潜在有害药物的过度处方：英国全科医疗的一项观察性研究

Overprescribing of potentially harmful medication: an observational study in England's general practice.

作者信息

Khan Tasneem, Copsey Bethan, Carder Paul, Johnson Stella, Imran Mohammed, Wang Kaiwen, Alderson Sarah

机构信息

Leeds Institute of Health Sciences, University of Leeds, Leeds, UK

Clinical Trials Research Unit, University of Leeds, Leeds, UK.

出版信息

BJGP Open. 2024 Jul 29;8(2). doi: 10.3399/BJGPO.2023.0156. Print 2024 Jul.

DOI:10.3399/BJGPO.2023.0156

PMID:38253399

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11300984/

Abstract

BACKGROUND

Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation.

AIM

To assess trends in general practice prescribing of five high-risk medications and their relationship with deprivation.

DESIGN & SETTING: An observational study was conducted using general practice data from three English regions with varied sociodemographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE).

METHOD

Practice-level prescribing data were obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibacterials. Prescribing trends were demonstrated using a linear model.

RESULTS

Reduction in NSAID, opioid, hypnotic and antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared with WY, IMD had a smaller association with prescribing in BC for NSAIDs (coefficient = -0.01578, = 0.004) and antibacterials (coefficient = -0.02769, = 0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (coefficient = 0.02443, <0.001), opioids (coefficient = 0.08919, <0.001), hypnotics (coefficient = 0.09038, <0.001), gabapentinoids (coefficient = 0.1095, <0.001), and antibacterials (coefficient = 0.01601, = 0.19).

CONCLUSION

The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status.

摘要

背景

在英国全科医疗中，潜在有害药物的过度处方与社会经济剥夺存在复杂关联。

目的

评估五种高风险药物在全科医疗中的处方趋势及其与剥夺的关系。

设计与设置

采用观察性研究，使用来自英国三个具有不同社会人口学因素地区的全科医疗数据：西约克郡和哈罗盖特（WY）、黑乡和西米德兰兹郡（BC）以及萨里郡和东萨塞克斯郡（SE）。

方法

获取了2016 - 2021年五个药物类别的基层医疗处方数据：阿片类药物、催眠药、加巴喷丁类药物、非甾体抗炎药（NSAIDs）和抗菌药物。使用线性模型展示处方趋势。

结果

在每个财政年度期间，NSAIDs、阿片类药物、催眠药和抗菌药物的处方量减少，加巴喷丁类药物的处方量增加，差异均具有统计学意义。多重剥夺指数（IMD）与除抗菌药物外的所有药物类别呈正相关，在纳入IMD与年龄的交互项后，抗菌药物显示出正相关。在调整IMD和人口因素后，地区与处方率独立相关。与WY相比，IMD与BC地区NSAIDs（系数 = -0.01578，P = 0.004）和抗菌药物（系数 = -0.02769，P = 0.007）处方的关联较小，而IMD与SE地区NSAIDs（系数 = 0.02443，P <0.001）、阿片类药物（系数 = 0.08919，P <0.001）、催眠药（系数 = 0.09038，P <0.001）、加巴喷丁类药物（系数 = 0.1095，P <0.001）和抗菌药物（系数 = 0.01601，P = 0.19）处方的关联较大。