HOPE-AO overprescribing in older adults with chronic pain: a protocol for qualitative interviews with patients and healthcare professionals

Background
Pain in the older population is often poorly identified and subsequently poorly managed. Many myths and misconceptions exist amongst both older adults and healthcare professionals, including fear of using other methods of pain management and failure to monitor the impact of current approaches. This leads to underreporting of pain by the older adult population, overprescribing of pain medication, and failure to monitor the impact of prescribed drugs until major health crises such as falls or other serious complications occur, which can result in hospitalisation.

Methods
The aim of this study was to explore chronic pain prescribing in older adults, both in terms of the population itself and in terms of individual perceptions, experiences and overall needs. As such, two work packages were employed, firstly to explore the wider prescribing patterns using the CPRD database (quantitative work package), and secondly to explore individual experiences using qualitative interviews (qualitative work package). The mixed methods methodology included an epidemiological approach along with qualitative methodology and a discrete choice experiment. Ultimately, the final outcomes of this investigation will lead to adopting a codesigned intervention which will be evaluated in a later research programme. This protocol focuses on both the qualitative work package and the wider project, including a brief outline of the quantitative work package. A more detailed technical protocol for the quantitative work package is available in a linked publication.

Plain Language Summary
People being prescribed too much pain medicine, for too long, and often when people don’t need it. Known as “overprescribing”, this is a particularly big problem in older adults. We need to solve overprescribing but are not yet sure about the best way of doing this.

Our project will investigate prescribing of pain medicine in older adults, to understand the issue and work towards a solution. There are two important things we need to look at; i) to understand more about the older adults who are taking pain medicines ii) to understand more about people’s experiences of taking pain medicines, along with their experiences of managing pain.

We will look at a big database of medical data, to understand more about who is taking these medicines, for how long, and what health conditions they have. We will interview 30 people who are taking these medicines, along with their family carers and 10 healthcare professionals. This will help us to understand people’s perception of how well these medicines work, how they feel about taking them, what else they do to manage their pain, and what they think about their wider healthcare.

We will develop a panel of ten people, overseen by a patient and public involvement lead. We have already worked with patients and members of the public in preparation for this project. The panel will meet monthly, and help with things like solving problems, sharing ideas and expertise, planning activities, and making sense of findings.

Towards the end of this project, we will bring together everything we have learned, and share what we have found out. We will prepare for a future project that follows on from this work, where we work with older adults with chronic pain, to design guidelines for better and safer pain management.