背景:COVID-19大流行扰乱了医疗保健服务,包括难以获得亲自护理,这可能增加了对强效药物止痛的需求。由于过量服用阿片类药物的风险,特别是弱势群体,我们的目标是量化COVID-19大流行期间措施的变化,总的来说,和关键子组。
方法:对于这项在英国进行的中断时间序列分析研究,经英国国家卫生服务局批准,我们使用了OpenSAFELY-TPP中超过2000万普通成人患者的常规临床数据,这是一个用于分析电子健康记录的安全软件平台。我们纳入了使用TPP-SystmOne软件在初级保健实践中注册的所有成年人。使用中断时间序列分析,我们量化了COVID-19大流行前的流行和新的阿片类药物处方(1月,2018年2月,2020),在封锁期间(3月,2020-3月,2021),和恢复期(4月,2021-6月,2022),总体和按人口统计学分层(年龄,性别,剥夺,种族,和地理区域),以及通过地址匹配算法识别的养老院中的人。
结果:在大流行期间,普遍的处方几乎没有变化,除了3月份的临时增长,2020年。从3月开始,我们观察到新的阿片类药物处方减少了9·8%(95%CI-14·5至-6·5),2020年,随着下降趋势的趋于平稳,4月后略有反弹,2021年(4·1%,95%CI-0·9至9·4)。阿片类药物处方率因人口统计学而异,但我们发现,除80岁或以上人群外,所有亚组的新处方均减少.在养老院居民中,四月,2020年,肠胃外阿片类药物处方增加了186·3%(153·1至223·9)。
结论:阿片类药物处方在老年人和养老院居民中暂时增加,可能反映了用于治疗临终COVID-19症状的用途。尽管弱势群体受到医疗保健中断的影响更大,大流行期间,大多数人口统计学亚组的阿片类药物处方差异并未扩大.需要进一步的研究来了解是什么推动了新阿片类药物处方的变化及其与大流行期间医疗保健供应变化的关系。
背景:惠康信托基金,医学研究理事会,国家健康与护理研究所,英国研究与创新,和英国健康数据研究。
BACKGROUND: The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups.
METHODS: For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records. We included all adults registered with a primary care practice using TPP-SystmOne software. Using interrupted time-series analysis, we quantified prevalent and new opioid prescribing before the COVID-19 pandemic (January, 2018-February, 2020), during the lockdown (March, 2020-March, 2021), and recovery periods (April, 2021-June, 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, and geographical region) and in people in care homes identified via an address-matching algorithm.
RESULTS: There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March, 2020. We observed a 9·8% (95% CI -14·5 to -6·5) reduction in new opioid prescribing from March, 2020, with a levelling of the downward trend, and rebounding slightly after April, 2021 (4·1%, 95% CI -0·9 to 9·4). Opioid prescribing rates varied by demographics, but we found a reduction in new prescribing for all subgroups except people aged 80 years or older. Among care home residents, in April, 2020, parenteral opioid prescribing increased by 186·3% (153·1 to 223·9).
CONCLUSIONS: Opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. Despite vulnerable populations being more affected by health-care disruptions, disparities in opioid prescribing by most demographic subgroups did not widen during the pandemic. Further research is needed to understand what is driving the changes in new opioid prescribing and its relation to changes to health-care provision during the pandemic.
BACKGROUND: The Wellcome Trust, Medical Research Council, The National Institute for Health and Care Research, UK Research and Innovation, and Health Data Research UK.