65 Factors and variation driving inappropriate opioid analgesic prescribing in the community: a systematic review protocol

Abstract

Objectives The prescription of opioid analgesics is rising in communities of high-income countries. Some of this increase may be appropriately addressing the growing number of people living with pain. Yet, the inappropriate prescribing of opioids (i.e. prescribing that deviates from evidence-based guidelines) may be causing more harms than potential benefits. Previous studies have focused disproportionately on demonstrating the increases in opioid prescribing without understanding what is driving the increase in prescribing. Therefore, We aim to systematically review the literature to establish what factors are driving inappropriate opioid prescribing and potential variation in opioid prescribing practices in high-income countries. Method We searched MEDLINE, EMBASE and Web of Science using ‘primary care’, ‘factors’, ‘variation’, ‘opioid’, ‘prescribing’ and derivatives of these. No language, date or additional limits were applied. The search was completed on 12 February 2018 and is registered on PROSPERO [CRD42018088057]. Studies are being reviewed by two authors who will independently select the eligible articles, extract the data, assess the risk of bias using ROBINS-I (Sterne et al. 2016) and quality of the evidence using GRADE. Relevant internet proceedings, reference lists of included studies and review articles will be examined. Inclusion criteria includes: observational studies, adults (aged ≥18) recruited in communities of high-income countries, a measurement of opioid prescribing, factors that explain prescribing and/or a measure of variation in prescribing practices. Inpatients or patients admitted to hospital (unless followed up in the community), patients with a pre-existing opioid-use disorder or addiction and case studies will be excluded. Results We identified 3950 records to be reviewed for inclusion or exclusion after 4421 duplicates were removed. We anticipate a range of patient-, practitioner- and system-level factors to be found that explain inappropriate opioid analgesic prescribing in the community. Variation is expected to be found across countries, on the indication for prescription and type of opioid prescribed. Conclusions The prescription of opioid analgesics is continuing to rise. Identifying potential patient-, prescriber- and system-level factors associated with opioid prescribing will be the first step in understanding the drivers of prescription and address unwarranted variation in the treatment of pain. This study will provide a framework for a primary database study to be designed that will develop our understanding of the growing treatment needs for people living with persistent pain.