In June 2015 NPS MedicineWise launched the program Chronic pain: opioids and beyond. The goal of this program was to improve wellbeing in patients with chronic non-cancer pain who are managed in primary care.
Twelve months after program launch, more than 2000 GPs across Australia were invited to complete an online survey to identify trends in GP knowledge and practice regarding the management of chronic non-cancer pain in primary care.
A total of 187 GPs who had participated in a 1-1 or group-based educational visit for this program completed the participant survey (response rate of 14%). A comparison group of 154 GPs who had not participated in an educational visit completed a control survey (response rate of 17%).
NPS MedicineWise would like to thank participating GPs for taking the time to complete our surveys.
GP respondents
GPs from all States and Territories completed the survey. Most GPs had been practising for more than 20 years and were employed in larger practices with three or more GPs. Forty-two per cent of participant GPs had participated in a 1-1 educational visit and 56% in a group-based visit.
Key findings
- GP participation in the Chronic pain program exceeded expectations, with more than 7300 GPs participating in the program activities.
- After participating in the program GPs reported an increase in knowledge regarding:
- using the ‘5As’ assessment tool to regularly review patients on opioid therapy (+57%)
- tapering the use of opioids and implementing an alternative treatment plan if treatment goals weren’t being met (+46%
- agreeing that opioids should be discontinued after a 4-week trial if there is no improvement in patient wellbeing (+32%).
- GPs reported an increase in practice in four key areas after participating in the program:
- discussing the use of pain management plans (+56%) and opioid contracts (+35%)
- developing pain management plans with relevant patients (+42%), and conducting routine assessments of pain and function in patients with chronic pain (+32%)
- routinely using a validated pain assessment tool to assess pain levels in patients (+25%)
- recommending non-pharmacological approaches such as dietary changes (+24%), cognitive behavioural therapy (+37%) and mindfulness-based approaches (+47%) in the management of chronic pain.
Examples of specific findings
According to best practice guidelines, the desired response for each of the five knowledge statements was for GPs to ‘strongly agree’ or ‘agree’. After participating in an educational visit, most participant GPs (> 90%) gave the desired response for each of the knowledge statements, which was a significant increase (p < 0.001) compared with before participation (Figure 1).
Figure 1: Comparison of GP respondents who gave the desired response to knowledge statements.
The proportion of participant GPs who would undertake each of the six desired actions (Table 1) when managing a patient on opioid therapy, significantly increased after participating in an educational visit.
After the program the proportions of participant GPs who would undertake four of the six desired actions were also significantly higher than those of the control GPs, indicating that this key message was effectively delivered.
Table 1: Comparison of GP respondent actions when managing a patient on opioid therapy
| Action | Participant GPs before | Participant GPs now | Control GPs |
|---|---|---|---|
| Discuss limited evidence for use of opioids in chronic pain and the potential for long-term medicine-related harms |
41% (77) | 90% (169) | 85% (131) |
| Use an oral modified-release formulation or transdermal preparation | 69% (130) | 82% (154) | 71% (110) |
| Regularly review using the 5As to assess if ongoing opioid therapy is needed | 27% (51) | 84% (158) | 62% (95) |
| Assess whether the patient is achieving their pain management goals on opioid therapy | 66% (124) | 92% (173) | 81% (125) |
| Taper the use of opioids and implement an alternative treatment plan if the patient’s treatment goals are not met | 43% (81) | 89% (166) | 80% (123) |
| Explain the need for engagement in active self-management strategies | 49% (92) | 88% (165) | 85% (13 |
The proportion of participant GPs who always or often assessed pain and function in relevant patients significantly increased (+32%, p < 0.001) after participating in an educational visit, as did the proportion of participant GPs who always or often developed a pain management plan with relevant patients (+42%, p < 0.001).
Compared with control GPs, a significantly higher proportion of participant GPs always or often performed these two actions (Table 2).
Table 2: Comparison of GP respondents who gave the desired response
| Action | Desired response |
Participant GPs before | Participant GPs now | Control GPs |
|---|---|---|---|---|
| Assess pain and function | Always / Often | 54% (93) | 86% (152) | 70% (108) |
| Develop a pain management plan | Always / Often | 26% (44) | 68% (122) | 52% (80 |
The Chronic pain program encouraged health professionals to discuss treatment with patients before starting them on opioid therapy.
The proportion of participant GPs who reported discussing individual goals of therapy with their patients increased significantly (p < 0.001) to 85% after participating in the Chronic pain program.
The proportions of participant GPs who discussed developing a pain management plan or using a pain diary or opioid contract with patients before starting opioid therapy increased by 56%, 43% and 35%, respectively.
Significant differences of more than 20% were also observed between participant-now GPs and control GPs (Table 3).
Table 3: Comparison of GP respondent discussions with patients
| discussion | Participant GPs before | Participant GPs now | Control GPs |
|---|---|---|---|
| Their individual goals of therapy | 47% (87) | 85% (159) | 71% (110) |
| Realistic expectation of pain relief | 57% (106) | 91% (170) | 88% (135) |
| Adverse effects and management thereof | 81% (152) | 88% (165) | 94% (144) |
| Use of non-pharmacological therapy strategies to assist pain management | 71% (133) | 90% (169) | 90% (138) |
| Developing a pain management plan | 19% (36) | 75% (141) | 55% (84) |
| Use of a pain diary to chart pain | 12% (22) | 55% (102) | 29% (45) |
| Use of an opioid contract | 23% (42) | 58% (108) | 31% (47) |
Summary
More than 7000 GPs participated in the Chronic pain: opioids and beyond program. Overall, GPs who participated in an educational visit for this program, either 1-1 or group-based, demonstrated significant improvements in knowledge and practice in key areas of chronic (non-cancer) pain management.
The educational visits encouraged GPs to have discussions with patients before starting them on opioid therapy, and also increased the practice of developing pain management plans with patients, and assessing pain and function for patients requiring opioids.
The program message on non-pharmacological strategies resonated with GPs and gave them additional strategies to introduce to patients experiencing chronic pain. The program was also successful in prompting significant increases in the use of the recommended 5As assessment tool for reviewing patients on opioid therapy.
The survey findings will inform future programs to better serve the needs of GPs.