What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

COVID-19 impacted on the wellbeing of adults (18-65), who exhibited “syndromes” of distress such as low mood and unexplained symptoms such as acute pain. Identification of this group of patients and taking a holistic, biopsychosocial and de-medicalised approach to care is paramount; these patients often come to harm from over-investigation and prescriptions of addictive medications such as opiates.

During the pandemic, the functional illness team at Pathfields Medical Group (primary care network) integrated with mental health teams, social prescribers, and physiotherapists to see if a joined up wellbeing focus may go further for this patient group.

It was noted that many patients were on long term controlled drugs. These drugs are easy to start but much harder to stop and in the long term cause significant patient distress. This study would like to understand the biopsychosocial factors that most contribute to long term controlled drug useage from prescribing that first script.

What does your project aim to achieve?

The aim of this project is to provide clinicians with an accurate prediction of the risk of prescribing a controlled drug so that an informed discussion may take place with the patient.

Specifically this study would like to ascertain the following primary aims:

1. What is the probability of becoming a long term user of opiates (defined as 4+ scripts of opiates in a six month period) from the first, second, and third script issued over a three month period?

2. Determine some of the biopsychosocial parameters that are most associated with long term opiate useage.

This may help to develop a risk prediction tool that predicts an individual person’s probability of becoming a long term opiate user will empower clinicians not to prescribe – and patients to not want clinicians to prescribe –  and cultivate much safer prescribing as a result.

How will the project be delivered?

Patients in Pathfields Patient Participation Group will be consulted and colleagues in Mental Health, Pain, Drug and Alcohol Teams, Primary Care, and Social prescribing and medical statistics will be consulted as appropriate.

A retrospective analysis will take place of all patients in Pathfields who have had 1-3 new scripts of opiates over a three month period during the years 2017-2019. The notes of all patients will be evaluated to ascertain whether they are still using opiates long term. Long term useage is defined as 4 or more scripts over at least six months following the first script to be issued.

The data will be analysed to determine the probability of becoming a long term user following initiation of the first, second, and third script. Following this a regression analysis will take place to ascertain the biopsychosocial risk factors that are most predictive of long term useage.

How is your project going to share learning?

Learning will be disseminated using the Q community, AHSNs, webinars, presentations at local, regional and national level, and publications in medical journals