Delivering a primary care review for people prescribed opioids for persistent pain: a qualitative study on the facilitators and barriers facing practice pharmacists.

Abstract

Often, people living with persistent non-cancer pain 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 (the PROMPPT review) for people prescribed opioids for persistent pain in UK primary care. To explore the perspectives of pharmacists working in UK general practice regarding the proposed PROMPPT review, and to identify barriers to and facilitators of its delivery in practice, including supporting opioid deprescribing where appropriate. Multi-method qualitative study conducted with pharmacists working in primary care, who were recruited via professional networks predominantly in the East Midlands and West Midlands, UK. Pharmacists with experience of consulting in primary care participated in semi-structured interviews (<i>n</i> = 13) and two focus groups (<i>n</i> = 16) to explore attitudes to, beliefs about, and experiences of the proposed PROMPPT review for people living with persistent pain. The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis. Facilitators and barriers were mapped to components of the Capability Opportunity Motivation - Behaviour (COM-B) model. In total, 16 facilitators and barriers relating to the delivery of the PROMPPT review were identified across 10 domains of the TDF. Factors included access to evidence-based patient-facing resources, receiving professional colleagues' peer support, and having a therapeutic alliance with patients. These mapped to the COM-B model components as follows: capability (knowledge, skills), opportunity (environmental context and resources, social influences), and motivation (social or professional role and identity, beliefs about capabilities, beliefs about consequences, intentions, goals, emotions). This study provides theoretically based evidence of factors influencing pharmacists' delivery of the proposed PROMPPT review in relation to pharmacist capability, motivation, and opportunity. This work informed the co-design of both the intervention and the pharmacist training package.