Associate Professor Suzanne Nielsen was successful in the 2017 round of Theme and CAG collaborative research seed funding for her project 'Room for improvement: implementing routine opioid outcome monitoring in community pharmacy’.
Can you please tell us about the initial project and what you are hoping to achieve?
The project came about because we knew that most opioids were supplied through community pharmacies, and we had seen rising harms in relation to pharmaceutical opioids, yet pharmacists didn’t have the tools to support them to prevent harms for patients who were prescribed opioids. The project aimed to develop and test Routine Opioid Outcome Monitoring (ROOM) in pharmacies, and ultimately support better conversations between pharmacists and people who are prescribed opioids about pain management and opioid safety.
Can you say a little about how the project developed into the larger project?
The project developed from an initial smaller piece of work that was supported by the Central and Eastern Sydney Primary Health Network to develop a screening tool for opioid use disorder. As that work progressed it became clear that it was important to screen for opioid-related problems as part of a more holistic approach ‘ROOM’. A holistic approach involves assessing outcomes like unmanaged pain, depression and side effects from opioids. With the support of the seed funding we were able to pilot the implementation of the broader ROOM tool into community pharmacy practice. We conducted an implementation study in 23 pharmacies across NSW and Victoria. Through this, we were able to learn about feasibility, acceptability of using the tool in addition to common problems with opioids that people the community were experiencing.
What impact has the project/s had?
There has been a lot of interest in the tools that we have developed so far, both the Opioid Use Disorder screening tool (the ‘OWLS’), and the ROOM tool. Since developing them we have had feedback about their use in a range of health settings in Australia and internationally, including an ongoing study in Canada which is testing the use of the tool across a large hospital network. I am regularly getting emails asking about using the tool, or providing feedback that it has been useful, which is really encouraging. We also found through the results that the level of opioid-related risk among those prescribed opioids was surprisingly high, yet naloxone supply was minimal –so this has highlighted an important aspect around improving opioids safety that we can address.
What are some of the highlights of the outcomes?
It has been great to hear that the research hasn’t ended up sitting in a report on a shelf, or limited to being an in academic paper. We did publish 6 papers on the development, validation and implementation of the tools, and that academic rigour is important. A highlight has been around hearing that the tools which we developed are being used in South Australia, Queensland, and Canada, and are being recommended in documents on government websites etc. It is great to be able to offer a clinical tool that people are finding useful for clinical care.
How did the project support new collaborations between the theme and SPHERE partners?
Through the work we have built a collaboration that now spans NSW and Victoria with academic and clinical partnerships. We hope that the next stage will involve larger trial of different implementation strategies to determine which approaches are more effective at supporting better outcomes with prescription opioids, and also see how we can more effectively delivery brief interventions with naloxone.
Is there any call to action or collaboration needs you would like to highlight?
I think one key thing that supported this project was input from our project advisory group who gave us really key insights from the consumer and health care professional perspective. Too much research happens in academia without those connections, and it is a shame because it is that collaboration and input from lived-experience and clinical experience that helps design research that is really useful to the community.
What’s next?
I am about to give a final webinar on the clinical aspects of the ROOM next week. After that, we are looking at testing how we can most effectively support pharmacists to use the tools we have developed to improve clinical outcomes with opioids. Through our implementation study we found that providing the ROOM tool in addition to training significantly increased pharmacists’ confidence to identify and respond to a range opioid-related problems. Yet, most pharmacists still had moderate rather than high levels of confidence at follow-up. As a result, we want to determine effective strategies to further improve pharmacists’ confidence. We also found that pharmacists who had lower levels of baseline knowledge and confidence were less likely to use the tool, so we want to test specific implementation strategies to support those pharmacists to identify and respond to opioid-related problems.