Opioid prescribing in general practice: use of a two-stage review tool to identify and assess high-dose prescribing.

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dc.contributor.author Ponton, Rhys en
dc.contributor.author Sawyer, Richard en
dc.date.accessioned 2018-12-09T21:13:55Z en
dc.date.issued 2018-08 en
dc.identifier.issn 2049-4637 en
dc.identifier.uri http://hdl.handle.net/2292/44901 en
dc.description.abstract Background:Long-term opioid analgesic prescribing in chronic non-cancer pain (CNCP) is a growing worldwide concern. This has implications for optimal healthcare management in general and chronic pain management specifically. This work documents the development of a review tool and its use in the South West of England in a locality that showed opioid prescribing levels higher than surrounding localities. Methods:An electronic tool which enabled calculation of total prescribed morphine-equivalent doses was developed to allow general practitioners (GPs) to undertake reviews of CNCP patients. This tool was used to assess strong opioid prescribing over a 3-month period at every GP practice (n = 41) in the locality. Every prescription for morphine, oxycodone, pethidine and fentanyl during this period was included.Aspects assessed included drug(s) prescribed, dose prescribed, whether tramadol was prescribed concurrently, whether the drugs were potentially being overused and/or whether the patient was in palliative care. Patients prescribed over 120 mg morphine equivalent per day were reviewed in greater depth, as this is an indication for specialist input. Results:In total, 1881 patients received a prescription in the assessment period. Morphine was the most commonly prescribed drug (n = 847). In all, 363 CNCP patients were prescribed a dose equal to or above 120 mg morphine a day, with a maximum morphine-equivalent dose of 890 mg being prescribed. Over 11% (n = 211) of patients were concurrently prescribed tramadol. The most frequently cited reason for prescription of high-dose opioids was found to be a musculoskeletal pain of the back, neck, joints or limbs. The care of 85 specific CNCP patients was reviewed and optimised. Discussion:No published work to date has documented such an in-depth analysis of primary-care opioid analgesic prescribing utilising prescriber data. Assessing total-dose morphine-equivalent prescribing using this method provides valuable insights into the potential need for urgent medication review. The tool developed may be of value to other GP practices following validation. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.relation.ispartofseries British journal of pain en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Opioid prescribing in general practice: use of a two-stage review tool to identify and assess high-dose prescribing. en
dc.type Journal Article en
dc.identifier.doi 10.1177/2049463717742420 en
pubs.issue 3 en
pubs.begin-page 171 en
pubs.volume 12 en
dc.rights.holder Copyright: The author en
pubs.end-page 182 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype research-article en
pubs.subtype Journal Article en
pubs.elements-id 751548 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Pharmacy en
dc.identifier.eissn 2049-4645 en
pubs.record-created-at-source-date 2018-07-31 en
pubs.dimensions-id 30057762 en

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