Patient Experiences And Acceptance Of Pharmacist-led Opioid Tapering Prior To Total Hip Or Knee Arthroplasty: A Qualitative Study

• By: PHINN, Katelyn (The University of Sydney, Australia)
• Co-author(s): Ms Katelyn Phinn (The University of Sydney, Sydney, Australia / Campbelltown Hospital, Campbelltown, Australia)
  Dr Shania Liu (The University of Sydney, Sydney, Australia / Prince of Wales Hospital, Randwick, Australia)
  Ms Jenny Chen (The University of Sydney, Sydney, Australia)
  Professor Asad Patanwala (The University of Sydney, Sydney, Australia / Royal Prince Alfred Hospital, Camperdown, Australia)
  Associate Professor Jennifer Stevens (University of New South Wales, Sydney, Australia / University of Notre Dame, Sydney, Australia)
  Associate Professor Justine Naylor (University of New South Wales, Sydney, Australia / Ingham Institute, Liverpool, Australia)
  Dr Jonathan Penm (The University of Sydney, Sydney, Australia / Prince of Wales Hospital, Randwick, Australia)
  
• Abstract:

  Introduction: Opioid analgesics are often prescribed in patients with osteoarthritis awaiting total hip or knee arthroplasty, despite poor evidence as to their benefits. Chronic opioid use prior to hip or knee replacement is associated with worse clinical outcomes. Emerging evidence has shown that these outcomes may be reversible through deprescribing opioid analgesics prior to surgery. A pilot-Randomised controlled trial (RCT) was conducted by the research team to establish the feasibility of pharmacist-led opioid tapering prior to hip or knee replacement. The primary objective of this study was to understand patient acceptability and experiences with pharmacist-led opioid tapering, thereby evaluating the feasibility of this intervention.
  Methods: Semi-structured interviews were conducted between July and September 2023. All patients that had received pharmacist-led opioid tapering prior to total hip or knee arthroplasty in the pilot RCT was invited to participate in this study. Interviews were audio recorded and transcribed verbatim. Data was analysed using an inductive thematic approach to identify main themes related to patient acceptance and experiences with pharmacist-led opioid tapering.
  Results: In total, 16 interviews were conducted with patients following pharmacist-led opioid tapering. Three main themes were identified: i) Need for intervention (pill-burden, fear of addiction, opioid-related adverse effects); ii) Patient’s acceptability of intervention (understood and listened to, personalised care, helped and supported, empowered through education); iii) Alternative recommendations made during intervention (multimodal analgesia, non-pharmacological techniques, other health-care professionals).
  Conclusion: Patients who underwent pharmacist-led opioid tapering felt empowered and supported in their pain management journey. Pharmacist-led opioid tapering was shown to be an acceptable and feasible intervention to reduce opioid dose prior to total hip or knee arthroplasty.