Indicator development programme
Open for comments Open until Request commenting lead permission
We have updated this service so that members of the same organisation can now collaborate on a joint online response.
Read our blog to learn more.
Pain: annual review long term opioid use
GID-IND10345: The percentage of patients on long-term opioids who have had a medication review in the preceding 12 months.
Indicator type
General practice indicator suitable for use in the QOF.
Rationale
Prolonged use of opioids may lead to drug tolerance and dependence. Reviewing long term opioids use can help reduce adverse events and clinical harm and result in a reduction of the number of opioids prescribed. The review is an opportunity to discuss the benefits and risks of continuing the current dose, adjusting the dose or stopping the medicine as well as discussing non-pharmacological pain management strategies. The intention of the indicator is to increase the proportion of patients on long-term opioids who have a medication review.
Source guidance
Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. NICE guideline NG215 (2022), recommendations 1.4.1,1.4.3 and 1.4.5
Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline NG193 (2021), recommendation 1.2.11
Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE guideline NG5 (2015), recommendations 1.4.1 to 1.4.3
Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. NICE guideline CG76 (2009), recommendations 1.3.1 and 1.3.2
Specification
Numerator: The number of patients in the denominator who have had a medication review in the preceding 12 months.
Denominator: The number of patients prescribed opioids for more than 3 consecutive months in the preceding 12 months.
Definitions:
Opioids are all opioids described in the 'strong opioids' and 'weak opioids' sections of the BNF treatment summary for analgesics, plus hydromorphone hydrochloride.
Long-term use of opioids is defined as prescriptions in the preceding 12 months that lasted for more than 3 consecutive months.
A medication review is a structured, critical examination of a person's medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medication‑related problems and reducing waste (NICE's guideline on medicines optimisation). All SNOMED codes for medication reviews are included (not just those specific to the review of opioid medication) to identify relevant electronic patient records. The medication review date must occur after the date of the first prescription of opioids within the period that exceeds 3 consecutive months.
Exclusions: None.
Personalised care adjustments or exception reporting should be considered to account for situations where the patient declines or does not attend.
Question for consultation:
13. Is the definition of long-term use of opioids appropriate?
How are you taking part in this consultation?
You will not be able to change how you comment later.
You must be signed in to answer questions