Dr Joanna Kesten
Senior Research Associate
Since 2015, Jo has been a member of the Population Health Sciences department within the University of Bristol working as a senior research associate on the National Institute for Health Research funded programme grants CLAHRC West and Health Protection Research Unit in Evaluation of Interventions. The focus of her research is the development and evaluation of public health interventions using applied social science qualitative research methods. Her research interests include understanding and tackling the challenges experienced by vulnerable individuals experiencing addiction to reduce the harms of injecting illicit drugs. She has gained experience of addiction science through research projects focused on people who inject drugs, drug dependent female street sex workers, primary care patients with opioid analgesic dependency and, homeless problem drinkers.
Aims
To evaluate the South Gloucestershire Opioid Pain Review Pilot, an individually-tailored intervention to help primary care patients with opioid analgesic dependence understand their relationship with opioids (prescribed for the treatment of chronic pain) and support alternative non-drug-based pain management strategies. The pilot was based in two GP practices in South Gloucestershire.
Methods
Quantitative data were collected on demographics, pre-post intervention changes in well-being and quality of life, opioid use and dose (measured as average daily morphine equivalent), pain intensity/relief and interference with life.
Twenty-five semi-structured interviews (18 service-users and 7 service-providers) explored experiences of the pilot.
Results
Fifty-nine patients were invited to use the service and 34 (58%) enrolled. A variety of interventions were provided in the sessions (e.g. pain management workbook, exercise planning and sleep hygiene) as well as referrals to external services (e.g. physiotherapy). On average, service-users showed improvement on all outcomes except pain relief. The median prescribed morphine equivalent opioid dose at baseline was 90 (IQR 60 to 240) and had reduced to 72 (IQR 30 to 160) at follow-up (p<0.001).
Service-users and providers received the pilot positively. Perceived benefits of the service related to service-user wellbeing and quality of life (e.g. improved confidence and self-esteem), use of pain management strategies (e.g. pacing) and changes in medication use.
Conclusions
The pilot has shown promising results. It was viewed as acceptable and beneficial to service-users. A randomised controlled trial is needed to test the effects of this type of care-pathway on opioid dependency and pain management.
