Evaluating the impact of an evidence informed, digitally deployed, GP remote consultation video intervention that aims to reduce opioid prescribing in primary care (2022-2023)
Funder: NHS Insights Prioritisation Programme (NIPP), £275,000
This is a joint project delivered by the Academic Health Science Network (AHSN) North East and North Cumbria, and NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC)
Opioid use in the Northeast of England is high. A video messaging pilot-intervention has been implemented, in response to the pandemic, to explain the rationale for opioid reduction and facilitate self-initiation of support. This study aims to evaluate the potential benefits, risks, and economic consequences of ‘at scale’ implementation.
About the project
During the pandemic, a novel process was developed by a GP in Yorkshire to remotely explain reasons for reduced opioid use and initiate support, targeted at patients identified as prescribed high levels of opioids. A short video suitable for smartphone viewing is messaged using a two-way communication system. Patients can watch the video more than once, and request additional support by replying with a simple text or email response.
This approach has already been rolled out in selected GP practices in a region in Northern England, targeted at patients identified as prescribed high levels of opioids. This process also enables efficient delivery of a discrete offer of help to at-risk individuals who often avoid service contact.
This is a mixed-methods study comprising of a quasi-experimental non-randomised before-and-after design and qualitative interviews. The intervention arm comprises 50 GP practices using System 1 (a clinical computer system which the intervention is currently integrated with) who will deliver the video to their patients via text message. The control arm comprises 50 practices using EMIS (a different clinical computer system) who will continue usual care. Monthly practice level data will be accessed and followed up for six months. A general linear model will be used to estimate the association between the exposure (video message vs. control) and the outcome (opioid prescribing).
Semi-structured interviews are also being undertaken remotely with selected participants including patients who received the video and health professionals involved in sending out the videos and providing additional support. The interviews aim to understand patient and health professional experiences and factors impacting upon the delivery and success of the intervention.
Opioid use is recognised as a significant problem within disadvantaged communities. Therefore, the intervention, by its very nature, aims to support and address health inequality by facilitating the timely and appropriate reduction of opioid prescribing. The qualitative component of this study will explore this intervention through a health inequalities lens.
Read the full study protocol (published in BMJ Open – February 2023)
This study has been developed with a public member with lived experience of opioid reduction, who has also reviewed and commented on video scripts, ethics supporting documents and recruitment strategies. The study leads have actively sought support from people from disadvantaged socioeconomic backgrounds to join this study to ensure this project reduces health inequalities in access, experience, and outcomes.
What does this work aim to achieve?
The overall aim is to evaluate the potential benefits, risks and economic consequences of ‘at scale’ implementation of this intervention. Objectives are:
- To estimate the associations between the video intervention and opioid prescribing using practice level data
- To estimate the high-level economic consequences for stakeholders
- To explore patient and practitioner experiences and factors impacting upon the success of the innovation
- To integrate data from objectives 1-3 to inform interpretation, dissemination, implementation and generate recommendations that address ICS and regional needs.
As well as evidence and rapid insights to inform the potential accelerated implementation of the intervention within the Integrated Care System, this study will provide evidence that could underpin the future adoption of the intervention into wide scale clinical management that can be disseminated as a future national programme via the Academic Health Science Network.
- There was considerable interest in primary care with early and positive engagement from the required General Practises willing to engage, to learn and to support those who find themselves using high doses of opioids
- It is possible to deliver applied research in a non research organisation
- It is possible to bring together teams across a large geography to deliver an important project that addresses an ICB priority.
- Where interventions to reduce opioid prescribing are available primary care is keen to participate despite the current service pressures in primary care.
What happens next?
The outcomes of this project will inform future planning around strategies to address opioid prescribing.
Ultimately if positive, the evaluation will lead to widespread implementation and the longer term outcomes of reduced opioid prescribing and associated positive impacts that this will bring communities.
Find out more
Study leads: Professor Julia Newton, AHSN NENC and Dr Cormac Ryan, Teesside University.
Further resources linked to this project can be found on the AHSN NENC website.
For more information, please email Professor Julia Newton: [email protected]