scholarly journals Self-harm and suicide during and after opioid agonist treatment among primary care patients in England: a cohort study

Author(s):  
Prianka Padmanathan ◽  
Harriet Forbes ◽  
Maria Theresa Redaniel ◽  
David Gunnell ◽  
Dan Lewer ◽  
...  
2019 ◽  
Vol 153 (1) ◽  
pp. 52-58
Author(s):  
Arden R. Barry ◽  
Chantal E. Chris

Background: This study sought to characterize the real-world treatment of chronic noncancer pain (CNCP) in patients on opioid therapy in primary care. Methods: A retrospective cohort study from 2014-18 was conducted at a multidisciplinary primary care clinic in Chilliwack, British Columbia. Included were adults on daily opioid therapy for CNCP. Patients receiving palliative care or ≤1 visit were excluded. Outcomes of interest included use of opioid/nonopioid pharmacotherapy, number/frequency of visits and proportion of patients able to reduce/discontinue opioid therapy. Results: Seventy patients (mean age 53 years, 53% male, 51% back pain) were included. Median follow-up was 6 visits over 12 months. Sixty-two patients (89%) reduced their opioid dose, 6 patients had no change and 2 patients required a dose increase. Mean opioid dose was reduced from 183 to 70 mg morphine equivalents daily. Twenty-four patients (34%) discontinued opioid therapy, 6 patients (9%) transitioned to opioid agonist therapy and 6 patients (9%) breached their opioid treatment agreement. Nonopioid pharmacotherapy included nonsteroidal anti-inflammatory drugs (64%), gabapentinoids (63%), tricyclic antidepressants (56%) and nabilone (51%). Discussion: Over half of patients were no longer on opioid therapy by the end of the study. Most patients had a disorder (e.g., back pain) for which opioids are generally not recommended. Overall mean opioid dose was reduced from baseline by approximately 60% over 1 year. Lack of access to specialized pain treatments may have accounted for high nonopioid pharmacotherapy usage. Conclusions: This study demonstrates that treatment of CNCP and opioid tapering can successfully be achieved in a primary care setting. Can Pharm J (Ott) 2020;153:xx-xx.


2013 ◽  
Vol 150 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Sebastian Köhler ◽  
Frans Verhey ◽  
Siegfried Weyerer ◽  
Birgitt Wiese ◽  
Kathrin Heser ◽  
...  

2019 ◽  
Vol 26 (17) ◽  
pp. 1843-1851 ◽  
Author(s):  
Anja Handschin ◽  
Stefanie Brighenti-Zogg ◽  
Jonas Mundwiler ◽  
Stéphanie Giezendanner ◽  
Claudia Gregoriano ◽  
...  

Aims Few data are available on cardiovascular risk stratification in primary care patients treated for arterial hypertension. This study aimed at evaluating the cardiovascular risk profile of hypertensive patients included into the Swiss Hypertension Cohort Study according to the 2013 European Society of Hypertension/European Society of Cardiology Guidelines. Methods The Swiss Hypertension Cohort Study is a prospective, observational study conducted by the Centre for Primary Health Care of the University of Basel from 2006 to 2013. Patients with a diagnosis of arterial hypertension (office blood pressure measurement ≥140/90 mmHg) were enrolled. Office blood pressure measurement, cardiovascular risk factors, subclinical organ damage, diabetes mellitus, and established cardiovascular and renal disease were recorded at baseline and at an annual interval during routine consultations by general practitioners in Switzerland. Results In total, 1003 patients were eligible for analysis (55.6% male, mean age: 64.0 ± 13.2 years). At baseline, 78.5% of patients presented with either more than three additional cardiovascular risk factors, diabetes mellitus or subclinical organ damage, while 44.4% of patients had a high or very high overall cardiovascular risk. Cardiovascular risk factors and information about diabetes mellitus, established cardiovascular disease and renal disease were recorded mostly completely, whereas substantial gaps were revealed regarding the assessment of subclinical organ damage. Conclusion The present findings demonstrate that the majority of primary care patients with arterial hypertension bear a substantial number of additional cardiovascular risk factors, subclinical and/or established organ damage. This emphasizes the need for continuous cardiovascular risk stratification and adequate treatment of arterial hypertension in Switzerland.


2010 ◽  
Vol 1 ◽  
Author(s):  
Martin Ebinger ◽  
Caroline Sievers ◽  
Jens Klotsche ◽  
Harald J. Schneider ◽  
Christopher O. Leonards ◽  
...  

2017 ◽  
Vol 15 (3) ◽  
pp. 246-254 ◽  
Author(s):  
Matthew J. Carr ◽  
Darren M. Ashcroft ◽  
Evangelos Kontopantelis ◽  
David While ◽  
Yvonne Awenat ◽  
...  

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Harm W. J. van Marwijk ◽  
Koen G. van der Kooy ◽  
Coen D. A. Stehouwer ◽  
Aartjan T. F. Beekman ◽  
Hein P. J. van Hout

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