Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England

Johnson, Lucy; Cole, Frances; Kinchin, Rebecca; Francis, Andrea; Winiarek, Konrad; Hampshire, Kate; Chazot, Paul

Abstract

To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England. Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention. All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians' self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system. Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period. Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [ = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall ( = .044) and, specifically across three of the five domains measured: supporting behavioural change ( = .028), supporting self-care ( = .008), and managing difficult consultations ( = .011). The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids. [Abstract copyright: © The Author(s) 2024.]

Citation

Johnson, L., Cole, F., Kinchin, R., Francis, A., Winiarek, K., Hampshire, K., & Chazot, P. (online). Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England. British Journal of Pain, https://doi.org/10.1177/20494637241291534

• Journal Article Type: Article
• Acceptance Date: Sep 17, 2024
• Online Publication Date: Oct 20, 2024
• Deposit Date: Oct 29, 2024
• Publicly Available Date: Oct 29, 2024
• Journal: British Journal of Pain
• Print ISSN: 2049-4637
• Electronic ISSN: 2049-4645
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/20494637241291534
• Keywords: Biopsychosocial, LWWP 10-Footsteps, chronic pain, primary care, pain management, self-management, confidence
• Public URL: https://durham-repository.worktribe.com/output/2991037