scholarly journals Healthcare resource utilisation and cost analysis associated with opioid analgesic use for non-cancer pain: A case-control, retrospective study between 2005 and 2015

2021 ◽  
pp. 204946372110458
Author(s):  
Emma Davies ◽  
Ceri J Phillips ◽  
Mari Jones ◽  
Bernadette Sewell
Keyword(s):  
Primary Care ◽  
Cost Analysis ◽  
Cancer Pain ◽  
Opioid Analgesic ◽  
Healthcare Utilisation ◽  
Opioid Analgesics ◽  
Case Control ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation ◽  
Control Subjects

Objective To examine differences in healthcare utilisation and costs associated with opioid prescriptions for non-cancer pain issued in primary care. Method A longitudinal, case-control study retrospectively examined Welsh healthcare data for the period 1 January 2005–31 December 2015. Data were extracted from the Secure Anonymised Information Linkage (SAIL) databank. Subjects, aged 18 years and over, were included if their primary care record contained at least one of six overarching pain diagnoses during the study period. Subjects were excluded if their record also contained a cancer diagnosis in that time or the year prior to the study period. Case subjects also received at least one prescription for an opioid analgesic. Controls were matched by gender, age, pain-diagnosis and socioeconomic deprivation. Healthcare use included primary care visits, emergency department (ED) and outpatient (OPD) attendances, inpatient (IP) admissions and length of stay. Cost analysis for healthcare utilisation used nationally derived unit costs for 2015. Differences between case and control subjects for resource use and costs were analysed and further stratified by gender, prescribing persistence (PP) and deprivation. Results Data from 3,286,215 individuals were examined with 657,243 receiving opioids. Case subjects averaged 5 times more primary care visits, 2.8 times more OPD attendances, 3 times more ED visits and twice as many IN admissions as controls. Prescription persistence over 6 months and greater deprivation were associated with significantly greater utilisation of healthcare resources. Opioid prescribing was associated with 69% greater average healthcare costs than in control subjects. National Health Service (NHS) healthcare service costs for people with common, pain-associated diagnoses, receiving opioid analgesics were estimated to be £0.9billion per year between 2005 and 2015. Conclusion Receipt of opioid prescriptions was associated with significantly greater healthcare utilisation and accompanying costs in all sectors. Extended prescribing durations are particularly important to address and should be considered at the point of initiation.

scholarly journals Healthcare professionals’ perceptions on the use of opioid analgesics for the treatment of cancer-related pain in Cyprus: A mixed-method study

2019 ◽  
Vol 7 ◽  
pp. 205031211984182
Author(s):  
Andreas Charalambous ◽  
Marios Zorpas ◽  
Constantina Cloconi ◽  
Yolanda Kading
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Main Barrier ◽  
Appropriate Education ◽  
Qualitative Phase ◽  
Poor Management

Objectives: Pain is considered the most common and debilitating symptom reported by patients affected by cancer, and opioids are at the front line for its effective management. However, the appropriate use of opioids can be limited by healthcare professionals’ perceptions on opioids. Therefore, the aim of this study was to explore their perceptions on the use of opioids medication. Methods: This was a study of sequential mixed-method design conducted in Cyprus. As part of the quantitative phase of the study, the Barriers to Opioid Analgesic Availability Test questionnaire was completed by 73 physicians randomly selected. In the qualitative phase, 28 healthcare professionals working in primary and secondary healthcare centers participated in two focus groups. They were asked to express their perceptions on the use of opioid analgesics for the treatment of cancer-related pain. Data were analyzed according to Colaizzis’ seven-stage phenomenological analysis. Results: The quantitative analysis showed that 69.85% of physicians acknowledge opiophobia as a main barrier to appropriate pain relief but also explicitly for cancer pain which is not adequately managed (45.19%). In terms of opioids availability, physicians stated that moderate to severe problems in opioids availability were mainly caused by their reluctance to prescribe opioids (49.3%) followed by the laws/regulations in place (41.08%). The qualitative analysis yielded the following six main themes: inadequate training of healthcare professionals in the use of opioid analgesics, inadequate patient/caregivers’ awareness of opioid analgesics, opiophobia in healthcare professionals, opiophobia of patients/caregivers, poor management of opioid analgesics by healthcare professionals and patients/caregivers, and ineffective pain relief with opioids. Conclusions: The lack of appropriate education is a significant barrier to opioids use in Cyprus. This is compounded by the attitudes and phobias of both healthcare professionals and the general public. In addition, there are barriers to opioid availability and unsatisfactory cancer pain relief.

