Prescribing trends of gabapentin, pregabalin, and oxycodone: a secondary analysis of primary care prescribing patterns in England.

BACKGROUND: The risk of iatrogenic harm from the use and misuse of prescription drugs such as gabapentin, pregabalin, and oxycodone is substantial. In recent years, deaths associated with these drugs in England have increased. AIM: To characterise general practice prescribing trends for gabapentin, pregabalin, and oxycodone - termed dependence forming medicines (DFM) - in England and describe potential drivers of unwarranted variation (that is, very high prescribing). DESIGN & SETTING: This study is a retrospective secondary analysis of open source, publicly available government data from various sources pertaining to primary care demographics and prescriptions. METHOD: This study used 5 consecutive years (April 2013-March 2018) of aggregate data to investigate longitudinal trends of prescribing and variation in prescribing trends at practice and clinical commissioning group (CCG) level. RESULTS: Annual prescriptions of gabapentin, pregabalin, and oxycodone increased each year over the period. Variation in prescribing trends was associated with GP practice deprivation quintile, where the most deprived GP practices prescribed 313% (P<0.001) and 238% (P<0.001) greater volumes of gabapentin and pregabalin per person respectively, than practices in the least deprived quintile. The highest prescribing CCGs of each of these drugs were predominantly in northern and eastern regions of England. CONCLUSION: Substantial increases in gabapentin, pregabalin, and oxycodone prescriptions are concerning and will increase iatrogenic harm from drug-related morbidity and mortality. More research is needed to understand the large variation in prescribing between general practices, and to develop and implement interventions to reduce unwarranted variation and increase the appropriateness of prescribing of these drugs.

Observational study to determine the utility of hospital administrative data to support case finding of English patients at higher risk of severe healthcare-related harm.

OBJECTIVES: To identify ways of using routine hospital data to improve the efficiency of retrospective reviews of case records for identifying avoidable severe harm DESIGN: Development and testing of thresholds and criteria for two indirect indicators of healthcare-related harm (long length of stay (LOS) and emergency readmission) to determine the yield of specified harms coded in Hospital Episode Statistics (HES). SETTING: Acute National Health Service hospitals in England. PARTICIPANTS: HES for acute myocardial infarction (AMI), bowel cancer surgery and hip replacement admissions from 2014 to 2015. INTERVENTIONS: Case-mix-adjusted linear regression models were used to determine expected LOS. Different thresholds were examined to determine the association with harm. Screening criteria for readmission included time to readmission, length of readmission and diagnoses in initial admission and readmission. The association with harm was examined for each criterion. RESULTS: The proportions of AMI cases with a harm code increased from 14% among all cases to 47% if a threshold of three times the expected LOS was used. For hip replacement the respective increase was from 10% to 51%. However as the number of patients at these higher thresholds was small, the overall proportion of harm identified is relatively small (15%, 19%, 9% and 8% among AMI, urgent bowel surgery, elective bowel surgery and hip replacement cohorts, respectively). Selection of the time to readmission had an effect on the yield of harms but this varied with condition. At least 50% of surgical patients had a harm code if readmitted within 7 days compared with 21% of patients with AMI. CONCLUSIONS: Our approach would select a substantial number of patients for case record review. Many of these cases would contain no evidence of healthcare-related harm. In practice, Trusts may choose how many reviews it is feasible to do in advance and then select random samples of cases that satisfy the screening criteria.

Can people afford to pay for health care? New evidence on financial protection in the United Kingdom

Financial protection is stronger in the United Kingdom than in many other European Union countries, reflecting relatively high levels of public spending on health; population entitlement to National Health Service (NHS) care based on residence; comprehensive service coverage; and very limited use of patient charges for services covered by the NHS. There are reasons to be concerned about access to health care and financial protection in the future. The NHS is facing exceptional financial pressure owing to public spending levels that are lower than needed, as well as cuts to social care budgets. Strategies to ration NHS care may increase the need for people to pay out of pocket. While those who can afford to do so may pay for private treatment, households already facing financial pressure may be forced to delay or forego care.The vital and effective role the NHS plays in protecting people from financial hardship when they are ill should be safeguarded by ensuring that public spending on health is adequate to meet health needs.This review is part of a series of country-based studies generating newevidence on financial protection in European health systems.