Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: a controlled interrupted time series analysis. [Dataset].

Abstract

Trends in national and regional community opioid prescribing data for Scotland were analysed from quarter one (Q1) 2005 to Q2 2020. Interrupted time series regression examined the association of SIGN 136 publication with prescribing rates for opioid-containing drugs. Gabapentinoid prescribing was used as a comparison drug. The publication of SIGN 136 was associated with a reduction in opioid prescribing rates. This suggests that changes in clinical policy through evidence-based national clinical guidelines may affect community opioid prescribing, though this may be partially replaced by gabapentinoids, and other factors may also contribute.

Citation

HÉBERT, H.L., MORALES, D.R., TORRANCE, N.A., SMITH, B.H. and COLVIN, L.A. 2022. Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: a controlled interrupted time series analysis. [Dataset]. Implementation science [online], 17(1), article number 77. Available from:https://implementationscience.biomedcentral.com/articles/10.1186/s13012-022-01251-2#Sec19

• Acceptance Date: Nov 9, 2022
• Online Publication Date: Nov 22, 2022
• Publication Date: Dec 31, 2022
• Deposit Date: Dec 1, 2022
• Publicly Available Date: Dec 1, 2022
• Publisher: Springer
• DOI: https://doi.org/10.1186/s13012-022-01251-2
• Keywords: Chronic pain; Clinical guideline; Interrupted time series analysis; Opioids; Prescribing rates
• Public URL: https://rgu-repository.worktribe.com/output/1823620
• Publisher URL: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-022-01251-2#Sec19
• Related Public URLs: https://rgu-repository.worktribe.com/output/1818055
• Type of Data: Supplementary tables and figures.
• Collection Date: May 23, 2022
• Collection Method: Data on all opioids and gabapentinoids, prescribed through primary care (in the community) by general practitioners (GPs) and non-medical prescribers and dispensed by community pharmacists in Scotland, were obtained from Public Health Scotland (PHS). This was based on aggregated and publicly available data [27]. PHS (https://www.publichealthscotland.scot/) is part of NHS Scotland and holds individual-level prescribing data through the Prescribing Information System (PIS), which is a national data system, set up in 2009, that captures all NHS prescriptions dispensed and reimbursed in the community (https://www.ndc.scot.nhs.uk/National-Datasets/data.asp?SubID=9). In the UK, healthcare policy is devolved to the individual nations and, in Scotland, community prescriptions are free at the point of delivery. Pharmacists are reimbursed for the prescriptions they dispense. The PIS covers the population of Scotland (approximately 5.3 million), with GPs accounting for approximately 95% of community prescribing, and a capture rate of 98.7% from prescription forms [28]. Also included in the data request were annual mid-year population estimates for Scotland as of 30th June each year. The Scottish Intercollegiate Guideline Network (SIGN) was established in 1993 by the Scottish Medical Royal Colleges and is now part of Healthcare Improvement Scotland, part of NHS Scotland. It produces evidence-based clinical practice guidelines for use across NHS Scotland, with accredited methodology [29], and is a member organisation of the Guidelines International Network (https://g-i-n.net/). SIGN 136 was published in December 2013 and, after a systematic review of the evidence, included key recommendations and best practice statements on safe and effective opioid prescribing (Supplementary Box S1). The Scottish Government requires Health Boards to identify areas of concern where they are not meeting SIGN's key recommendations, so they become important benchmark standards for care. The Scottish Government also provides regular feedback of opioid prescribing data to individual GP Practices as National Therapeutic Indicators, to ensure the implementation of SIGN 136. Therefore, it has formed the basis of pain service provision and improvement in Scotland since its publication. The guideline is aimed at all healthcare professionals involved in the assessment and management of adult patients with chronic non-malignant pain in non-specialist settings. At the time of publication, hard copies were disseminated to all primary care practices across Scotland and the guideline is available for download from SIGN's website (https://www.sign.ac.uk/assets/sign136.pdf). A patient version was also available [30]. The opioids section of this guideline (section 5.3 "Opioids") was subsequently updated in August 2019 [31]. However, for this study, we only considered the original 2013 publication as the "intervention".