scholarly journals Relationship Between Opioid Analgesic Prescription and Unemployment in Patients Seeking Acupuncture for Chronic Pain in Urban Primary Care

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1528-1533 ◽  
Author(s):  
Elizabeth Chuang ◽  
Eric N Gil ◽  
Qi Gao ◽  
Benjamin Kligler ◽  
M Diane McKee
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Baseline Survey ◽  
Patient Reported ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Analgesic Use

Abstract Objective The widespread use of opioid analgesics to treat chronic nonmalignant pain has contributed to the ongoing epidemic of opioid-related morbidity and mortality. Previous studies have also demonstrated a relationship between opioid analgesic use and unemployment due to disability. These studies have been limited to mainly white European and North American populations. The objective of this study is to explore the relationship between opioid analgesic use for chronic nonmalignant pain in an urban, mainly black and Hispanic, low-income population. Design This is a cross-sectional observational study. Setting Subjects were recruited from six urban primary care health centers. Subjects Adults with chronic neck, back, or osteoarthritis pain participating in an acupuncture trial were included. Methods Survey data were collected as a part of the Acupuncture Approaches to Decrease Disparities in Pain Treatment two-arm (AADDOPT-2) comparative effectiveness trial. Participants completed a baseline survey including employment status, opioid analgesic use, the Brief Pain Inventory, the global Patient Reported Outcomes Measurement Information Systems quality of life measure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. A multivariable logistic regression model was built to examine the association between opioid analgesic use and unemployment. Results Opioid analgesic use was associated with three times the odds of unemployment due to disability while controlling for potential confounders, including depression, pain severity, pain interference, global physical and mental functioning, and demographic characteristics. Conclusions This study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.

scholarly journals Healthcare utilisation prior to suicide in persons with alcohol use disorder: national cohort and nested case–control study

2020 ◽  
Vol 217 (6) ◽  
pp. 710-716
Author(s):  
Casey Crump ◽  
Alexis C. Edwards ◽  
Kenneth S. Kendler ◽  
Jan Sundquist ◽  
Kristina Sundquist
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Large Population ◽  
Healthcare Utilisation ◽  
Case Control ◽  
Increased Risk ◽  
National Cohort ◽  
Nested Case Control

BackgroundAlcohol use disorder (AUD) is common and associated with increased risk of suicide.AimsTo examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention.MethodA national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case–control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls.ResultsIn 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86–8.46) and 2.22 (95% CI 2.11–2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter <2 weeks or <3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), <2 weeks: PR = 3.86, 95% CI 3.50–4.25, PD = 26.4, 95% CI 24.2–28.6; <3 months: PR = 2.03, 95% CI 1.94–2.12, PD = 34.9, 95% CI 32.6–37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses.ConclusionsSuicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.

scholarly journals Opioid analgesics and chronic non-cancer pain: a prescription for research in primary care

2016 ◽  
Vol 33 (6) ◽  
pp. 569-571 ◽  
Author(s):  
Jeffrey F Scherrer ◽  
F David Schneider ◽  
Patrick J Lustman
Keyword(s):  
Primary Care ◽  
Cancer Pain ◽  
Opioid Analgesics

scholarly journals Healthcare resource utilisation and mortality outcomes in international migrants to the UK: analysis protocol for a linked population-based cohort study using Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and the Office for National Statistics (ONS)

2021 ◽  
Vol 5 ◽  
pp. 156
Author(s):  
Neha Pathak ◽  
Parth Patel ◽  
Rachel Burns ◽  
Lucinda Haim ◽  
Claire X. Zhang ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Resource ◽  
Health Conditions ◽  
Practice Research ◽  
Resource Utilisation ◽  
Clinical Practice Research Datalink ◽  
Main Study ◽  
Healthcare Resource Utilisation ◽  
International Migrants ◽  
The Uk

