Patient perspectives and experiences of pharmacist-partnered opioid tapering prior to total hip or knee arthroplasty: A nested qualitative study.

Opioid use prior to hip or knee arthroplasty is associated with worse outcomes after surgery. Opioid tapering is recommended prior to surgery, but little is known about the most appropriate methods and what patients' perspectives and experiences may be. The aim of this study was to understand patient perspectives and experiences of pharmacist-partnered opioid tapering prior to total hip or knee arthroplasty. This qualitative study was nested in a pilot randomised clinical trial which aimed to establish the feasibility of pharmacist-partnered opioid tapering prior to hip or knee replacement. All participants who were part of the pharmacist-partnered opioid tapering service were invited to participate. Data were analysed using an inductive thematic approach to identify main themes related to patient experiences and perspectives of pharmacist-partnered opioid tapering. In total, 16 interviews were conducted. Four main themes were identified regarding patient perspectives on pharmacist-partnered opioid tapering: (i) Challenges in managing opioid use (limited pain relief and adverse effects, fear of opioid use disorder, wanting better post-surgical outcomes, General Practitioner (GP) unavailability to support tapering opioids); (ii) Empathetic, personalised care (Emotional support throughout opioid tapering, patient-centred strategies); (iii) Empowerment through education (non-pharmacological strategies, simple analgesia, opioid tapering strategies); and (iv) Support for pharmacist to deliver service (patient support, patient reported General Practitioner support). Patients who underwent pharmacist-partnered opioid tapering felt empowered and supported in their pain management journey. Pharmacist-partnered opioid tapering appears to be an acceptable intervention to reduce opioid dose prior to total hip or knee arthroplasty. PERSPECTIVE: This qualitative study highlights patients perspectives on pharmacist-partnered opioid tapering before hip or knee arthroplasty. Participants valued pharmacists patient-focused, empathetic approaches to tapering, and many were motivated by the goal of improving surgical outcomes.