Factors influencing trends in opioid prescribing for older people: a scoping review

Abstract Aim: The review aimed to identify factors influencing opioid prescribing as regular pain-management medication for older people. Background: Chronic pain occurs in 45%–85% of older people, but appears to be under-recognised and under-treated. However, strong opiate prescribing is more prevalent in older people, increasing at the fastest rate in this age group. Methods: This review included all study types, published 1990–2017, which focused on opioid prescribing for pain management among older adults. Arksey and O’Malley’s framework was used to scope the literature. PubMed, EBSCO Host, the UK Drug Database, and Google Scholar were searched. Data extraction, carried out by two researchers, included factors explaining opioid prescribing patterns and prescribing trends. Findings: A total of 613 papers were identified and 53 were included in the final review consisting of 35 research papers, 10 opinion pieces and 8 grey literature sources. Factors associated with prescribing patterns were categorised according to whether they were patient-related, prescriber-driven, or system-driven. Patient factors included age, gender, race, and cognition; prescriber factors included attitudes towards opioids and judgements about ‘normal’ pain; and policy/system factors related to the changing policy landscape over the last three decades, particularly in the USA. Conclusions: A large number of context-dependent factors appeared to influence opioid prescribing for chronic pain management in older adults, but the findings were inconsistent. There is a gap in the literature relating to the UK healthcare system; the prescriber and the patient perspective; and within the context of multi-morbidity and treatment burden.

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Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

International Journal of Pharmacy Practice ◽

10.1093/ijpp/riab015.059 ◽

2021 ◽

Vol 29 (Supplement_1) ◽

pp. i48-i49

Author(s):

S Visram ◽

J Saini ◽

R Mandvia

Keyword(s):

Data Analysis ◽

Pain Management ◽

Cancer Pain ◽

Educational Intervention ◽

Opioid Analgesics ◽

Educational Outreach ◽

Opioid Prescribing ◽

Prescribing Trends ◽

The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

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Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Pain Medicine ◽

10.1093/pm/pnz344 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1400-1407 ◽

Cited By ~ 1

Author(s):

Adam N Romman ◽

Connie M Hsu ◽

Lin-Na Chou ◽

Yong-Fang Kuo ◽

Rene Przkora ◽

...

Keyword(s):

Pain Management ◽

Medicare Part D ◽

Medical Specialty ◽

Medicare Part ◽

Provider Type ◽

Cross Sectional ◽

Part D ◽

Opioid Prescribing ◽

Prescribing Trends ◽

Level Analysis

Abstract Objective To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. Methods We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Results From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. Conclusions From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.

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Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults

Pain Management Nursing ◽

10.1016/j.pmn.2021.03.011 ◽

2021 ◽

Author(s):

Alisa Johnson ◽

Staja Q. Booker

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Pain Management ◽

Chronic Pain Management

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What influences diet quality in older people? A qualitative study among community-dwelling older adults from the Hertfordshire Cohort Study, UK

Public Health Nutrition ◽

10.1017/s1368980017001203 ◽

2017 ◽

Vol 20 (15) ◽

pp. 2685-2693 ◽

Cited By ~ 35

Author(s):

Ilse Bloom ◽

Wendy Lawrence ◽

Mary Barker ◽

Janis Baird ◽

Elaine Dennison ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Older People ◽

Social Engagement ◽

Community Dwelling ◽

Related Factors ◽

Age Related ◽

Hertfordshire Cohort Study ◽

The Uk ◽

Community Dwelling Older Adults

AbstractObjectiveTo explore influences on diet in a group of community-dwelling older adults in the UK.DesignData were collected through focus group discussions with older people; discussions were audio-recorded, transcribed verbatim and transcripts analysed thematically.SettingHertfordshire, UK.SubjectsParticipants were sampled purposively from the Hertfordshire Cohort Study, focusing on those whose diets had been assessed at two time points: 1998–2001 and 2011.ResultsNinety-two adults participated (47 % women; 74–83 years) and eleven focus groups were held. A number of age-related factors were identified that were linked to food choices, including lifelong food experiences, retirement, bereavement and medical conditions, as well as environmental factors (such as transport). There appeared to be variability in how individuals responded to these influences, indicating that other underlying factors may mediate the effects of age-related factors on diet. Discussions about ‘keeping going’, being motivated to ‘not give up’, not wanting to be perceived as ‘old’, as well as examples of resilience and coping strategies, suggest the importance of mediating psychological factors. In addition, discussion about social activities and isolation, community spirit and loneliness, indicated the importance of social engagement as an influence on diet.ConclusionsInterventions to promote healthier diets in older age should take account of underlying psychological and social factors that influence diet, which may mediate the effects of age-related factors.

