The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: An observational database study
Open Access
- 2 July 2012
- journal article
- Published by Wiley in European journal of pain
- Vol. 17 (3), 434-443
- https://doi.org/10.1002/j.1532-2149.2012.00189.x
Abstract
Background Numerous 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. Methods This 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. Results A 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. Conclusions Significant 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.Keywords
This publication has 15 references indexed in Scilit:
- Trends in Antipsychotic Use in Dementia 1999-2007Archives of General Psychiatry, 2011
- Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases.2007
- Estimating Average Annual Percent Change for Disease Rates without Assuming Constant ChangeBiometrics, 2006
- Prescribing behaviour according to Dutch and European guidelines on the management of hypercholesterolaemia (1992–1999)British Journal of Clinical Pharmacology, 2006
- Data Quality of General Practice Electronic Health Records: The Impact of a Program of Assessments, Feedback, and TrainingJournal of the American Medical Informatics Association, 2004
- Low back pain.2003
- Co-proxamol and suicide: a study of national mortality statistics and local non-fatal self poisoningsBMJ, 2003
- Permutation tests for joinpoint regression with applications to cancer ratesStatistics in Medicine, 2000
- Persistent Pain and Well-beingJAMA, 1998
- Implementing guidelines and innovations in general practice: which interventions are effective?1998