The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: An observational database study

Abstract

BackgroundNumerous national guidelines have been issued to assist general practitioners’ safe analgesic prescribing. Their effectiveness is unclear. The objective of this study was to examine trends in general practitioners’ prescribing behaviour in relation to national guidelines.MethodsThis was a retrospective observational database study of registered adult patients prescribed an analgesic (2002–2009) from the Consultations in Primary Care Archive – 12 North Staffordshire general practices. Prescribing guidance from the UK Medicines Regulatory Health Authority (MHRA) regarding non-steroidal anti-inflammatory drugs (NSAIDs) and co-proxamol, and the National Institute for Health and Clinical Excellence (NICE) osteoarthritis (OA) management guidelines were considered. Analgesic prescribing rates were examined, arranged according to a classification of six equipotent medication groups: (1) basic analgesics; (2)–(5) increasingly potent opioids and (6) NSAIDs. In each quarter from 2002 to 2009, the number of patients per 10,000 registered population receiving a prescription for the first time from each group was determined. Quarters associated with significant changes in the underlying prescribing trend were determined using joinpoint regression.ResultsA significant decrease in incident co-proxamol and Cox-2 prescribing occurred around the time of the first MHRA advice to stop using them and were rarely prescribed thereafter. The new prescribing of weak analgesics (e.g., co-codamol 8/500) increased at this same time. Initiating topical NSAIDs significantly increased around the time of the NICE OA guidelines.ConclusionsSignificant prescribing changes occurred when national advice and guidelines were issued. The effectiveness of this advice may vary depending upon the content and method of dissemination. Further evaluation of the optimal methods for delivering prescribing guidance is required.

A European multicentre drug utilisation study of the impact of regulatory measures on prescribing of codeine for pain in children

“…A significance level of 5% was used to assess the need for each extra joinpoint, starting from zero joinpoints. The timepoint for the joinpoint (with 95% confidence intervals) can then be compared with the dates of the interventions …”

Changes in opioid and other analgesic use 1995–2010: Repeated cross‐sectional analysis of dispensed prescribing for a large geographical population inScotland

“…Reluctance in the use of strong opioids for non-malignant pain started to decrease, and from the mid-1990s, their use in chronic non-cancer analgesia became more common (Dhalla et al, 2011), with opioid prescribing increasing worldwide (Olsen et al, 2006;Hamunen et al, 2009;Leong et al, 2009;Fischer et al, 2011;Ponizovsky et al, 2011). Some older drugs were withdrawn, notably dextropropxyphene in the United Kingdom, and other promising new drugs such as Cox-2 NSAIDs have proved to have unexpected toxicity (Hawton et al, 2009; Medicines and Healthcare products Regulatory Agency & Commission on Human Medicines, 2009; Bedson et al, 2012). Some older drugs were withdrawn, notably dextropropxyphene in the United Kingdom, and other promising new drugs such as Cox-2 NSAIDs have proved to have unexpected toxicity (Hawton et al, 2009; Medicines and Healthcare products Regulatory Agency & Commission on Human Medicines, 2009; Bedson et al, 2012).…”

“…Newer anti-epileptic drugs (AEDs) such as gabapentin and pregabalin were found to be useful in the treatment of painful neuropathic conditions (Spina and Perugi, 2004) and are now recommended as first-line treatment for neuropathic pain (NICE, 2010), also leading to an increase in their prescribing (Tsiropoulos et al, 2006;Oteri et al, 2010). Different studies have examined analgesic use, most commonly by measuring the drug volume in terms of defined daily doses and showing rising opioid use (Hamunen et al, 2009;Leong et al, 2009;Fischer et al, 2011;Ponizovsky et al, 2011), but much variation exists between countries in the pattern of opioids used (Caudill-Slosberg et al, 2004;Olsen et al, 2006;Hamunen et al, 2009;Hawton et al, 2009;Leong et al, 2009;Fredheim et al, 2010;Fischer et al, 2011;Ponizovsky et al, 2011;Bedson et al, 2012). Different studies have examined analgesic use, most commonly by measuring the drug volume in terms of defined daily doses and showing rising opioid use (Hamunen et al, 2009;Leong et al, 2009;Fischer et al, 2011;Ponizovsky et al, 2011), but much variation exists between countries in the pattern of opioids used (Caudill-Slosberg et al, 2004;Olsen et al, 2006;Hamunen et al, 2009;Hawton et al, 2009;Leong et al, 2009;Fredheim et al, 2010;Fischer et al, 2011;Ponizovsky et al, 2011;Bedson et al, 2012).…”

Managing back pain and osteoarthritis without paracetamol

“…Over the past 10 years prescriptions for topical NSAIDs, such as ibuprofen, have more than doubled in the UK 3. Topical NSAIDs (such as ibuprofen) are available over the counter, are as effective as oral NSAIDs for knee osteoarthritis, and are associated with fewer side effects 4.…”