scholarly journals The effects of an evidence- and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care: A controlled interrupted time series analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003796
Author(s):  
Sarah L. Alderson ◽  
Tracey M. Farragher ◽  
Thomas A. Willis ◽  
Paul Carder ◽  
Stella Johnson ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
High Risk ◽  
High Risk Patient ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescribing ◽  
Patient Groups ◽  
Comparative Feedback ◽  
Strong Opioids

Background The rise in opioid prescribing in primary care represents a significant international public health challenge, associated with increased psychosocial problems, hospitalisations, and mortality. We evaluated the effects of a comparative feedback intervention with persuasive messaging and action planning on opioid prescribing in primary care. Methods and findings A quasi-experimental controlled interrupted time series analysis used anonymised, aggregated practice data from electronic health records and prescribing data from publicly available sources. The study included 316 intervention and 130 control primary care practices in the Yorkshire and Humber region, UK, serving 2.2 million and 1 million residents, respectively. We observed the number of adult patients prescribed opioid medication by practice between July 2013 and December 2017. We excluded adults with coded cancer or drug dependency. The intervention, the Campaign to Reduce Opioid Prescribing (CROP), entailed bimonthly, comparative, and practice-individualised feedback reports to practices, with persuasive messaging and suggested actions over 1 year. Outcomes comprised the number of adults per 1,000 adults per month prescribed any opioid (main outcome), prescribed strong opioids, prescribed opioids in high-risk groups, prescribed other analgesics, and referred to musculoskeletal services. The number of adults prescribed any opioid rose pre-intervention in both intervention and control practices, by 0.18 (95% CI 0.11, 0.25) and 0.36 (95% CI 0.27, 0.46) per 1,000 adults per month, respectively. During the intervention period, prescribing per 1,000 adults fell in intervention practices (change −0.11; 95% CI −0.30, −0.08) and continued rising in control practices (change 0.54; 95% CI 0.29, 0.78), with a difference of −0.65 per 1,000 patients (95% CI −0.96, −0.34), corresponding to 15,000 fewer patients prescribed opioids. These trends continued post-intervention, although at slower rates. Prescribing of strong opioids, total opioid prescriptions, and prescribing in high-risk patient groups also generally fell. Prescribing of other analgesics fell whilst musculoskeletal referrals did not rise. Effects were attenuated after feedback ceased. Study limitations include being limited to 1 region in the UK, possible coding errors in routine data, being unable to fully account for concurrent interventions, and uncertainties over how general practices actually used the feedback reports and whether reductions in prescribing were always clinically appropriate. Conclusions Repeated comparative feedback offers a promising and relatively efficient population-level approach to reduce opioid prescribing in primary care, including prescribing of strong opioids and prescribing in high-risk patient groups. Such feedback may also prompt clinicians to reconsider prescribing other medicines associated with chronic pain, without causing a rise in referrals to musculoskeletal clinics. Feedback may need to be sustained for maximum effect.

scholarly journals Evaluation of a complex intervention to improve primary care prescribing: a phase IV segmented regression interrupted time series analysis

2017 ◽  
Vol 67 (658) ◽  
pp. e352-e360 ◽  
Author(s):  
Sean MacBride-Stewart ◽  
Charis Marwick ◽  
Neil Houston ◽  
Iain Watt ◽  
Andrea Patton ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
High Risk ◽  
Older People ◽  
Secondary Analysis ◽  
Interrupted Time Series ◽  
Segmented Regression ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Primary Analysis

BackgroundIt is uncertain whether improvements in primary care high-risk prescribing seen in research trials can be realised in the real-world setting.AimTo evaluate the impact of a 1-year system-wide phase IV prescribing safety improvement initiative, which included education, feedback, support to identify patients to review, and small financial incentives.Design and settingAn interrupted time series analysis of targeted high-risk prescribing in all 56 general practices in NHS Forth Valley, Scotland, was performed. In 2013–2014, this focused on high-risk non-steroidal anti-inflammatory drugs (NSAIDs) in older people and NSAIDs with oral anticoagulants; in 2014–2015, it focused on antipsychotics in older people.MethodThe primary analysis used segmented regression analysis to estimate impact at the end of the intervention, and 12 months later. The secondary analysis used difference-in-difference methods to compare Forth Valley changes with those in NHS Greater Glasgow and Clyde (GGC).ResultsIn the primary analysis, downward trends for all three NSAID measures that were existent before the intervention statistically significantly steepened following implementation of the intervention. At the end of the intervention period, 1221 fewer patients than expected were prescribed a high-risk NSAID. In contrast, antipsychotic prescribing in older people increased slowly over time, with no intervention-associated change. In the secondary analysis, reductions at the end of the intervention period in all three NSAID measures were statistically significantly greater in NHS Forth Valley than in NHS GGC, but only significantly greater for two of these measures 12 months after the intervention finished.ConclusionThere were substantial and sustained reductions in the high-risk prescribing of NSAIDs, although with some waning of effect 12 months after the intervention ceased. The same intervention had no effect on antipsychotic prescribing in older people.

