Association of socioeconomic deprivation with opioid prescribing in primary care in England: a spatial analysis

Nowakowska, Magdalena; Zghebi, Salwa S; Perisi, Rosa; Chen, Li‐Chia; Ashcroft, Darren M.; Kontopantelis, Evangelos

doi:10.1136/jech-2020-214676

Cited by 20 publications

(20 citation statements)

References 22 publications

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“… 7 More than 231 million opioid prescriptions were dispensed in primary care in 2018–2019 alone. 8 Research also shows a variation in prescribing patterns across geographical locations and socioeconomic factors. The majority of the highest prescribing areas are located in the North of England and deprivation is strongly associated with opioid prescribing when accounting for population demographics and disease prevalence.…”

Section: Introductionmentioning

confidence: 99%

Digitally deployed, GP remote consultation video intervention that aims to reduce opioid prescribing in primary care: protocol for a mixed-methods evaluation

Allen²,

Batterham

et al. 2023

BMJ Open

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IntroductionOpioid prescribing rates are disproportionately high in the North of England. In addition to patients’ complex health needs, clinician prescribing behaviour is also a key driver. Although strategies have been initiated to reduce opioid prescribing nationally, the COVID-19 pandemic has interrupted service provision and created challenges for the system and health professionals to tackle this complex issue. A pilot intervention using smartphone video messaging has been developed to remotely explain the rationale for opioid reduction and facilitate self-initiation of support. The aim of this study is to evaluate the potential benefits, risks and economic consequences of ‘at scale’ implementation.Methods and analysisThis will be a mixed-methods study comprising a quasi-experimental non-randomised before-and-after study and qualitative interviews. The intervention arm will comprise 50 General Practitioner (GP) Practices using System 1 (a clinical computer system hosting the intervention) who will deliver the video to their patients via text message. The control arm will comprise 50 practices using EMIS (a different computer system) who will continue usual care. Monthly practice level prescribing and consultation data will be observed for 6 months postintervention. A general linear model will be used to estimate the association between the exposure and the main outcome (opioid prescribing; average daily quantity (ADQ)/1000 specific therapeutic group age-sex related prescribing unit). Semi-structured interviews will be undertaken remotely with purposively selected participants including patients who received the video, and health professionals involved in sending out the videos and providing additional support. Interviews will be audio recorded, transcribed and analysed thematically.Ethics and disseminationEthics approval has been granted by the NHS Health Research Authority Research Ethics Committee (22/PR/0296). Findings will be disseminated to the participating sites, participants, and commissioners, and in peer-reviewed journals and academic conferences.Trial registration numberNCT05276089.

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Section: Introductionmentioning

confidence: 99%

Digitally deployed, GP remote consultation video intervention that aims to reduce opioid prescribing in primary care: protocol for a mixed-methods evaluation

Allen²,

Batterham

et al. 2023

BMJ Open

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“…This is reflected in the plethora of research that studies spatial aspects of health in different ways, for example, as spatial patterns of diseases and mortality (e.g. Marshall 1991, Lawson 2018, Kulldorff, Nagarwalla 1995, Santos et al 2020, Nowakowska et al 2021, geographical distribution of healthcare services and their utilization (e.g. Santana et al 2009, Gravelle et al 2014, Longo et al 2017, Okoli et al 2020, Shinjo, Aramaki 2012, Pongiglione et al 2020, Renner 2020), E1 E2 A. Renner, R. Santos, B. Pongiglione, R. Hoffmann or environmental shocks on population health (Gemmell et al 2000, Analitis et al 2008, Almendra et al 2017.…”

Section: Introductionmentioning

confidence: 99%

Editorial for the Special Issue “Spatial and regional aspects of health”

Renner¹,

Santos

Pongiglione

et al. 2022

REGION

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The health crisis caused by the COVID-19 pandemic highlights, more than ever, the necessity of scientific research to inform policy action. During such a crisis it is vital that any measures taken by policy makers mitigate the consequences of risks without causing long-lasting social and economic harm. Spatial aspects play an important role here: knowledge about the spread of a disease through space and social networks, the effectiveness of different policy responses, and the economic and social implications for the population are of particular relevance. As any policy action is embedded in its institutional and social environment, not every measure is effective in all contexts. Moreover, infectious diseases can spread at different speed in different places, requiring tailored interventions. Careful evaluation and comparison of different settings, including the organization of the healthcare systems and the geographic and demographic characteristics of a region or country, is therefore essential. The COVID-19 pandemic has made manifest the importance of the spatial and geographical dimension of health, however, the relevance of this interlinkage is not limited to the spread of contagious diseases. Differences in accessibility of services between urban and rural regions, the varying costs of access to healthcare for different (socioeconomic) groups of the population, the impact of these on healthcare utilization, and environmental shocks on population health are just a few examples illustrating the close link between space, socioeconomic factors and health. This special issue of REGION is presented in two parts. In the first part, papers explore the spread and impact of the COVID-19 pandemic on the health and economy. In the second part, papers investigate regional and spatial aspects of the healthcare sector with a focus on health disparities.

