Elsemiek Jansen - Groot Koerkamp, SIR Institute For Pharmacy Practice And Policy, Leiden, The Netherlands
Loes de Kleijn, Erasmus MC, Rotterdam, The Netherlands
Romina Fakhry, Utrecht University, Utrecht, The Netherlands
Mette Heringa, SIR Institute For Pharmacy Practice And Policy, Leiden, The Netherlands
Alessandro Chiarotto, Erasmus MC, Rotterdam, The Netherlands
Hanneke Rijkels-Otters, Erasmus MC, Rotterdam, The Netherlands
Jeanet Blom, LUMC, Leiden, The Netherlands
Bart Koes, Erasmus MC, Rotterdam, The Netherlands
Marcel Bouvy, Utrecht University, Utrecht, The Netherlands
ABSTRACT
Background information
In the past decades, opioid prescriptions have been rising in Netherlands. The primary care guideline on pain was recently updated to tackle inappropriate opioid use. Health care providers are in need of tools for implementation.
Purpose
To construct a tool to prevent and reduce inappropriate opioid use for non-cancer pain for primary care.
Method
A Delphi approach was used. A draft of an intervention tool was constructed based on literature and Dutch primary care guidelines regarding pain. In the three-round consensus process, a multidisciplinary expert panel of 21 experts assessed the content, usability and feasibility of the components.
Results
The draft tool consisted of two parts: part A to reduce opioid initiation and short-term use, and part B to reduce chronic (>3 months) opioid use. In three rounds, components and subcomponents were added, deleted and adapted until consensus was reached. The final part A consisted of 6 components: education, decision tree for start, risk assessment, agreements on dose and duration of use, guidance and follow-up, and interdisciplinary collaboration. The final part B consisted of 5 components: education, patient identification, risk assessment, motivation and tapering.
Conclusion
By a consensus process, a tool for primary care to prevent and reduce inappropriate opioid use was developed, with 6 components to reduce initiation and short-term use of opioids for non-cancer pain and 5 components to reduce long-term opioid use in patients with chronic non-cancer pain. The tool will be tested in a feasibility and implementation study in 2022/2023.