Opioid prescribing trends and geographical variation in England, 1998-2018: a retrospective database study
Opioid prescribing trends and geographical variation in England, 1998-2018: a retrospective database study
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DOI：
10.1016/s2215-0366(18)30471-1
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发表时间：
2019-02-01
影响因子：
64.3
通讯作者：
Goldacre, Ben
中科院分区：
文献类型：
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作者：
Curtis, Helen J.;Croker, Richard;Goldacre, Ben
在英国，有一种呼吁加强对阿片类药物处方的监测，特别是对慢性疼痛的强阿片类药物的监测，很少有临床益处的证据。我们的目的是全面评估1998年至2018年英国初级保健中阿片类药物处方的趋势和变化，并评估与一般实践中大剂量阿片类药物处方行为相关的因素。方法：我们使用开放数据源对英国所有全科医生的处方进行回顾性数据库研究。对于所有标准阿片类药物，我们计算了处方项目的数量、成本和口服吗啡当量，以解释强度的变化。我们评估了1998年至2017年的长期处方趋势，2018年的地理变化模式，并调查了与阿片类药物处方增加相关的实践因素。我们还分析了高剂量长效阿片类药物的处方。从1998年到2016年，英格兰的阿片类药物处方增加了34%（从每1000名患者568名增加到每1000名患者761名）。在对总口服吗啡当量进行校正后，增加了127%（从每1000人19万毫克增加到431万毫克）。从2016年到2017年，处方数量有所下降。如果每个诊所都以最低的十分位数开高剂量阿片类药物，那么在6个月期间就可以少开54.3万张高剂量处方。更大的执业名单规模、农村性和剥夺与更高的高剂量处方率相关。某执业所所属的临床调试组占大剂量处方变化的11.7%。我们已经开发了一个公开可用的交互式在线工具，OpenPrescribing.net，它显示了英国所有初级保健阿片类药物处方数据，直至个人实践水平。未能解释阿片类药物的强度将大大低估阿片类药物处方在英国国家卫生服务（NHS）的真实增长。我们的研究结果支持呼吁采取更大的行动来促进慢性疼痛处方的最佳实践，并减少地域差异。本研究为阿片类药物处方的常规监测提供了一个模型，以帮助靶向干预措施减少高剂量处方。爱思唯尔有限公司版权所有版权所有。
Background There is a call for greater monitoring of opioid prescribing in the UK, particularly of strong opioids in chronic pain, for which there is little evidence of clinical benefit. We aimed to comprehensively assess trends and variation in opioid prescribing in primary care in England, from 1998 to 2018, and to assess factors associated with high-dose opioid prescribing behaviour in general practices.Methods We did a retrospective database study using open data sources on prescribing for all general practices in England. For all standard opioids we calculated the number of items prescribed, costs, and oral morphine equivalency to account for variation in strength. We assessed long-term prescribing trends from 1998 to 2017, patterns of geographical variation for 2018, and investigated practice factors associated with higher opioid prescribing. We also analysed prescriptions for long-acting opioids at high doses.Findings Between 1998 and 2016, opioid prescriptions increased by 34% in England (from 568 per 1000 patients to 761 per 1000). After correcting for total oral morphine equivalency, the increase was 127% (from 190 000 mg to 431 000 mg per 1000 population). There was a decline in prescriptions from 2016 to 2017. If every practice prescribed high-dose opioids at the lowest decile rate, 543 000 fewer high-dose prescriptions could have been issued over a period of 6 months. Larger practice list size, ruralness, and deprivation were associated with greater high-dose prescribing rates. The clinical commissioning group to which a practice belongs accounted for 11.7% of the variation in high-dose prescribing. We have developed a publicly available interactive online tool, OpenPrescribing.net, which displays all primary care opioid prescribing data in England down to the individual practice level.Interpretation Failing to account for opioid strength would substantially underestimate the true increase in opioid prescribing in the National Health Service (NHS) in England. Our findings support calls for greater action to promote best practice in chronic pain prescribing and to reduce geographical variation. This study provides a model for routine monitoring of opioid prescribing to aid targeting of interventions to reduce high-dose prescribing. Copyright (C) 2018 Elsevier Ltd. All rights reserved.