Impact of eliciting treatment priorities on analgesic prescribing in older patients with high levels of polypharmacy

Background: Multimorbidity guidelines recommend tailoring care to patients’ priorities. The Supporting Prescribing in Multimorbidity in Primary Care (SPPiRE) trial focused on optimising medicines use in older adults with significant polypharmacy and tailoring prescribing and deprescribing to individual priorities. This study aimed to compare self-reported and GP-recorded patient priorities and examine the impact of prioritising pain on analgesic prescribing. Methods: This secondary cohort analysis of the SPPIRE trial and process evaluation assessed baseline participants-identified priorities and intervention group GP-recorded priorities during medication reviews with agreement assessed using Cohen’s kappa. Analgesic prescribing patterns and daily morphine milligram equivalents (MME) changes during the study period were summarised. , The impact of pain (self-reported, GP-recorded and severe or extreme pain on the baseline EQ5D) on opioid intensification was analysed using multilevel models accounting for GP practice clustering and intervention effects. . Results: 403 patients (mean age 76.5 years) were included; 178 (44.2%) reported pain as a priority at baseline. Agreement between self-reported and GP-recorded pain was poor (kappa 0.118, p=0.05). Most analgesic prescriptions decreased during the study, except for potent opioids, which increased in both trial arms. All three pain variables were associated with increased odd of opioid intensification at follow-up. Conclusion: In this older population of patients with significant polypharmacy, identifying pain as a priority was associated with an increased likelihood of opioid intensification, despite guidelines advising against their use for chronic pain. This study highlights the challenges faced by GPs treating pain in older adults with multimorbidity. This Stata do file contains the code used to perform the analyses described in this study.