Ndlovu, Mehluli (2014) Modelling factors associated with long-term prescription patterns of analgesia for musculoskeletal conditions in primary care. Doctoral thesis, Keele University.

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Abstract

Musculoskeletal (MSK) pain is a major reason why people consult their general practitioner. Analgesia plays a central role in its treatment but do not always work, resulting in the need to switch amongst analgesia potency levels. Stronger analgesia is however associated with increased adverse effects.
The aim was to investigate the use of robust statistical approaches to determine socio-demographic and clinical factors associated with receiving and switching, prescribed analgesia in primary care management of MSK pain.
The first phase reviewed statistical methods previously used in modelling medication switching, and established that Cox proportional hazards and logistic regression models were predominantly used. The second phase investigated the prevalence of prescribed analgesia, factors associated with being prescribed analgesia, and prescription patterns in the management of new MSK conditions using a general practice database. In 3236 incident consulters, 42% were prescribed analgesia, NSAIDs being most prescribed. In a 5 year follow-up period, three prescription patterns were identified: no analgesia or basic analgesia only, use of NSAIDs, and multiple-potency analgesia combinations. The main baseline factors associated with being prescribed analgesia, and stronger analgesia were increasing age and having been previously prescribed analgesia. The third phase used Cox and Weibull frailty models to identify factors associated with switching analgesia and switching to stronger analgesia. The main factors identified were age, gender and initially prescribed analgesia.
The fourth phase used a prevalent cohort of 1610 patients aged 50+ with linked self-reported and medical record data. Patient-reported factors such as level of physical function and pain interference were also associated with switching of analgesia. Using a propensity score approach to modelling outcomes suggested those who switched analgesia did not have better three year outcomes, but further research is required to establish if switching analgesia is beneficial in reducing pain and improving function.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Michael Debenham
Date Deposited: 07 Oct 2016 15:17
Last Modified: 07 Oct 2016 15:17
URI: http://eprints.keele.ac.uk/id/eprint/2254

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