11 research outputs found

    Barriers and facilitators to opioid deprescribing among Advanced Nurse Practitioners: A qualitative interview study

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    Aim: To explore the experiences primary care Advanced Nurse Practitioners have had in relation to deprescribing opioids in chronic nonā€malignant pain. Design: A qualitative interview study. Methods: Primary care Advanced Nurse Practitioners were recruited from across the Northern Ireland GP Federations. Data collection for this study took place between April and June 2022. In total, 10 semiā€structured online interviews were conducted. Interviews were audio and visually recorded, transcribed verbatim and interpreted using a thematic analysis framework. The COREQ criteria were used to guide the reporting of this study. Results: The Advanced Nurse Practitioners experienced several challenges associated with opioid deprescribing and the implementation of current chronic pain guidelines. The main barriers identified were difficulties engaging patients in deprescribing discussions, a lack of availability of supportive therapies and poor access to secondary care services. The barriers identified directly impacted on their ability to deliver best practice which resulted in a sense of professional powerlessness. Conclusion: The experiences of the Advanced Nurse Practitioners demonstrate that opioid deprescribing in patients with chronic pain is challenging, and implementation of current chronic pain guidelines is difficult. Impact: This study contributes to existing literature on the topic of reducing opioid prescribing and as far as the authors are aware, is the first study to examine the experiences of primary care advanced nurse practitioners in this context. These findings will be of interest to other primary care practitioners, and prescribers involved in the management of chronic nonā€malignant pain. Patient or Public Contribution: No patient or public contribution

    Estimating and Examining the Costs of Inpatient Diabetes Care in an Irish Public Hospital

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    AIM: To estimate and examine hospitalisation costs of Type 1 and Type 2 diabetes in an Irish public hospital. METHODS: A retrospective audit of hospital inpatient admissions over a 5ā€year period was undertaken, and a wide range of admissionā€related data were collected for a sample of 7,548 admissions. Hospitalisations were costed using the diagnosisā€related group methodology. A series of descriptive, univariate and multivariate regression analyses were undertaken. RESULTS: The mean hospitalisation cost for Type 1 diabetes was ā‚¬4,027 and for Type 2 diabetes was ā‚¬5,026 per admission. Sex, admission type and length of stay were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 1 diabetes. Age, admission type, diagnosis status, complications status, discharge destination, length of stay and year were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 2 diabetes. Length of stay was associated with higher mean costs, with each additional day increasing Type 1 diabetes costs by ā‚¬260 (pĀ =Ā 0.001) and Type 2 diabetes by ā‚¬216 (pĀ <Ā 0.001). Unscheduled admissions were associated with significantly lower costs than elective admissions; ā‚¬1,578 (pĀ =Ā 0.035) lower for Type 1 diabetes and ā‚¬2,108 (pĀ <Ā 0.001) lower for Type 2 diabetes. CONCLUSIONS: This study presents estimates of the costs of diabetes care in the Irish public hospital system and identifies the factors which influence costs for Type 1 and Type 2 diabetes. These findings may be of interest to patients, the public, researchers and those with influence over diabetes policy and practice in Ireland and internationally
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