Association of opioid prescribing practices with chronic pain and benzodiazepine co-prescription: a primary care data linkage study
Association of opioid prescribing practices with chronic pain and benzodiazepine co-prescription: a primary care data linkage study
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DOI：
10.1016/j.bja.2018.02.022
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发表时间：
2018-06-01
影响因子：
9.8
通讯作者：
Colvin, L.
中科院分区：
文献类型：
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作者：
Torrance, N.;Mansoor, R.;Colvin, L.
背景：阿片类药物处方在全世界范围内都在增加，相关的滥用和其他危害也在增加。我们研究了苏格兰全国阿片类药物处方率、处方质量指标、苯二氮卓类药物的联合处方以及与疼痛严重程度的关系。方法：苏格兰阿片类药物处方的电子联系来自：(I)来自NHS苏格兰信息服务部的国家数据(2003-2012年)；(Ii)苏格兰一代的个人数据：苏格兰家庭健康研究。对国家数据进行了描述性分析，建立了多水平模型，以检查与处方率变化相关的因素。结果：强效阿片类药物处方数量从2003年的474 385张增加到2012年的1 036 446张，增加了一倍多，弱阿片类药物处方数量从3 261 547张增加到4 852 583张。在苏格兰，2012年有938 674人开了阿片类药物处方(占总人口的18%)。最贫困地区的患者接受强阿片类药物的可能性是最贫穷地区患者的3.5倍。不同地理区域之间的处方率有很大差异，其中很大一部分是被剥夺了。在25-40岁的女性中，40%的人同时服用了苯二氮卓类药物。疼痛严重程度与阿片类药物处方的接收之间存在显著关联。超过50%的报告剧烈疼痛的人没有开阿片类止痛药。结论：我们发现在苏格兰，在初级保健中使用阿片类药物很常见，而且越来越多，尤其是对于剧烈疼痛。阿片类药物和苯二氮卓类药物的联合处方很常见。
Background: Opioid prescribing is increasing worldwide with associated increases in misuse and other harms. We studied variations in national opioid prescription rates, indicators of prescribing quality, co-prescribing of benzodiazepines and relationship with pain severity in Scotland.Methods: Electronic linkages of opioid prescribing in Scotland were determined from: (i) national data from Information Services Division, NHS Scotland (2003-2012); and (ii) individual data from Generation Scotland: Scottish Family Health Study. Descriptive analyses were conducted on national data, multilevel modelling to examine factors associated with variations in prescribing rates. chi(2) tests examined associations between individual pain severity and opioid prescriptions.Results: The number of strong opioid prescriptions more than doubled from 474 385 in 2003 to 1 036 446 in 2012, and weak opioid prescribing increased from 3 261 547 to 4 852 583. In Scotland, 938 674 individuals were prescribed an opioid in 2012 (18% of the population). Patients in the most deprived areas were 3.5 times more likely to receive a strong opioid than patients in the least deprived. There was significant variation in prescribing rates between geographical areas, with much of this explained by deprivation. Of women aged 25-40 yr prescribed a strong opioid, 40% were also prescribed a benzodiazepine. There was significant association between pain severity and receipt of opioid prescription. Over 50% of people reporting severe pain were not prescribed an opioid analgesic.Conclusions: We found opioid prescribing in primary care to be common and increasing in Scotland, particularly for severe pain. Co-prescribing of opioids and benzodiazepines was common.