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. 2013 Apr 5;3(4):e002361.
doi: 10.1136/bmjopen-2012-002361. Print 2013.

Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial

Hanne Bruhn  1 , Christine M Bond, Alison M Elliott, Philip C Hannaford, Amanda J Lee, Paul McNamee, Blair H Smith, Margaret C Watson, Richard Holland, David Wright
Affiliations

Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial

Hanne Bruhn et al. BMJ Open. .

Abstract

Objectives: To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.

Design: An exploratory randomised controlled trial.

Setting: Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).

Participants: Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.

Outcome measures: Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.

Results: In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).

Conclusions: This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.

Trial registration: www.isrctn.org/ISRCTN06131530. Medical Research Council funding.

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Figures

Figure 1
Figure 1
CONSORT flow diagram.
See this image and copyright information in PMC

References

    1. Elliott AM, Smith BH, Penny KI, et al. The epideomiology of chronic pain in the community. Lancet 1999;354:1248–52 - PubMed
    1. Elliott AM, Smith BH, Hannaford P, et al. The course of chronic pain in the community: results of a 4-year follow-up study. Pain 2002;99:299–307 - PubMed
    1. Becker N, Bondegaard Thomsen A, Olsen AK, et al. Pain epidemiology and health related quality of life in chronic non-malignant painpain center patients referred to a Danish multidisciplinary. Pain 1997;73:393–400 - PubMed
    1. Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287–333 - PubMed
    1. Gureje O, Von Korff M, et al. , Persistent pain and well-being: a World Health Organization Study in Primary Care. JAMA 1998;280:147–51 - PubMed

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