Evidence map›Paper›PMID 27178970›Full record

ArticleBMJ open2016

Prescribed opioids in primary care: cross-sectional and longitudinal analyses of influence of patient and practice characteristics.

Robbie Foy, Ben Leaman, Carolyn McCrorie, Duncan Petty, Allan House, Michael Bennett, Paul Carder, Simon Faulkner, Liz Glidewell, Robert West

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
60citing papers in PubMed, 2 pooled it
8.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

60 citing papers in PubMed, 2 syntheses or guidelines pooled it, 95 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Article
  6. Review
  7. Article
  8. Article
  9. Article
  10. Observational
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Taking the pain out of pain.British journal of pain · 2023
    Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Robbie FoyLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Ben LeamanCalderdale Metropolitan Borough Council, Halifax, UK.
Carolyn McCrorieLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Duncan PettyLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Allan HouseLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Michael BennettLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Paul CarderYorkshire & Humber Commissioning Support Unit, Bradford, UK.
Simon FaulknerHealth and Social Care Information Centre, Leeds, UK.
Liz GlidewellLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Robert WestLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
University of Leeds · GBCalderdale College · GBNHS Digital · GB

Funding

Department of Health PB-PG-1010-23041
6 · The paper itself

Abstract

objectivesTo examine trends in opioid prescribing in primary care, identify patient and general practice characteristics associated with long-term and stronger opioid prescribing, and identify associations with changes in opioid prescribing.

designTrend, cross-sectional and longitudinal analyses of routinely recorded patient data.

setting111 primary care practices in Leeds and Bradford, UK.

participantsWe observed 471 828 patient-years in which all patients represented had at least 1 opioid prescription between April 2005 and March 2012. A cross-sectional analysis included 99 847 patients prescribed opioids between April 2011 and March 2012. A longitudinal analysis included 49 065 patient-years between April 2008 and March 2012. We excluded patients with cancer or treated for substance misuse.

main outcome measuresLong-term opioid prescribing (4 or more prescriptions within 12 months), stronger opioid prescribing and stepping up to or down from stronger opioids.

resultsOpioid prescribing in the adult population almost doubled for weaker opioids over 2005-2012 and rose over sixfold for stronger opioids. There was marked variation among general practices in the odds of patients stepping up to stronger opioids compared with those not stepping up (range 0.31-3.36), unexplained by practice-level variables. Stepping up to stronger opioids was most strongly associated with being underweight (adjusted OR 3.26, 1.49 to 7.17), increasing polypharmacy (4.15, 3.26 to 5.29 for 10 or more repeat prescriptions), increasing numbers of primary care appointments (3.04, 2.48 to 3.73 for over 12 appointments in the year) and referrals to specialist pain services (5.17, 4.37 to 6.12). Compared with women under 50 years, men under 50 were less likely to step down once prescribed stronger opioids (0.53, 0.37 to 0.75).

conclusionsWhile clinicians should be alert to patients at risk of escalated opioid prescribing, much prescribing variation may be attributable to clinical behaviour. Effective strategies targeting clinicians and patients are needed to curb rising prescribing, especially of stronger opioids.

Indexed as

AdolescentAdultAgedAnalgesics, OpioidCross-Sectional StudiesDrug PrescriptionsEnglandFamily PracticeFemaleHumansMaleMiddle AgedPractice Patterns, Physicians'Young AdultAnalgesics, OpioidOpioidsPrescribingPrimaryVariations

Identifiers

PMID27178970
PMCPMC4874107
OpenAlexW2333594898

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.