Evaluation of a primary care-based opioid and pain review service: a mixed-methods evaluation in two GP practices in England

Scott, Lauren J; Kesten, Joanna M; Bache, Kevin; Hickman, Matthew; Campbell, Rona; Pickering, Anthony; Redwood, Sabi; Thomas, Kyla H

doi:10.3399/bjgp19x707237

Cited by 15 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32 CCGs with elevated prescribing levels observed in some but not all areas could benefit from practice and community based interventions which could lead to a reduction in opioid use and improvement in health outcomes of people treated with opioids. 33 In the face of no one-size-fits-all intervention successful at improving opioid prescribing patterns, 17 evidence provided in this study can guide policy designers in ensuring that appropriate resources are allocated where they can bring the most benefits.…”

Section: Discussionmentioning

confidence: 96%

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

Nowakowska

Zghebi

Perisi

et al. 2020

J Epidemiol Community Health

View full text Add to dashboard Cite

BackgroundThe increasing trends in opioid prescribing and opioid-related deaths in England are concerning. A greater understanding of the association of deprivation with opioid prescribing is needed to guide policy responses and interventions.MethodsThe 2018/2019 English national primary care prescribing data were analysed spatially. Prescribing of opioids in general practice was quantified by defined daily doses (DDD) and attributed to 32 844 lower layer super output areas (LSOAs), the geographical units representing ~1500 people. Linear regression was used to model the effect of socioeconomic deprivation (quintiles) on opioid prescribing while accounting for population demographics and the prevalence of specific health conditions. Adjusted DDD estimates were compared at each deprivation level within higher organisational areas (Clinical Commissioning Groups, CCGs).ResultsIn total, 624 411 164 DDDs of opioids were prescribed. LSOA-level prescribing varied between 1.7 and 121.04 DDD/1000 population/day. Prescribing in the most deprived areas in the North of England was 1.2 times higher than the national average for areas with similar deprivation levels and 3.3 times higher than the most deprived areas in London. Prescribing in the most deprived areas was on average 9.70 DDD/1000 people/day (95% CI 9.41 to 10.00) higher than the least deprived areas. Deprivation-driven disparities varied between individual CCGs. In the most unequal CCG, prescribing in the most deprived areas was twice that in the least deprived areas.ConclusionOpioid prescribing varied substantially across England and deprivation was strongly associated with prescribing. This paper provides evidence for guiding policy interventions and allocation of resources to areas with the highest levels of opioid prescribing.

show abstract

Section: Discussionmentioning

confidence: 96%

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

Nowakowska

Zghebi

Perisi

et al. 2020

J Epidemiol Community Health

View full text Add to dashboard Cite

show abstract

“…An article published in February 2020 by Scott et al [ 31 ▪ ] evaluated a primary care-based opioid and pain review service using a mixed methods approach. In the United Kingdom, primary care refers to the management of patients with a general practice setting, which is where the majority of patients are managed unless they require specialist treatment.…”

Section: Effectiveness Of Novel Opioid and Pain Review Servicesmentioning

confidence: 99%

“…In total, 34 patients enrolled in the novel service and a decrease in median prescribed opioid dose was observed from baseline ( P < 0.0001). Improvements in health, wellbeing and quality of life were also observed [ 31 ▪ ]. The authors concluded that the service was well received overall and appeared to have potential benefits, warranting further exploration of this care pathway through a randomized controlled trial.…”

Section: Effectiveness Of Novel Opioid and Pain Review Servicesmentioning

confidence: 99%

Opioids in the United Kingdom: safety and surveillance during COVID-19

Osborne

2021

Current Opinion in Psychiatry

View full text Add to dashboard Cite

Purpose of review Opioid use is prevalent in the United Kingdom and prior to the COVID-19 pandemic it had been recognized that the safety of opioids was an important issue to be monitored by the UK medicines regulatory agency. With the emergence of COVID-19, this requirement has been even greater. This review was undertaken to determine the impact of the pandemic on safety and surveillance of opioids in the United Kingdom. Recent findings During the COVID-19 pandemic, the surveillance of opioids in the United Kingdom continued, although primary research was often conducted with data prior to the pandemic. Of those studies that were conducted while the pandemic was ongoing, access to opioids (or opioid substitution therapy) and the subsequent effect on patient safety was the main theme. Summary In the United Kingdom, changes in accessibility to the healthcare system and how healthcare providers operated during the COVID-19 pandemic may have had unintended consequences on use and safety of opioids, due to the shift in focus to preventing COVID-19 from overwhelming the healthcare system. The findings from this review support the need to continue surveillance in the United Kingdom, including the impact of the COVID-19 pandemic on opioid utilization and safety.

show abstract

“…In England, if every general practice prescribed highdose opioids at the same rate as the lowest decile of practices, a cost saving of £24.8 million and 543,000 fewer high-dose opioid prescriptions could be achieved in 6 months [5]. Thus, investing in resources and programs tailored to people taking opioids in primary care such as the service evaluated by Scott et al [53] could reduce the need for people on high doses to visit emergency departments.…”

Section: Implications For Practice and Policymentioning

confidence: 99%

Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis

Richards

Mahtani

Muthee

et al. 2020

BMC Med

View full text Add to dashboard Cite

Background: The risks of harms from opioids increase substantially at high doses, and high-dose prescribing has increased in primary care. However, little is known about what leads to high-dose prescribing, and studies exploring this have not been synthesized. We, therefore, systematically synthesized factors associated with the prescribing of high-dose opioids in primary care. Methods:We conducted a systematic review of observational studies in high-income countries that used patientlevel primary care data and explored any factor(s) in people for whom opioids were prescribed, stratified by oral morphine equivalents (OME). We defined high doses as ≥ 90 OME mg/day. We searched MEDLINE, Embase, Web of Science, reference lists, forward citations, and conference proceedings from database inception to 5 April 2019. Two investigators independently screened studies, extracted data, and appraised the quality of included studies using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We pooled data on factors using random effects meta-analyses and reported relative risks (RR) or mean differences with 95% confidence intervals (CI) where appropriate. We also performed a number needed to harm (NNT H ) calculation on factors when applicable. Results:We included six studies with a total of 4,248,119 participants taking opioids, of whom 3.64% (n = 154,749) were taking high doses. The majority of included studies (n = 4) were conducted in the USA, one in Australia and one in the UK. The largest study (n = 4,046,275) was from the USA. Included studies were graded as having fair to good quality evidence. The co-prescription of benzodiazepines (RR 3.27, 95% CI 1.32 to 8.13, I 2 = 99.9%), depression (RR 1.38, 95% CI 1.27 to 1.51, I 2 = 0%), emergency department visits (RR 1.53, 95% CI 1.46 to 1.61, I 2 = 0%, NNT H 15, 95% CI 12 to 20), unemployment (RR 1.44, 95% CI 1.27 to 1.63, I 2 = 0%), and male gender (RR 1.21, 95% CI 1.14 to 1.28, I 2 = 78.6%) were significantly associated with the prescribing of high-dose opioids in primary care.Conclusions: High doses of opioids are associated with greater risks of harms. Associated factors such as the coprescription of benzodiazepines and depression identify priority areas that should be considered when selecting, identifying, and managing people taking high-dose opioids in primary care. Coordinated strategies and services that promote the safe prescribing of opioids are needed. Study registration: PROSPERO, CRD42018088057

show abstract

Evaluation of a primary care-based opioid and pain review service: a mixed-methods evaluation in two GP practices in England

Cited by 15 publications

References 36 publications

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

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

Opioids in the United Kingdom: safety and surveillance during COVID-19

Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis

Contact Info

Product

Resources

About