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“…Previous studies have observed gender, age and socio-economic deprivation to be implicated for higher OMEQ doses of opioids (Spooner 2016;Todd et al 2018;Macfarlane et al 2020;Nowakowska et al 2020;Richards et al 2020). Studies…”

Section: Comparison Of Trends In Opioid Burdenmentioning

confidence: 96%

“…Added to this, concerns about rising rates of opioid prescribing in the UK have escalated since the start of the 2000's Ruscitto et al 2015). This is in part, a result of the highly publicised problems experienced in North America (Weisberg and Stannard 2013;Vokinger 2018;Verhamme and Bohnen 2019) again, concentrated in areas of greatest socioeconomic deprivation (Kurani et al 2020;Nowakowska et al 2020). Wales is a country where a sizeable part of the population have poor health (Public Health Wales Observatory 2018; StatsWales 2020; NHS Wales 2021) and live in relative poverty (Barnard 2018).…”

Section: Why Is Research Needed In Wales?mentioning

confidence: 99%

“…Higher prevalence of pain, and consequently opioid prescribing, in women is acknowledged (Dao and LeResche 2000;Rhudy and Williams 2005;Pieretti et al 2016), even if the reasons for it are less well understood (Terplan 2017;Mazure and Fiellin 2018). Higher levels of ill-health or pain in areas of greater socioeconomic deprivation are often used as the explanation for higher rates of opioid prescribing (Todd et al 2018;Nowakowska et al 2020;Schifanella et al 2020) whilst acknowledging that this alone is not justification enough. Of particular concern is the harms of opioids medicines are likely to have greater impact in those areas where health is already worse.…”

Section: Concerns About Increasing Rates Of Opioid Prescribing In Wal...mentioning

confidence: 99%

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Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

Davies¹

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Background:Opioid prescribing in the UK has increased significantly since the start of the millennium and has been associated with a rise in chronic pain reporting. In Wales, despite concern about rising rates of opioid analgesic prescribing, no detailed examination of the data had been undertaken to assess the changes in prescribing and its consequent impact on the population. Methods:In this study, anonymised, individual level data of people diagnosed with non-cancer pain in Wales was extracted from the Secure Anonymised Information Linkage (SAIL) Databank and used to scrutinise opioid analgesic prescribing trends in people aged 18 years and over, establish whether legislation or clinical guidance impacted on those trends and examine associations with increased healthcare use. The study was conducted in two phases. Phase 1 included a retrospective, repeated cross-sectional analysis of opioid analgesics issued from Primary Care, stratified by gender, age and socioeconomic status. Phase 2 of the study evaluated differences in healthcare service use and costs between individuals receiving opioids for defined non-cancer pain-related diagnoses and matched patients not receiving opioids. Results:Total opioid prescribing increased by 43.6% and strong opioids by 306.2% between 2005 and 2015. Women received 1.5 times more prescriptions than men. Increasing age was associated with higher prescribing rates. People in the most deprived areas received 2.4 times more prescriptions than in least deprived. People receiving opioid prescriptions accessed primary care four times more frequently than controls and had twice the number of hospital admissions. Opioid prescription was associated with 41% higher healthcare costs than noted in controls. Conclusion:This research highlights the need to develop a national strategy to address pain management and opioid stewardship in Wales. We must consider how to address the wide variability observed, particularly between areas of differing socioeconomic status. Further research should investigate what underlies continued opioid prescribing and how alternative strategies can be implemented in practice to reduce population harm and optimise the use of limited healthcare resources.

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Association of socioeconomic deprivation with opioid prescribing in primary care in England: a spatial analysis

Cited by 20 publications

References 22 publications

Digitally deployed, GP remote consultation video intervention that aims to reduce opioid prescribing in primary care: protocol for a mixed-methods evaluation

Digitally deployed, GP remote consultation video intervention that aims to reduce opioid prescribing in primary care: protocol for a mixed-methods evaluation

Editorial for the Special Issue “Spatial and regional aspects of health”

Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

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