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Improving access to adult vaccination: a tool for healthy ageing

Working with Older People ◽

10.1108/wwop-01-2014-0003 ◽

2014 ◽

Vol 18 (2) ◽

pp. 58-66 ◽

Cited By ~ 1

Author(s):

Jonathan Scrutton ◽

David Sinclair ◽

Trinley Walker

Keyword(s):

Older People ◽

Group Discussion ◽

Grey Literature ◽

Healthy Ageing ◽

Active Ageing ◽

Content Type ◽

Health And Social Care ◽

Potential Benefits ◽

The Government ◽

The Uk

Purpose – The purpose of this paper is to demonstrate how access to vaccination for older people in the UK can be both improved and used as a tool for healthy ageing. Design/methodology/approach – ILC-UK released a report “Adult Immunisation in the UK”, which applied a UK perspective to a 2013 Supporting Active Ageing Through Immunisation (SAATI) report on immunisation. The ILC report combined the SAATI findings with a traditional literature review, a policy review incorporating grey literature and the outcomes of a focus group discussion. This paper highlights the key findings of the ILC-UK report. Findings – Vaccination needs to be included as part of proactive strategies to promote healthy and active ageing. Initiatives need to be explored that increase the rate of delivery of vaccinations. Barriers to the vaccination of health and social care professionals working with older people need to be removed. The government should explore using psychological insights into human behaviour to improve the take-up of vaccinations amongst adults. The range of settings where older people can receive vaccination needs to be expanded. Information on the potential benefits of immunisation should be made readily available and easily accessible to older people. Practical implications – The paper calls for a structural shift in how vaccination services in the UK are organised. Social implications – The paper calls for a cultural shift in how society views immunisation and the role it has to play in the healthy ageing process. Originality/value – The paper uses new European research on immunisation and applies it to the UK's situation.

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Safety and Efficacy Considerations of Gabapentin as Adjunctive Therapy to Opioids in the Perioperative Setting for Older Adults

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.436. ◽

2020 ◽

Vol 35 (10) ◽

pp. 436-438

Author(s):

Edgar Garcia ◽

Justin P. Reinert ◽

Michael Veronin

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Pain Management ◽

Adverse Effects ◽

Older Adult ◽

Adjunctive Therapy ◽

Adult Patients ◽

Opioid Epidemic ◽

Safety And Efficacy ◽

Initial Choice

While opioids have historically been the initial choice of analgesic for both acute and chronic pain, legislative and deprescribing trends as a result of the opioid epidemic have demonstrated an increase in the use of adjunctive therapies. These adjunctive agents are being utilized with increased frequency, especially in older adult patients, as a mechanism to mitigate any likelihood of dependency and in an effort to provide multimodal pain management. As this patient population can be more challenging because of comorbidities, the presence of polypharmacy, pharmacokinetic, and pharmacodynamic changes, it is important to evaluate the risk of any relevant adverse effects for opioids and adjuncts that can lead to higher risk of opioid toxicities. Gabapentin is one of the most commonly added adjunctive medications; however, its safety and efficacy in conjunction with opioids has not been exclusively considered in older adult patients in the perioperative setting. This report will summarize available evidence for gabapentin as an adjunctive therapy to opioids in older adult patients undergoing surgery.

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Cost-effectiveness of ziconotide in intrathecal pain management for severe chronic pain patients in the UK

Current Medical Research and Opinion ◽

10.1185/03007990903090849 ◽

2009 ◽

Vol 25 (8) ◽

pp. 2007-2019 ◽

Cited By ~ 10

Author(s):

S. Dewilde ◽

L. Verdian ◽

G. D. H. MacLaine

Keyword(s):

Chronic Pain ◽

Cost Effectiveness ◽

Pain Management ◽

Chronic Pain Patients ◽

Severe Chronic Pain ◽

The Uk ◽

Pain Patients

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Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

Journal of Pain Research ◽

10.2147/jpr.s136478 ◽

2017 ◽

Vol Volume 10 ◽

pp. 1395-1400 ◽

Cited By ~ 21

Author(s):

Amy Pearson ◽

Rajat Moman ◽

Susan Moeschler ◽

Jason Eldrige ◽

W. Michael Hooten

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Opioid Therapy ◽

Chronic Pain Management ◽

Opioid Prescribing ◽

Provider Survey

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Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults

Pain Medicine ◽

10.1093/pm/pnz215 ◽

2019 ◽

Vol 21 (2) ◽

pp. e68-e78 ◽

Cited By ~ 2

Author(s):

Mary R Janevic ◽

Varick Shute ◽

Susan L Murphy ◽

John D Piette

Keyword(s):

Older Adults ◽

Chronic Pain ◽

African American ◽

Pain Management ◽

Feasibility Trial ◽

Chronic Pain Management ◽

Step Counts ◽

African American Adults ◽

Activity Trackers ◽

Wearable Activity Trackers

Abstract Background Wearable activity trackers may facilitate walking for chronic pain management. Objective We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity. Design Randomized controlled pilot and feasibility trial. Subjects Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls). Methods Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration. Results More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls. Conclusions With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.

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