Pharmacists interviewed have reported finding the PROMPPT training useful and perceive that it fills a gap in the currently available training. The PROMPPT intervention development work focused specifically on opioids and evidence supporting patient centred interventions to address gabapentinoid overprescribing is lacking. Therefore, we propose conducting additional research exploring how gabapentinoids are currently reviewed, and the barriers and facilitators in reducing gabapentinoids, in order to design an intervention for patients prescribed gabapentinoids for persistent pain based on the PROMPPT approach. Aims and Objectives Aim To investigate how the findings from the PROMPPT intervention development work can inform development of an intervention to tackle gabapentinoid overprescribing. Objectives To explore: How gabapentin and pregabalin prescribing are currently reviewed in UK primary care Barriers to and facilitators of reducing gabapentinoids in a primary care pharmacist-led review What changes are needed to adapt the PROMPPT approach to support people with persistent pain to safely reduce gabapentinoids, where appropriate To design: 4. An intervention for people prescribed gabapentinoids based on the PROMPPT approach. Development work plan Study objectives will be addressed by two linked empirical studies with stakeholder and patient and public involvement and engagement embedded throughout: Interviews with people prescribed gabapentin and pregabalin for persistent pain Focus groups with practice pharmacists Engagement workshops with patients, public and clinical stakeholders to design the research and to determine the changes needed to the PROMPPT intervention (patient advisory group (PAG), community groups representing underserved populations and mixed stakeholder group) Timelines for delivery An 18-month project is proposed with the following timelines: Months 1-2 Obtain ethical approvals and first stakeholder meetings (all groups) Months 3-10 Interviews complete, second stakeholder meetings (PAG and community groups) Months 10-15 Focus groups complete, final stakeholder meetings (all groups) Months 15-18 Design intervention and write reports and publications Impact and Dissemination A practice pharmacist-led primary care intervention for patients prescribed gabapentinoids will be designed in readiness for testing in a future evaluation study. This project has the potential to benefit patients and the NHS by: Improving patient safety by reducing inappropriate gabapentinoid use Supporting pharmacists to develop their consultation and communication skills Reducing costs of prescribing gabapentinoids and treating side-effects We will work closely with Keele University s Impact Accelerator Unit, patient representatives, and stakeholder members to ensure outputs reach their potential.