Primary care workload in the management of chronic pain: A retrospective cohort study using a GP database to identify resource implications for UK primary care

Abstract

The management of chronically painful conditions is relatively labour intensive, as there is no single treatment regime that can be reliably forecast to control symptoms across a broad range of patients and underlying conditions. The achievement of effective and well tolerated analgesia therefore carries considerable workload implications. This study set out to quantify the impact of managing therapy with nonsteroidal antiinflammatories and nonopiate analgesics within UK general practice. Two separate cohorts of patients were defined from the MediPlus GP database, in order to characterise the workload impact of both established and new patients being treated with antiinflammatory / analgesic agents. Where treatment changes occurred, the underlying reasons for these changes were identified, if possible. The relative importance of these reasons was appraised and expressed both in terms of the number of appointments used and the direct costs attributable. Similar results were obtained for both cohorts. Changes of therapy reflected side effects, intolerance and allergy in 23-25% of cases, lack of efficacy in 20-22%, and resolution of the underlying condition in 7-10% of cases. No reason was attributable in 44-47% of changes. Extrapolating these results to a national level suggests that management of therapy in these patients accounts for 4.6 million appointments per year, equivalent to 793 whole time GPs, at a total cost of around £69 million. The use of nonsteroidal antiinflammatories and nonopiate analgesics is associated with a significant impact on primary care workload, with poor efficacy being the trigger for almost as many consultations as poor tolerability. Addressing this issue may offer an important contribution towards reducing maximum waiting time for appointments in general practice towards the target of 48 hours.