scholarly journals Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0146
Author(s):  
Chris Sampson ◽  
Eleanor Bell ◽  
Amanda Cole ◽  
Christopher B Miller ◽  
Tracey Marriott ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cognitive Behavioural Therapy ◽  
Interrupted Time Series ◽  
Behavioural Therapy ◽  
Interrupted Time Series Analysis ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Quasi Experimental ◽  
Care Costs

BackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed.AimWe sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio.MethodWe use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

scholarly journals Community-based testing of migrants for infectious diseases (COMBAT-ID): impact, acceptability and cost-effectiveness of identifying infectious diseases among migrants in primary care: protocol for an interrupted time-series, qualitative and health economic analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e029188 ◽  
Author(s):  
Manish Pareek ◽  
Helen C Eborall ◽  
Fatimah Wobi ◽  
Kate S Ellis ◽  
Evangelos Kontopantelis ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
Hepatitis B ◽  
Infectious Diseases ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Series Analysis

BackgroundMigration is a major global driver of population change. Certain migrants may be at increased risk of infectious diseases, including tuberculosis (TB), HIV, hepatitis B and hepatitis C, and have poorer outcomes. Early diagnosis and management of these infections can reduce morbidity, mortality and onward transmission and is supported by national guidelines. To date, screening initiatives have been sporadic and focused on individual diseases; systematic routine testing of migrant groups for multiple infections is rarely undertaken and its impact is unknown. We describe the protocol for the evaluation of acceptability, effectiveness and cost-effectiveness of an integrated approach to screening migrants for a range of infectious diseases in primary care.Methods and analysisWe will conduct a mixed-methods study which includes an observational cohort with interrupted time-series analysis before and after the introduction of routine screening of migrants for infectious diseases (latent TB, HIV, hepatitis B and hepatitis C) when first registering with primary care within Leicester, UK. We will assess trends in the monthly number and rate of testing and diagnosis for latent TB, HIV, hepatitis B and hepatitis C to determine the effect of the policy change using segmented regression analyses at monthly time-points. Concurrently, we will undertake an integrated qualitative sub-study to understand the views of migrants and healthcare professionals to the new testing policy in primary care. Finally, we will evaluate the cost-effectiveness of combined infection testing for migrants in primary care.Ethics and disseminationThe study has received HRA and NHS approvals for both the interrupted time-series analysis (16/SC/0127) and the qualitative sub-study (16/EM/0159). For the interrupted time-series analysis we will only use fully anonymised data. For the qualitative sub-study, we will gain written, informed, consent. Dissemination of the results will be through local and national meetings/conferences as well as publications in peer-reviewed journals.

scholarly journals Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0233062
Author(s):  
Rocío Fernández-Urrusuno ◽  
Carmen Marina Meseguer Barros ◽  
Regina Sandra Benavente Cantalejo ◽  
Elena Hevia ◽  
Carmen Serrano Martino ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Multifaceted Interventions

Interrupted Time-Series Analysis to Evaluate the Impact of a National Antimicrobial Stewardship Campaign on Antibiotic Prescribing: A Typical Practice in China’s Primary Care

2020 ◽  
Author(s):  
Hui Li ◽  
Yanhong Gong ◽  
Jing Han ◽  
Shengchao Zhang ◽  
Shanquan Chen ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Targeted Interventions ◽  
The Impact ◽  
Outpatient Prescriptions

Abstract Background After implementing the 2011 national antimicrobial stewardship campaign, few studies focused on evaluating its effect in China’s primary care facilities. Methods We randomly selected 11 community health centers in Shenzhen, China, and collected all outpatient prescriptions of these centers from 2010–2015. To evaluate the impact of local interventions on antibiotic prescribing, we used a segmented regression model of interrupted time series to analyze seven outcomes, i.e., percentage of prescriptions with antibiotics, and percentages of prescriptions with broad-spectrum antibiotics, with parenteral antibiotics, and with two or more antibiotics in all prescriptions or antibiotics-containing prescriptions. Results Overall, 1 482 223 outpatient prescriptions were obtained. The intervention was associated with a significant immediate change (–5.2%, P=.04) and change in slope (–3.1% per month, P<.01) for the percentage of prescriptions with antibiotics, and its relative cumulative effect at the end of the study was –74.0% (95% confidence interval, –79.0% to –69.1%). After the intervention, the percentage of prescriptions with broad-spectrum, and with parenteral antibiotics decreased dramatically by 36.7% and 77.3%, respectively, but their percentages in antibiotic-containing prescriptions decreased insignificantly. Percentage of prescriptions with two or more antibiotics in all prescriptions or antibiotics-containing prescriptions only showed immediate changes, but significant changes in slope were not observed. Conclusions A typical practice in Shenzhen, China, showed that strict enforcement of antimicrobial stewardship campaign could effectively reduce antibiotic prescribing in primary care with a stable long-term effect. However, prescribing of broad-spectrum and parenteral antibiotics was still prevalent. More targeted interventions are required to promote appropriate antibiotic use.

