Elizabeth Brown
Clinical Pharmacist
Sullivan Way GP Practice
The Challenge
Elizabeth is a pharmacist in Wigan, an area of Greater Manchester with high deprivation. Through her work she was aware that the use of gabapentinoids was one of the highest in the country and there was a need to review this as part of the revised National guidance that had recently been released around the poor risk/benefit profile and long-term effects of the drugs for patients. The National Institute for Health and Care Excellence (NICE) no longer recommends gabapentinoids for managing sciatica, low back pain and chronic primary pain.
Through her daily work Elizabeth was aware that patients who were taking these medications also had additional complex medical issues such as chronic pain and mental health issues.
Patient feedback
“Having a nurse explain the test and facts was very helpful“
“Informative and helpful“
“I learnt a lot and the knowledge and intentions of the team to help was evident”
“I felt that the workshops were run professionally and and our views were all considered and valued”
The Innovation
To address these issues and as part of her work within the CARE programme, Elizabeth conducted a search of people taking either gabapentin or pregabalin to identify why they were being prescribed and the scope of the problem. Two groups were identified for reviews, those aged 60 years and under who were known to have back problems who may be being prescribed gabapentinoids inappropriately, and the frail or elderly who are at greater risk of the side effects contributing to falls.
With this information Elizabeth initially conducted telephone appointments with patients to review and discuss medication changes, but soon realised that the nature of the discussions around deprescribing can be challenging and would be better face to face.
As a result, Elizabeth now invites patients viaAccuRx (text message), to attend a face-to-face appointment with her and uses a motivational interviewing approach combined with patient education. Utilising evidence-based online resources, such as Live Well with Pain, Elizabeth has achieved positive results.
The appointments can be for as long as required and on several occasions, Elizabeth has been able to refer patients to other services to provide continued support with other health professionals, such as social prescribers. Elizabeth has also visited a local organisation called ‘Be Well’ who provide physical activity, weight management and support with pain management. With these excellent links, Elizabeth has been able to refer patients directly to them for additional support as required.
In addition to this work, Elizabeth is hoping to develop the service further by conducting some group consultations where appropriate and this is hoped to also provide an additional peer support for patients.
Although the work has been slow to start, Elizabeth has 78 patients identified with 46 having been invited to attend a review. Five of these patients have stopped and six reduced their gabapentinoid medication. Elizabeth also takes the opportunity to review patients’ medication usage as part of the annual medication review for patients.
The Impact
- Patients: Improved health and wellbeing and overall quality of life
- System: Reduction in prescribing of gabapentinoids and increased collaborative working with the local authority
- Practitioner: Increased knowledge and collaborative working with other providers
