Prescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristics

ObjectivesTo examine trends in opioid prescribing in primary care, identify patient and general practice characteristics associated with long-term and stronger opioid prescribing, and identify associations with changes in opioid prescribing.DesignTrend, cross-sectional and longitudinal analyses of r...

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Vydané v:BMJ open Ročník 6; číslo 5; s. e010276
Hlavní autori: Foy, Robbie, Leaman, Ben, McCrorie, Carolyn, Petty, Duncan, House, Allan, Bennett, Michael, Carder, Paul, Faulkner, Simon, Glidewell, Liz, West, Robert
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England BMJ Publishing Group LTD 13.05.2016
BMJ Publishing Group
Predmet:
Adolescent
Adult
Aged
Analgesics
Analgesics, Opioid - therapeutic use
Cancer
Cross-Sectional Studies
Drug dosages
Drug Prescriptions - statistics & numerical data
England
Family Practice - trends
Female
General practice / Family practice
Humans
Male
Middle Aged
Mortality
Narcotics
Pain management
Performance management
Population
Practice Patterns, Physicians' - statistics & numerical data
Primary care
Trends
Young Adult
United Kingdom > UK
Prescribing
Variations
Opioids
Primary
ISSN:2044-6055, 2044-6055
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Shrnutí:ObjectivesTo examine trends in opioid prescribing in primary care, identify patient and general practice characteristics associated with long-term and stronger opioid prescribing, and identify associations with changes in opioid prescribing.DesignTrend, cross-sectional and longitudinal analyses of routinely recorded patient data.Setting111 primary care practices in Leeds and Bradford, UK.ParticipantsWe observed 471 828 patient-years in which all patients represented had at least 1 opioid prescription between April 2005 and March 2012. A cross-sectional analysis included 99 847 patients prescribed opioids between April 2011 and March 2012. A longitudinal analysis included 49 065 patient-years between April 2008 and March 2012. We excluded patients with cancer or treated for substance misuse.Main outcome measuresLong-term opioid prescribing (4 or more prescriptions within 12 months), stronger opioid prescribing and stepping up to or down from stronger opioids.ResultsOpioid prescribing in the adult population almost doubled for weaker opioids over 2005–2012 and rose over sixfold for stronger opioids. There was marked variation among general practices in the odds of patients stepping up to stronger opioids compared with those not stepping up (range 0.31–3.36), unexplained by practice-level variables. Stepping up to stronger opioids was most strongly associated with being underweight (adjusted OR 3.26, 1.49 to 7.17), increasing polypharmacy (4.15, 3.26 to 5.29 for 10 or more repeat prescriptions), increasing numbers of primary care appointments (3.04, 2.48 to 3.73 for over 12 appointments in the year) and referrals to specialist pain services (5.17, 4.37 to 6.12). Compared with women under 50 years, men under 50 were less likely to step down once prescribed stronger opioids (0.53, 0.37 to 0.75).ConclusionsWhile clinicians should be alert to patients at risk of escalated opioid prescribing, much prescribing variation may be attributable to clinical behaviour. Effective strategies targeting clinicians and patients are needed to curb rising prescribing, especially of stronger opioids.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2015-010276