An estimated 14.2% (9.34 million people) of people living in the UK in 2019 were international migrants. Despite this, there are no large-scale national studies of their healthcare resource utilisation and little is known about how migrants access and use healthcare services. One ongoing study of migration health in the UK, the Million Migrants study, links electronic health records (EHRs) from hospital-based data, national death records and Public Health England migrant and refugee data. However, the Million Migrants study cannot provide a complete picture of migration health resource utilisation as it lacks data on migrants from Europe and utilisation of primary care for all international migrants. Our study seeks to address this limitation by using primary care EHR data linked to hospital-based EHRs and national death records.  Our study is split into a feasibility study and a main study. The feasibility study will assess the validity of a migration phenotype, a transparent reproducible algorithm using clinical terminology codes to determine migration status in Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. If the migration phenotype is found to be valid, the main study will involve using the phenotype in the linked dataset to describe primary care and hospital-based healthcare resource utilisation and mortality in migrants compared to non-migrants. All outcomes will be explored according to sub-conditions identified as research priorities through patient and public involvement, including preventable causes of inpatient admission, sexual and reproductive health conditions/interventions and mental health conditions. The results will generate evidence to inform policies that aim to improve migration health and universal health coverage.

Do General Practices Which Provide An Acupuncture Service Have Low Referral Rates and Prescription Costs? A Pilot Survey

2008 ◽  
Vol 26 (4) ◽  
pp. 205-213 ◽  
Author(s):  
Gina Johnson ◽  
Adrian White ◽  
Ruth Livingstone
Keyword(s):  
Primary Care ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Nationwide Survey ◽  
Pain Clinic ◽  
Mean Values ◽  
Referral Rates ◽  
Prescription Costs ◽  
The Mean ◽  
Access To Data

Background Studies by individual acupuncture practitioners have given an indication that offering acupuncture in primary care may reduce the need for referral to secondary care and reduce the costs of prescriptions. It would be informative to find out whether these findings can be supported by data from other practices. The aim of this study was to test the feasibility of surveying national data on referrals and prescribing. Methods Three primary care trusts (PCTs) were selected, and all practices within each trust were sent an email asking whether any member of the primary care team offered acupuncture, and if so how many appointments per week. Data on rates of referral to orthopaedic, physiotherapy, pain and rheumatology clinics were then sought from the PCT, both for the practices offering acupuncture and for the PCT as a whole. Similarly, data on costs of prescriptions for non-steroidal (NSAID) and non-opioid analgesic drugs were obtained from the Prescription Pricing Authority. Results Out of the 109 practices surveyed, a total of 14 (13%) offered acupuncture services to some extent. There was wide variation in provision between the different PCTs. The eight practices which offered at least one appointment per week for every 2000 registered patients were included in the analysis. The mean values (and SDs) for the three PCTs and for the eight acupuncture practices, respectively, were as follows: for referral to various clinics: orthopaedic 32.3 (16.2) and 27.4 (10.87); pain clinic 1.6 (1.3) and 2.8 (1.6); physiotherapy 13.4 (14.5) and 29.5 (10.0); and rheumatology 4.7 (2.3) and 6.4 (3.0). The mean values for costs of non-opioid analgesics were £1820 (£442) and £2008 (£762); and for NSAIDs were £4148 (£269) and £4476 (£1366), respectively. There were no trends towards a reduction of clinic referral or prescription costs. Conclusions We have conducted the first survey of the effects of provision of acupuncture in UK general practice, using data provided by the NHS, and uncovered a wide variation in the availability of the service in different areas. We have been unable to demonstrate any consistent differences in the prescribing or referral rates that could be due to the use of acupuncture in these practices. The wide variation in the data means that if such a trend exists, a very large survey would be needed to identify it. However, we discovered inaccuracies and variations in presentation of data by the PCTs which have made the numerical input, and hence our results, unreliable. Thus the practicalities of access to data and the problems with data accuracy would preclude a nationwide survey.

