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.
Highlights
General practitioners (GPs) are subjected to external influences that might change their prescribing behaviour
This study demonstrated dramatic reductions in new prescribing of moderate analgesics and Cox-2 anti-inflammatory, balanced by increases in weak analgesic prescribing in the 6 months prior to related specific prescribing guidance from the Medicines and Healthcare products Regulatory Agency (MHRA)
At the time of the release of the National Institute for Health and Clinical Excellence (NICE) OA guidelines, there was an increase in the prescribing of topical non-steroidal anti-inflammatory drugs (NSAIDs)
Summary
General practitioners (GPs) are subjected to external influences that might change their prescribing behaviour. Numerous national guidelines have been issued to assist general practitioners’ safe analgesic prescribing. 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. 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
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