Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

Davies‐Kershaw, Hilary; Petersen, Inge; Nazareth, Irwin; Stevenson, Fiona

doi:10.3399/bjgp18x695309

Cited by 10 publications

(15 citation statements)

References 17 publications

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“…CC incidence rates for younger age bands were lower in primary care than in hospital admissions, which was unexpected, given that GP practices should receive and record noti cation of any inpatient admissions and that primary care may be the rst place individuals turn to for help with SUD (47). This nding supports existing evidence of under-recording of SUD in primary care (but in this instance may relate to the recording of SUD, MD or both).…”

Section: Strengths and Limitationssupporting

confidence: 54%

“…This is also likely to be the case for illicit drug use (45), (46). Rates of recording may vary over time or between GP practices, due to experience, training, practice protocols and government policies (47). The exclusion of codes relating to consumption levels may also mean that some individuals with problematic, hazardous or harmful alcohol consumption are not detected.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…This nding supports existing evidence of under-recording of SUD in primary care (but in this instance may relate to the recording of SUD, MD or both). There are well documented sensitivities about discussing and recording SUD in primary care (47) which may be ampli ed for younger patients. Survival and mortality rates were signi cantly poorer for individuals with CC, but were also signi cantly worse for individuals with SUD only, suggesting that SUD (with or without cooccurring MD) is a key risk factor, particularly for males.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

Rees

Watkins

Keauffling³

et al. 2020

Preprint

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Background Mental disorder (MD) and problem, hazardous or harmful substance use (SUD) are associated with poorer than average health and greater mortality. We analysed routine data to estimate incidence of co-occurring (CC) MD and SUD, and to estimate all-cause mortality and survival with CC, a single MD or SUD diagnosis or neither condition (NC), in young people aged 11-25 in Wales, UK. Methods A retrospective population-based electronic cohort study using data from the Secure Anonymised Information Linkage (SAIL) Databank. Participants were 958,603 individuals aged 11-25 between 2008 and 2017, with a subset for mortality and survival analysis of 465,242 individuals born between 1983 and 1997 and present in the data on 1st January 2008. Incidence was defined as date of first recorded occurrence of a CC code. Incidence and observed unadjusted mortality were reported as rates per 1,000 person-years at risk (PYAR). We plotted Kaplan-Meier survival curves and carried out Cox regression to estimate hazard ratios for risk of death by condition group (CC; MD or SUD only; NC). Results CC incidence in primary care significantly decreased, from 2.5/1,000 PYAR (95% CI 2.3-2.6) in 2008 to 2.1/1,000 (95% CI 2.0-2.2) in 2017 (Incidence rate ratio (IRR) = 0.9, 95% CI 0.8-1.0, p=0.01), and in hospital admissions remained stable, from 2.3/1,000 (95% CI 2.1-2.4) in 2008 to 2.2/1,000 (95% CI 2.0-2.3) in 2017 (IRR = 1.0, 95% CI 0.9-1.1). Higher incidence was associated with male sex, older age and greater deprivation.Observed unadjusted mortality rates for CC (1.4/1,000 PYAR, 95% CI 1.2-1.5) and SUD only (1.1/1,000, 95% CI 0.9-1.4) were significantly higher than for MD only (0.4/1,000, 95% CI 0.3-0.4) and no condition (NC) (0.3/1,000, 95% CI 0.2-0.3). Risk of death was significantly higher for CC (HR = 8.7, 95% CI 7.5-10.0, p<0.001), SUD only (HR = 4.5, 95% CI 3.4-5.9, p<0.001) and MD only (HR = 2.7, 95% CI 2.4-3.1, p<0.001), compared with NC.Conclusions Male sex, older age and greater deprivation were associated with significantly higher CC incidence. CC, and also SUD or MD only, were associated with greater risk of death, compared with individuals with NC.

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Section: Strengths and Limitationssupporting

confidence: 54%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

Rees

Watkins

Keauffling³

et al. 2020

Preprint

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“…In the present study, only 0.2% of those with a history of asthma were identified as also having a clinical code associated with OUD. The decisions taken by primary care physicians to record substance use are complex 39 and therefore it is necessary to be cautious in generalising the present results. As this was a database study, it was also not possible to determine current OUD and the findings therefore relate to a lifetime history which may include both current and past OUD.…”

Section: Discussionmentioning

confidence: 99%

A primary care database study of asthma among patients with and without opioid use disorders

Oliver

Hulin

Mitchell

2020

npj Prim. Care Respir. Med.

