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Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England
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Reichel, Hannah, Stanbrook, Rhian, Johnson, Hans, Proto, William, Shantikumar, Mary, Bakhshi, Pooja, Hillman, Sarah C., Todkill, Dan and Shantikumar, Saran (2021) Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England. British Journal of General Practice, 71 (704). e201-e208. doi:10.3399/bjgp20X714101 ISSN 0960-1643.
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Official URL: https://doi.org/10.3399/bjgp20X714101
Abstract
Background: In March 2018, NHS England published guidance for Clinical Commissioning Groups (CCGs; NHS bodies that commission health services for local areas) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia.
Aims: To investigate: the impact of guidance publication on prescribing rates of simple analgesia (oral paracetamol, oral ibuprofen and topical non-steroidal anti-inflammatory drugs [NSAIDS]) in primary care; CCG implementation intentions; and whether it has created a health inequality based on socioeconomic status.
Design and Setting: Interrupted time series analysis of primary care prescribing data in England.
Methods: Practice-level prescribing data from January 2015 to March 2019 were obtained from NHS Digital. Interrupted time series analyses assessed the association of guidance publication with prescribing rates. The association between practice-level prescribing rates and Index of Multiple Deprivation score (a marker of socioeconomic deprivation) before and after publication was quantified using multivariable Poisson regression. Freedom of information requests were submitted to all CCGs.
Results: There was a 4% reduction in prescribing of simple analgesia following guidance publication (adjusted incidence rate ratio [aIRR] 0.96, 95% CI 0.92-0.99, p=0.027), adjusting for underlying time trend and seasonality. Practice-level prescribing rates were greater in more deprived areas. There was considerable diversity across CCGs in whether or how they chose to implement the guidance.
Conclusion: Guidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating an additional health inequality. Careful implementation by CCGs would be required to optimise cost-saving to the NHS.
Item Type: | Journal Article | ||||||||
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Alternative Title: | |||||||||
Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RB Pathology R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Analgesia, Pain -- Treatment, Pain medicine -- Formulae, receipts, prescriptions , Physicians (General practice) | ||||||||
Journal or Publication Title: | British Journal of General Practice | ||||||||
Publisher: | Royal College of General Practitioners | ||||||||
ISSN: | 0960-1643 | ||||||||
Official Date: | March 2021 | ||||||||
Dates: |
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Volume: | 71 | ||||||||
Number: | 704 | ||||||||
Page Range: | e201-e208 | ||||||||
DOI: | 10.3399/bjgp20X714101 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 9 March 2021 | ||||||||
Date of first compliant Open Access: | 25 February 2022 | ||||||||
RIOXX Funder/Project Grant: |
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