Improving the quality and experience of care for patients prescribed medicines with a risk of dependence or withdrawal

Background A recent review by Public Health England found that 11.5 million people, equivalent to 26% of the adult population, were prescribed medications with a risk of dependence or withdrawal in 2017/2018.

During the initial conceptualisation of this study, we established an advisory group of patients who have experienced medication dependence to identify and prioritise areas for research.

Most had experienced unsatisfactory patient care during medically managed withdrawal and felt that patient experience of care should be a research priority.

Public Health England acknowledges that patients prescribed these medications do not always receive appropriate care and has called for further research.

Aims and objectives This 18 month study aims to improve the quality and experience of care for patients prescribed benzodiazepines, Z-drugs, antidepressants, opioids and gabapentinoids.

The study will bring together patients and healthcare staff from Norwich Clinical Commissioning Group to i) develop understanding of current patient and staff experience, ii) identify strategies and priorities to improve the experience and quality of care, iii) design and implement change to improve the quality and experience of care.

Methods The study will use Experienced Based Co-Design, a form of participatory action research that has been designed for and within the NHS to improve treatment and care. We will work with three GP practices to recruit and interview 20 patients and 15 health professionals. Patient interviews will focus on key phases of the patient journey and will be video-recorded.

Staff interviews will explore what is and isn t working well from their perspective and will be audio-recorded. All interviews will be analysed for key themes.

Patient interviews will be used to create a 30-minute trigger film which highlights the key emotional moments throughout the patient journey.

Using the findings and the patient film we will hold feedback events for staff and patients to identify key areas for improvement. A co-design team of both staff and patients will then be established to design and implement solutions.

Anticipated impact and dissemination We anticipate that this study will contribute to improved patient experience and a reduction in harm associated with medication dependence, withdrawal and the adverse effects of long-term use. The key audiences for this research are healthcare professionals, patients and policy makers.

Outputs will include a list of 10 things that patients say would improve their experience , an edited film from patients interviews, quick guides for healthcare workers and patients, interactive webinars for professionals and patients, policy briefings, presentations at meetings, conferences and practitioner events and academic papers.

The findings will be disseminated to GP practices and patients in Norfolk and Suffolk through research briefings distributed via email, Twitter and the public facing website. We will give presentations at GP forums.

The findings will also be shared with more than 3,000 Substance Misuse Management in General Practice members comprising doctors, pharmacists, nurses, keyworkers and patient advocates via the organisation's newsletter and website.