scholarly journals Assessing the impact of a restrictive opioid prescribing law in West Virginia

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cara L. Sedney ◽  
Maryam Khodaverdi ◽  
Robin Pollini ◽  
Patricia Dekeseredy ◽  
Nathan Wood ◽  
...  
Keyword(s):  
Time Series ◽  
West Virginia ◽  
Moving Average ◽  
Monitoring Program ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescribing ◽  
Small Change ◽  
The Impact ◽  
First Time

Abstract Background The Opioid Reduction Act (SB 273) took effect in West Virginia in June 2018. This legislation limited ongoing chronic opioid prescriptions to 30 days’ supply, and first-time opioid prescriptions to 7 days’ supply for surgeons and 3 days’ for emergency rooms and dentists. The purpose of this study was to determine the effect of this legislation on reducing opioid prescriptions in West Virginia, with the goal of informing future similar policy efforts. Methods Data were requested from the state Prescription Drug Monitoring Program (PDMP) including overall number of opioid prescriptions, number of first-time opioid prescriptions, average daily morphine milligram equivalents (MME) and prescription duration (expressed as “days’ supply”) given to adults during the 64 week time periods before and after legislation enactment. Statistical analysis was done utilizing an autoregressive integrated moving average (ARIMA) interrupted time series analysis to assess impact of both legislation announcement and enactment while controlling secular trends and considering autocorrelation trends. Benzodiazepine prescriptions were utilized as a control. Results Our analysis demonstrates a significant decrease in overall state opioid prescribing as well as a small change in average daily MME associated with the date of the legislation’s enactment when considering serial correlation in the time series and accounting for pre-intervention trends. There was no such association found with benzodiazepine prescriptions. Conclusion Results of the current study suggest that SB 273 was associated with an average 22.1% decrease of overall opioid prescriptions and a small change in average daily MME relative to the date of legislative implementation in West Virginia. There was, however, no association of the legislation on first-time opioid prescriptions or days’ supply of opioid medication, and all variables were trending downward prior to implementation of SB 273. The control demonstrated no relationship to the law.

scholarly journals The effect of a specialist paramedic primary care rotation on appropriate non-conveyance decisions: a controlled interrupted time series analysis

2020 ◽  
Author(s):  
Richard Pilbery ◽  
Tracey Young ◽  
Andrew Hodge
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cost Effectiveness ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Ambulance Service ◽  
Control Group ◽  
Interrupted Time Series Analysis ◽  
Cost Effectiveness Ratio ◽  
The Cost

AbstractIntroductionNHS ambulance service conveyance rates in the UK are almost 70%, despite an increase in non-emergency cases. This is increasing the demands on crowded emergency departments (ED) and contributes to increased ambulance turnaround times. Yorkshire Ambulance Service introduced a specialist paramedic (SP) role to try and address this, but non-conveyance rates in this group have not been as high as expected.MethodsWe conducted a controlled interrupted time series analysis of appropriate non-conveyance rates in the 12 months before and after an SP primary care placement, using matched groups of patients cared for by SPs and control paramedics. A costing analysis examined the average cost per appropriate non-conveyance and the cost-effectiveness ratio between groups.ResultsBetween June 2017 and December 2019 there were 7349 incidents attended by intervention group SPs and eligible for inclusion. Following removal of cases with missing data, 5537/7349 (75.3%) cases remained. Post-placement, the intervention group demonstrated an increase in appropriate non-conveyance rate by 32.2% (95%CI 20.1–44.3%, p<0.001) and a reduction in the trend of appropriate non-conveyance relative to the control group of −1.8% (95%CI −3.5—0.0%, p=0.045).Post-placement, the cost per appropriate non-conveyance for intervention paramedics was a mean of £501.94 (95% bootstrapped CI £477.99–£526.46) versus £1217.89 (95% bootstrapped CI £1121.49–£1321.85) for the control group. This represents a mean saving of £715.95 per appropriate non-conveyance (95% bootstrapped CI £638.23–£795.69) for SPs compared to the control group, and a cost-effectiveness ratio of £2226.04 per percentage increase in appropriate non-conveyance (95% bootstrapped CI £1854.11–£2748.44).ConclusionIn this single UK NHS ambulance service study, we found a clinically important and statistically significant increase in appropriate non-conveyance rates by specialist paramedics who had completed a 10-week GP placement. This improvement persisted for the 12-month period following the placement and demonstrated cost savings compared to usual care.

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