Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

Background and purpose — Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and—if necessary—weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions i...

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Autores principales:	Allan Abbott, Kristin Gustafsson, Caddie Zhou, Ola Rolfson, Gunilla Limbäck Svensson
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/571e7edc18644d15a25ee268372ddb25
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spelling	oai:doaj.org-article:571e7edc18644d15a25ee268372ddb252021-11-04T15:00:42ZAnalgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking1745-36741745-368210.1080/17453674.2021.1992932https://doaj.org/article/571e7edc18644d15a25ee268372ddb252021-10-01T00:00:00Zhttp://dx.doi.org/10.1080/17453674.2021.1992932https://doaj.org/toc/1745-3674https://doaj.org/toc/1745-3682Background and purpose — Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and—if necessary—weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008–2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008–2012) compared with after (2012–2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods — Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results — Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2–5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs –8.6% (CI –9.6 to –7.6), weak opioids –6.8% (CI –7.7 to –5.9), glucosamine –9.5% (CI –9.8 to –8.8). and hyaluronic acid –1.6% (CI –1.8 to –1.5) but discordantly increased for strong opioids 2.8% (CI 2.1–3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0–3.1). Interpretation — In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes non-pharmacological before pharmacological interventions. Additional modest improvements occurred in the stepped-care prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.Allan AbbottKristin GustafssonCaddie ZhouOla RolfsonGunilla Limbäck SvenssonTaylor & Francis GrouparticleOrthopedic surgeryRD701-811ENActa Orthopaedica, Vol 0, Iss 0, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Allan Abbott Kristin Gustafsson Caddie Zhou Ola Rolfson Gunilla Limbäck Svensson Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
description	Background and purpose — Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and—if necessary—weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008–2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008–2012) compared with after (2012–2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods — Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results — Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2–5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs –8.6% (CI –9.6 to –7.6), weak opioids –6.8% (CI –7.7 to –5.9), glucosamine –9.5% (CI –9.8 to –8.8). and hyaluronic acid –1.6% (CI –1.8 to –1.5) but discordantly increased for strong opioids 2.8% (CI 2.1–3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0–3.1). Interpretation — In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes non-pharmacological before pharmacological interventions. Additional modest improvements occurred in the stepped-care prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.
format	article
author	Allan Abbott Kristin Gustafsson Caddie Zhou Ola Rolfson Gunilla Limbäck Svensson
author_facet	Allan Abbott Kristin Gustafsson Caddie Zhou Ola Rolfson Gunilla Limbäck Svensson
author_sort	Allan Abbott
title	Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
title_short	Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
title_full	Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
title_fullStr	Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
title_full_unstemmed	Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
title_sort	analgesic prescriptions received by patients before commencing the boa model of care for osteoarthritis: a swedish national registry study with matched reference and clinical guideline benchmarking
publisher	Taylor & Francis Group
publishDate	2021
url	https://doaj.org/article/571e7edc18644d15a25ee268372ddb25
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Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking

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