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

Authors

  • Allan Abbott Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
  • Kristin Gustafsson Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping; Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping
  • Caddie Zhou Centre of Registries Västra Götaland, Gothenburg
  • Ola Rolfson Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg https://orcid.org/0000-0001-6534-1242
  • Gunilla Limbäck Svensson Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg; Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden

DOI:

https://doi.org/10.1080/17453674.2021.1992932

Keywords:

Hip, Knee, Non-pharmacological treatment, Osteoarthritis, Pharmacological treatment

Abstract

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 nonpharmacological before pharmacological interventions. Additional modest improvements occurred in the steppedcare 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.

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Published

2022-01-03

How to Cite

Abbott, A., Gustafsson, K., Zhou, C., Rolfson, O., & Svensson, G. L. (2022). 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. Acta Orthopaedica, 93, 51–58. https://doi.org/10.1080/17453674.2021.1992932

Issue

Section

National/international register study