Delivering a primary care review for people prescribed opioids for persistent pain: facilitators and barriers facing practice pharmacists

Background People living with persistent non-cancer pain often are prescribed opioids long-term, despite a lack of evidence for their long-term effectiveness and safety. This study informed the design of a new practice pharmacist-led review (PROMPPT review) for people prescribed opioids for persistent pain in UK primary care.

Aim To explore the perspectives of pharmacists working in UK general practices regarding the proposed PROMPPT review and identify barriers to and facilitators of its delivery in practice, including supporting opioid deprescribing where appropriate.

Design & setting Multi-method qualitative study in primary care.

Method Pharmacists with experience of consulting in primary care participated in semi-structured interviews (n=13) and two focus groups (n=16) to explore attitudes, beliefs and experiences of a proposed PROMPPT review for people living with persistent pain. The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis.

Results 16 facilitators and barriers for delivery of a pharmacist-led PROMPPT review were identified across 10 domains of the TDF and mapped to components of the COM-B model of capability (knowledge, skills), motivation (social or professional role and identity, beliefs about capabilities, beliefs about consequences, intentions, goals, emotions), and opportunity (environmental context and resources, social influences).

Conclusion This study provides theoretically based evidence of factors influencing pharmacists’ delivery of PROMPPT reviews in relation to pharmacist capability, motivation, and opportunity. Factors included access to evidence-based patient-facing resources, receiving professional colleagues’ peer support, and having a therapeutic alliance with patients. This work informed the co-design of the intervention and pharmacist training package.