Changes in opioid prescribing during the COVID-19 pandemic in England: an interrupted time-series analysis in the OpenSAFELY-TTP cohort.

IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Public Health Pub Date : 2024-07-01 DOI:10.1016/S2468-2667(24)00100-2
Andrea L Schaffer, Colm D Andrews, Andrew D Brown, Richard Croker, William J Hulme, Linda Nab, Jane Quinlan, Victoria Speed, Christopher Wood, Milan Wiedemann, Jon Massey, Peter Inglesby, Seb C J Bacon, Amir Mehrkar, Chris Bates, Ben Goldacre, Alex J Walker, Brian MacKenna
{"title":"Changes in opioid prescribing during the COVID-19 pandemic in England: an interrupted time-series analysis in the OpenSAFELY-TTP cohort.","authors":"Andrea L Schaffer, Colm D Andrews, Andrew D Brown, Richard Croker, William J Hulme, Linda Nab, Jane Quinlan, Victoria Speed, Christopher Wood, Milan Wiedemann, Jon Massey, Peter Inglesby, Seb C J Bacon, Amir Mehrkar, Chris Bates, Ben Goldacre, Alex J Walker, Brian MacKenna","doi":"10.1016/S2468-2667(24)00100-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups.</p><p><strong>Methods: </strong>For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records. We included all adults registered with a primary care practice using TPP-SystmOne software. Using interrupted time-series analysis, we quantified prevalent and new opioid prescribing before the COVID-19 pandemic (January, 2018-February, 2020), during the lockdown (March, 2020-March, 2021), and recovery periods (April, 2021-June, 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, and geographical region) and in people in care homes identified via an address-matching algorithm.</p><p><strong>Findings: </strong>There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March, 2020. We observed a 9·8% (95% CI -14·5 to -6·5) reduction in new opioid prescribing from March, 2020, with a levelling of the downward trend, and rebounding slightly after April, 2021 (4·1%, 95% CI -0·9 to 9·4). Opioid prescribing rates varied by demographics, but we found a reduction in new prescribing for all subgroups except people aged 80 years or older. Among care home residents, in April, 2020, parenteral opioid prescribing increased by 186·3% (153·1 to 223·9).</p><p><strong>Interpretation: </strong>Opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. Despite vulnerable populations being more affected by health-care disruptions, disparities in opioid prescribing by most demographic subgroups did not widen during the pandemic. Further research is needed to understand what is driving the changes in new opioid prescribing and its relation to changes to health-care provision during the pandemic.</p><p><strong>Funding: </strong>The Wellcome Trust, Medical Research Council, The National Institute for Health and Care Research, UK Research and Innovation, and Health Data Research UK.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":25.4000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7616651/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Public Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/S2468-2667(24)00100-2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups.

Methods: For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records. We included all adults registered with a primary care practice using TPP-SystmOne software. Using interrupted time-series analysis, we quantified prevalent and new opioid prescribing before the COVID-19 pandemic (January, 2018-February, 2020), during the lockdown (March, 2020-March, 2021), and recovery periods (April, 2021-June, 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, and geographical region) and in people in care homes identified via an address-matching algorithm.

Findings: There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March, 2020. We observed a 9·8% (95% CI -14·5 to -6·5) reduction in new opioid prescribing from March, 2020, with a levelling of the downward trend, and rebounding slightly after April, 2021 (4·1%, 95% CI -0·9 to 9·4). Opioid prescribing rates varied by demographics, but we found a reduction in new prescribing for all subgroups except people aged 80 years or older. Among care home residents, in April, 2020, parenteral opioid prescribing increased by 186·3% (153·1 to 223·9).

Interpretation: Opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. Despite vulnerable populations being more affected by health-care disruptions, disparities in opioid prescribing by most demographic subgroups did not widen during the pandemic. Further research is needed to understand what is driving the changes in new opioid prescribing and its relation to changes to health-care provision during the pandemic.

Funding: The Wellcome Trust, Medical Research Council, The National Institute for Health and Care Research, UK Research and Innovation, and Health Data Research UK.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
英格兰 COVID-19 大流行期间阿片类药物处方的变化:OpenSAFELY-TTP 队列的间断时间序列分析。
背景:COVID-19 大流行扰乱了医疗保健服务的提供,包括难以获得亲自护理,这可能会增加对强效药物止痛的需求。由于阿片类药物处方过量存在风险,尤其是对弱势群体而言,因此我们旨在量化 COVID-19 大流行期间总体和主要亚群体的措施变化:在这项在英格兰进行的间断时间序列分析研究中,我们使用了 OpenSAFELY-TPP 中 2000 多万名全科成年患者的常规临床数据,OpenSAFELY-TPP 是一个用于分析电子健康记录的安全软件平台。我们将使用 TPP-SystmOne 软件在全科诊所登记的所有成人纳入其中。利用间断时间序列分析法,我们对 COVID-19 大流行之前(2018 年 1 月至 2020 年 2 月)、封锁期间(2020 年 3 月至 2021 年 3 月)和恢复期(2021 年 4 月至 2022 年 6 月)的阿片类药物处方的普遍性和新增处方进行了量化,并按人口统计学(年龄、性别、贫困程度、种族和地理区域)和通过地址匹配算法确定的护理院患者进行了分层:大流行期间,除了 2020 年 3 月出现暂时性增长外,处方的普遍性变化不大。我们观察到,自 2020 年 3 月起,阿片类药物的新处方量减少了 9-8%(95% CI -14-5~-6-5),下降趋势趋于平缓,2021 年 4 月后略有反弹(4-1%,95% CI -0-9~9-4)。阿片类药物的处方率因人口统计学特征而异,但我们发现,除 80 岁或以上的老年人外,所有亚群体的新处方量都有所减少。在 2020 年 4 月的护理院居民中,肠外阿片类药物处方增加了 186-3%(153-1 至 223-9):在老年人和护理院住户中,阿片类药物处方量暂时有所增加,这可能反映了用于治疗临终COVID-19症状的情况。尽管弱势群体受到医疗服务中断的影响更大,但在大流行期间,大多数人口亚群在阿片类药物处方方面的差异并未扩大。需要进一步开展研究,以了解是什么因素导致了阿片类药物新处方的变化,以及这种变化与大流行期间医疗保健服务的变化之间的关系:资助机构:惠康信托基金会、医学研究委员会、英国国家健康与护理研究所、英国研究与创新组织以及英国健康数据研究组织。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Lancet Public Health
Lancet Public Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
55.60
自引率
0.80%
发文量
305
审稿时长
8 weeks
期刊介绍: The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.
期刊最新文献
Correction to Lancet Public Health 2024; 9: e834–35 The 2024 China report of the Lancet Countdown on health and climate change: launching a new low-carbon, healthy journey Workplace mortality risk and social determinants among migrant workers: a systematic review and meta-analysis Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study Alcohol and mortality in Mexico: prospective study of 150 000 adults
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1