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

• Published in: Acta orthopaedica Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 8
• Main Authors: Abbott, Allan, Gustafsson, Kristin, Zhou, Caddie, Rolfson, Ola, Svensson, Gunilla Limbäck
• Format: Journal Article
• Language: English
• Published: Sweden Taylor & Francis 2022; Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation; Medical Journals Sweden
• Subjects: Aged; Analgesics - therapeutic use; Benchmarking; classification; criteria; Cross-Sectional Studies; efficacy; Female; Hip; hip osteoarthritis; Humans; Knee; Male; management; metaanalysis; Middle Aged; Non-pharmacological treatment; Orthopedics; Ortopedi; Osteoarthritis; Osteoarthritis, Hip - drug therapy; Osteoarthritis, Knee - drug therapy; pain; Pharmacological treatment; population; Practice Patterns, Physicians; Registries; safety; Sweden; Sweden
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.1080/17453674.2021.1992932

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.