Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England

BACKGROUND: In March 2018, NHS England published guidance for clinical commissioning groups (CCGs) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia. AIM: To investigate the impact of guidance publication on prescri...

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Autores principales: Reichel, Hannah, Stanbrook, Rhian, Johnson, Hans, Proto, William, Shantikumar, Mary, Bakhshi, Pooja, Hillman, Sarah, Todkill, Dan, Shantikumar, Saran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906621/
https://www.ncbi.nlm.nih.gov/pubmed/33619051
http://dx.doi.org/10.3399/bjgp20X714101
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author Reichel, Hannah
Stanbrook, Rhian
Johnson, Hans
Proto, William
Shantikumar, Mary
Bakhshi, Pooja
Hillman, Sarah
Todkill, Dan
Shantikumar, Saran
author_facet Reichel, Hannah
Stanbrook, Rhian
Johnson, Hans
Proto, William
Shantikumar, Mary
Bakhshi, Pooja
Hillman, Sarah
Todkill, Dan
Shantikumar, Saran
author_sort Reichel, Hannah
collection PubMed
description BACKGROUND: In March 2018, NHS England published guidance for clinical commissioning groups (CCGs) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia. AIM: To investigate the impact of guidance publication on prescribing rates of simple analgesia (oral paracetamol, oral ibuprofen, and topical non-steroidal anti-inflammatory drugs) in primary care; CCG guidance implementation intentions; and whether the guidance has created health inequality based on socioeconomic status. DESIGN AND SETTING: Interrupted time series analysis of primary care prescribing data in England. METHOD: Practice-level prescribing data from January 2015 to March 2019 were obtained from NHS Digital. Interrupted time series analyses were used to assess the association of guidance publication with prescribing rates. The association between practice-level prescribing rates and Index of Multiple Deprivation scores before and after publication was quantified using multivariable Poisson regression. Freedom of information requests were submitted to all CCGs. RESULTS: There was a statistically significant 4.4% reduction in prescribing of simple analgesia following guidance publication (adjusted incidence rate ratio 0.96, 95% CI = 0.92 to 0.99, P = 0.027), adjusting for underlying time trend and seasonality. There was considerable diversity across CCGs in whether or how they chose to implement the guidance. Practice-level prescribing rates were greater in more deprived areas. CONCLUSION: Guidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating additional health inequality. Careful implementation by CCGs would be required to optimise cost saving to the NHS.
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spelling pubmed-79066212021-03-03 Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England Reichel, Hannah Stanbrook, Rhian Johnson, Hans Proto, William Shantikumar, Mary Bakhshi, Pooja Hillman, Sarah Todkill, Dan Shantikumar, Saran Br J Gen Pract Research BACKGROUND: In March 2018, NHS England published guidance for clinical commissioning groups (CCGs) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia. AIM: To investigate the impact of guidance publication on prescribing rates of simple analgesia (oral paracetamol, oral ibuprofen, and topical non-steroidal anti-inflammatory drugs) in primary care; CCG guidance implementation intentions; and whether the guidance has created health inequality based on socioeconomic status. DESIGN AND SETTING: Interrupted time series analysis of primary care prescribing data in England. METHOD: Practice-level prescribing data from January 2015 to March 2019 were obtained from NHS Digital. Interrupted time series analyses were used to assess the association of guidance publication with prescribing rates. The association between practice-level prescribing rates and Index of Multiple Deprivation scores before and after publication was quantified using multivariable Poisson regression. Freedom of information requests were submitted to all CCGs. RESULTS: There was a statistically significant 4.4% reduction in prescribing of simple analgesia following guidance publication (adjusted incidence rate ratio 0.96, 95% CI = 0.92 to 0.99, P = 0.027), adjusting for underlying time trend and seasonality. There was considerable diversity across CCGs in whether or how they chose to implement the guidance. Practice-level prescribing rates were greater in more deprived areas. CONCLUSION: Guidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating additional health inequality. Careful implementation by CCGs would be required to optimise cost saving to the NHS. Royal College of General Practitioners 2021-02-23 /pmc/articles/PMC7906621/ /pubmed/33619051 http://dx.doi.org/10.3399/bjgp20X714101 Text en © The Authors http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
spellingShingle Research
Reichel, Hannah
Stanbrook, Rhian
Johnson, Hans
Proto, William
Shantikumar, Mary
Bakhshi, Pooja
Hillman, Sarah
Todkill, Dan
Shantikumar, Saran
Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
title Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
title_full Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
title_fullStr Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
title_full_unstemmed Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
title_short Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
title_sort guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in england
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906621/
https://www.ncbi.nlm.nih.gov/pubmed/33619051
http://dx.doi.org/10.3399/bjgp20X714101
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