scholarly journals A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services

2021 ◽  
Vol 6 (5) ◽  
pp. 151-163
Author(s):  
Jamie Ferguson ◽  
Myriam Alexander ◽  
Stuart Bruce ◽  
Matthew O'Connell ◽  
Sue Beecroft ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Healthcare Resource ◽  
Healthcare Utilisation ◽  
Bone Infection ◽  
Resource Utilisation ◽  
Clinical Indicators ◽  
Healthcare Resource Utilisation ◽  
Before And After ◽  
Hospital Stays ◽  
The Impact

Abstract. Aims: An investigation of the impact of a multidisciplinary bone infection unit (BIU) undertaking osteomyelitis surgery with a single-stage protocol on clinical outcomes and healthcare utilisation compared to national outcomes in England. Patients and Methods: A tertiary referral multidisciplinary BIU was compared to the rest of England (ROE) and a subset of the 10 next busiest centres based on osteomyelitis treatment episode volume (Top Ten), using the Hospital Episodes Statistics database (HES). A total of 25 006 patients undergoing osteomyelitis surgery between April 2013 and March 2017 were included. Data on secondary healthcare resource utilisation and clinical indicators were extracted for 24 months before and after surgery. Results: Patients treated at the BIU had higher orthopaedic healthcare utilisation in the 2 years prior to their index procedure, with more admissions (p< 0.001) and a mean length of stay (LOS) over 4 times longer than other groups (10.99 d, compared to 2.79 d for Top Ten and 2.46 d for the ROE, p< 0.001). During the index inpatient period, the BIU had fewer mean theatre visits (1.25) compared to the TT (1.98, p< 0.001) and the ROE (1.64, p= 0.001). The index inpatient period was shorter in the BIU (11.84 d), 33.6 % less than the Top Ten (17.83 d, p< 0.001) and 29.9 % shorter than the ROE (16.88 d, p< 0.001). During follow-up, BIU patients underwent fewer osteomyelitis-related reoperations than Top Ten centres (p= 0.0139) and the ROE (p= 0.0137). Mortality was lower (4.71 %) compared to the Top Ten (20.06 %, p< 0.001) and the ROE (22.63 %, p< 0.001). The cumulative BIU total amputation rate was lower (6.47 %) compared to the Top Ten (15.96 %, p< 0.001) and the ROE (12.71 %, p< 0.001). Overall healthcare utilisation was lower in the BIU for all inpatient admissions, LOS, and Accident and Emergency (A&amp;E) attendances. Conclusion: The benefits of managing osteomyelitis in a multi-disciplinary team (MDT) specialist setting included reduced hospital stays, lower reoperation rates for infection recurrence, improved survival, lower amputation rates, and lower overall healthcare utilisation. These results support the establishment of centrally funded multidisciplinary bone infection units that will improve patient outcomes and reduce healthcare utilisation.

scholarly journals Impact of Catheter Ablation on Quality of Life and Healthcare Utilisation

2021 ◽  
Vol 10 (4) ◽  
pp. 258-261
Author(s):  
Sanghamitra Mohanty ◽  
Andrea Natale
Keyword(s):  
Quality Of Life ◽  
Catheter Ablation ◽  
Healthcare Utilisation ◽  
Substantial Improvement ◽  
Resource Utilisation ◽  
Emergency Room Visits ◽  
Healthcare Resource Utilisation ◽  
Cardiovascular Comorbidities ◽  
Very High

Impairment of quality of life (QoL) is a well-known complication of AF. Because of the association of AF with older age and many other cardiovascular comorbidities, there are multiple factors that could influence QoL score even after successful AF intervention. However, substantial improvement in QoL has been reported following catheter ablation for AF regardless of ablation outcomes. In terms of healthcare resource utilisation, the expenses associated with AF are very high because of the hospitalisations for AF-related thromboembolic complications, aggravation of heart failure, AF interventions, and emergency room visits for incessant arrhythmia episodes, and they represent a large economic burden worldwide. Several trials have shown a drastic reduction in healthcare costs following successful AF ablation. In this review, the authors discuss this evidence systematically.

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