Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial
- Hanne Bruhn1,
- Christine M Bond2,
- Alison M Elliott2,
- Philip C Hannaford2,
- Amanda J Lee3,
- Paul McNamee4,
- Blair H Smith5,
- Margaret C Watson2,
- Richard Holland6,
- David Wright7
- 1Health Services Research Unit, Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
- 2Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
- 3Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- 4Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
- 5Division of Population Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- 6Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
- 7School of Pharmacy, University of East Anglia, Norwich, UK
- Correspondence to Professor C M Bond;
- Received 16 November 2012
- Revised 6 February 2013
- Accepted 7 February 2013
- Published 5 April 2013
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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