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Summary: Background: Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth‐based pharmacist‐partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care. Methods: This study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre‐operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre‐operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by > 50% before surgery. Results: Between December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1–4 [1–6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p < 0.001). Conclusions: The findings of this pilot study support the feasibility of a telehealth‐delivered, pharmacist‐partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted. [ABSTRACT FROM AUTHOR]

Background: Total hip and knee arthroplasties are common surgeries performed worldwide, but the management of pain during the subacute period (defined as hospital discharge to 3 months postoperatively) is poorly understood. This study aimed to determine patients' experiences, facilitators and barriers to subacute pain management following total hip or knee arthroplasty. Methods: Semi‐structured interviews with a purposive sample of patients following total hip or knee arthroplasty were conducted between June and August 2022. Participants were recruited from two tertiary metropolitan hospitals. Interviews were audio‐recorded and transcribed verbatim. Data were analysed using an inductive thematic approach to identify common themes. Results: In total, 30 interviews were conducted with patients following hip or knee arthroplasty. Four main themes were identified: (i) Physical constitution before surgery (joint condition, analgesic use, age, and hearing); (ii) Attitude and knowledge (motivation, outlook on life, attitude towards taking medications, individual benchmarking, and knowledge); (iii) Socio‐ethno‐cultural factors (family and community connection, language, and religion), and (iv) Health‐system support (health‐professional delivered education, medications, services, staff, and costs). Conclusions: Participants' experiences of subacute pain following hip or knee arthroplasty were shaped by multidimensional factors. Strategies to empower patients through increased education and support during postoperative opioid tapering as well as a shift to a biopsychosocial approach to pain management during the subacute period may improve patient and health‐system outcomes. [ABSTRACT FROM AUTHOR]

This study attempts to understand the factors that influence clinician resistance to the implementation of health information technology in a mandatory setting. A survey study was conducted with 202 clinicians regarding their perceptions of the implementation of electronic medication management systems (eMMS) in an Australian hospital. The data was collected during the initial roll-out of eMMS for model validation and quantitative analysis. The overall results indicated that performance expectancy, switching costs, and facilitating conditions are direct predictors of clinician resistance, whereas effort expectancy and social influence showed indirect effects on clinician resistance through performance expectancy or switching costs. The study is among the first study that investigates passive clinician resistance to the implementation of health information technology in a health organisation. This study also focused on opposition behaviour among under-examined degrees of resistance. This study provides some insights to the hospital management on how to mitigate clinician resistance in the implementation of health information technology. Other types of clinician resistance, such as postponement and rejection, are not examined in this study. Future research on postponement behaviour and rejection behaviour is needed to have a more comprehensive view of clinician resistance. [ABSTRACT FROM AUTHOR]