OBJECTIVES: To examine trends in the initial prescription of commonly-prescribed analgesics and patient- as well as practice-level factors related to their selection in incident OA.
METHODS: Patients consulting with incident clinical OA between 2000-2016 were identified within The Health Improvement Network in the United Kingdom (UK) general practice. Excluded were patients who had history of cancer or were prescribed the analgesics of interest within 6 months before diagnosis of OA. Initial analgesic prescription included oral non-selective NSAID, oral selective cyclooxygenase-2 inhibitor, topical NSAID, paracetamol, topical salicylate or oral/transdermal opioid within 1 month after OA diagnosis.
RESULTS: approximately 44% of patients with incident OA (n = 125 696) were prescribed one of these analgesics. Incidence of oral NSAID prescriptions decreased whereas other analgesic prescriptions, including oral opioid prescriptions, increased (all P-for-trend < 0.001). Patients with a history of gastrointestinal disease were more likely to receive topical NSAIDs, paracetamol or oral/transdermal opioids. Only 38% of patients with history of gastrointestinal disease and 21% of patients without it had co-prescription of gastroprotective agent with oral NSAIDs. Oral/transdermal opioid prescription was higher among the elderly (>/=65 years), women, obesity, current smoker, and patients with gastrointestinal, cardiovascular or chronic kidney disease. Prescription of oral opioids increased with social deprivation (P-for-trend < 0.05) and was highest in Scotland, whereas transdermal opioid prescription was highest in Northern Ireland (all P-for-homogeneity-test < 0.05).
CONCLUSION: The initial prescription pattern of analgesics for OA has changed over time in the UK. Co-prescription of gastroprotective agents with oral NSAIDs remains suboptimal, even among those with prior gastrointestinal disease.
|投稿者||Zeng, Chao; Zhang, Weiya; Doherty, Michael; Persson, Monica S M; Mallen, Christian; Swain, Subhashisa; Li, Xiaoxiao; Wei, Jie; Lei, Guanghua; Zhang, Yuqing|
|組織名||Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha,;China.;Division of Rheumatology, Allergy, and Immunology, Department of Medicine,;Massachusetts General Hospital, Boston, MA, USA.;The Mongan Institute, Massachusetts General Hospital, Harvard Medical School,;Boston, MA, USA.;Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham,;Keele, UK.;Pain Centre Versus Arthritis UK, Nottingham, UK.;Primary Care Centre Versus Arthritis, School of Primary, Community and Social;Care, Keele University, Keele, UK.;Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.;Health Management Center, Xiangya Hospital, Central South University, Changsha,;Hunan Engineering Research Center of Osteoarthritis, Changsha, China.;National Clinical Research Center of Geriatric Disorders, Xiangya Hospital,;Central South University, Changsha, China.|