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Substance misuse is associated with poor asthma outcome and death. People with opioid use disorder (OUD) may be at particular risk, however, there have been no case-control studies of asthma care and outcomes in this patient group. A primary care database study of patients with asthma aged 16-65 years was conducted using a matched case-control methodology. The dataset comprised 275,151 adults with asthma, of whom 459 had a clinical code indicating a lifetime history of OUD. Cases with a history of OUD were matched to controls 1:3 by age, gender, smoking status and deprivation index decile. Attendance at annual review (30%) and for immunisation (25%) was poor amongst the overall matched study population (N = 1832). Compared to matched controls, cases were less likely to have attended for asthma review during the previous 12 months (OR = 0.60, 95% CI 0.45-0.80) but had similar immunisation rates. Higher rates of ICS (OR = 1.50, 1.13-1.98) and oral prednisolone use (OR = 1.71, 1.25-2.40) were seen amongst those with a history of OUD and 7.2% had a concurrent diagnosis of COPD (OR = 1.86, 1.12-2.40). We found that people with asthma and a history of OUD have worse outcomes on several commonly measured metrics of asthma care. Further research is required to identify reasons for these findings, the most effective strategies to help this vulnerable group access basic asthma care, and to better understand long-term respiratory outcomes.

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“…In addition, GPs often expressed hesitancy in recording drugrelated problems in electronic patient records for fear of adverse consequences for the patient or for the patientphysician relationship. 13 Additional factors that may help us understand the lack of drug service-related coding in our dataset are lack of available services, and low uptake of existing services. First, the shift from NHS control over specialist drug services to third sector control in 2012 has been associated with funding cuts and decreasing access to services.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Service Utilization Among People at High Risk of Fatal Opioid Overdose: A Short Communication on an Autopsy Study

Jones

Bradshaw

Jones

et al. 2020

J Prim Care Community Health

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Objectives: We sought to explore the sociodemographics and primary care service utilization among people who died from opioid overdose and to assess the possibility of using this information to identify those at high risk of opioid overdose using routine linked data. Methods: Data related to decedents of opioid overdose between January 1, 2012 and December 31, 2015 were linked with general practitioner (GP) records over a period of 36 months prior to death. Results: Of n = 312 decedents of opioid overdose, 73% were male (n = 228). Average age at death was 40.72 (SD 11.92) years. A total of 63.8% of the decedents were living in the 2 most deprived quintiles according to the Welsh Index of Multiple Deprivation. Over 80% (n = 258) of the decedents were recorded as having at least 1 GP episode during the 36-month observation period prior to death. The median number of episodes per decedent was 75 [38-118]. Overall, 31.8% (n = 82) of decedents with at least 1 GP episode received a prescription for a proton pump inhibitor and 31% (n = 80) were prescribed a broad-spectrum antibiotic. According to their GP records, less than 10% were referred to or receiving specialist drug treatment (n = 24, 9.3%); or were known to be drug dependent (n = 21, 8.14%), or a drug user (n = 5, 1.94%). In all, 81% were recorded as smokers (n = 209) and 10.5% as ex-smokers (n = 27). Conclusions: The majority of decedents of opioid overdose were in contact with GP services prior to death. GPs are either often unaware of high-risk opioid use, or rarely record details of opioid use in patient notes. It is possible that GP awareness of high-risk opioid use could be increased. For example, awareness of the risks associated with opioid use, and the relationship between the sociodemographic and clinical characteristics of opioid overdose decedents could be raised using educational materials prominently displayed in waiting areas. Clinicians in primary care may be in an excellent position to intervene in problematic opioid use.

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Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

Abstract: When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

Cited by 10 publications

References 17 publications

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

A primary care database study of asthma among patients with and without opioid use disorders

Primary Care Service Utilization Among People at High Risk of Fatal Opioid Overdose: A Short Communication on an Autopsy Study

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