Investigation of trends in the provision of opioid analgesics for non-cancer pai

• Conditions: M42.97; M42.98; M43.1; M47.87; M54.5; M99.53; Kissing spine; M42.17; M47.88; M48.2

• Registration Number: DRKS00024854
• Lead Sponsor: ehrstuhl für Medizinmanagement, Universität Duisburg-Essen

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2021-04-28
• Study Completion: 2024-02-29
• Last Update Posted: 19 August 2024

Recruitment & Eligibility

• Status: Complete
• Sex: All
• Target Recruitment: 1152

Inclusion Criteria

Guideline Interviews with General Practitioners and Specialists:
Physicians with advanced training in orthopedics and/or trauma surgery as well as neurology, general practitioners, internists, and pain physicians.

Written survey of insureds:
- No change of insurance in the period 1/1/2019-31/03/2020 (insurance with DAK Gesundheit).
Up to 5 days of absence at a stretch are accepted. Persons who meet the above criteria and deceased in the period under consideration are included.
- At least one prescription per quarter of opioid analgesics in Q1 and Q2 2020. If there are prescriptions only in Q1 and Q2 2020, there must be at least 90 days between the first and the last prescription date.
- Coding a diagnosis in one of the quarters in 2020 regarding:
- Chronic back pain: ICD-10-GM M42.16-M42.19, M42.90, M42.96-99, M43.0, M43.1, M47.26, M47.27, M47.29, M47.86, M47.87, M47.88, M47.99, M48.06, M48.2, M54.16, M54.5, M55.3, M.99.33; M99.43, M99.53.
- Arthritis pain: ICD-10-GM M15-M19
Age > 17 years in Q1 2020: date of birth 1/1/2002 and before.

Care epidemiology based on routine data:
- No change of insurance in the period 1/1/2017-31/03/2021 (insurance with DAK Gesundheit). Up to 5 days of absence at a stretch are accepted. Persons who meet the above criteria and deceased in the period under consideration are included.

- At least one prescription per quarter of opioid analgesics in at least 2 consecutive quarters. If there are prescriptions in only 2 consecutive quarters, there must be at least 90 days between the first and last date of prescription . A first prescription must be between Q1 2018 and Q1 2019.

- Age > 17 years in the quarter of the first prescription of an opioid analgesic within the selection peroid (Q1 2018- Q1 2019)

Stakeholder Interviews:
The decision on which stakeholder groups to interview will be made during the course of the project based on previous project findings.

Exclusion Criteria

Written survey of insureds:
Diagnosis of a malignant neoplasm in one of the quarters in 2020:
ICD-10-GM: C00-C97 with the endings G and Z or no ending.
Evidence of palliative care in one of the quarters in 2020:
- ICD-10-GM: Z51.5
- EBM: 01425 to 01426, 03370 to 03373, 04370 to 04373, 37300 to 37320
- DRG: ZE60, ZE145, ZE2020-133, ZE2020-134
- OPS: 8-982, 8-98e, 8-98h, 1-265.b, 1-773, 1-774

Care epidemiology based on routine data:
Diagnosis of a malignant neoplasm in one of at least two consecutive quarters of prescription of an opioid analgesic: ICD-10-GM: C00-C97 with the endings G and Z (outpatient) or no ending (inpatient).
Evidence of palliative care in one of at least 2 consecutive quarters of prescription of opioid analgesic
- ICD-10-GM: Z51.5
- EBM: 01425 to 01426, 03370 to 03373, 04370 to 04373, 37300 to 37320
- DRG: ZE60, ZE145, ZE2020-133, ZE2020-134
- OPS: 8-982, 8-98e, 8-98h, 1-265.b, 1-773, 1-774

Study & Design

• Study Type: observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Survey and administrative claims (health insurance): Presence of overuse and/or misuse of opioid analgesics. <br>(i) Identification of specific patient groups affected by overuse and/or misuse.<br>(ii) Identification of specific patient populations that show evidence of abuse, and dependency disorders<br>(iii) Identification of differences in patient groups with and without evidence of abuse, misuse, and dependency disorders<br>(iv) Identification of sites in the health care system where prescriptions of opioid analgesics are made as acute treatment or as long-term therapy. Identification of sites where patients present with evidence of misuse, abuse, or dependence disorders.

Secondary Outcome Measures

Name	Time	Method
Survey and administrative claims (health insurance): <br>Identification of factors that have an impact on the risk of abuse, misuse, or dependency disorders.<br><br>(i) Identification of evidence of patient-side and/or structural issues related to process quality of care<br>(ii) Analysis of the care of patients with non-tumor-related pain in the context of long-term therapy with opioid analgesics with regard to guideline-based care <br><br>Identification of underlying conditions or inhibiting factors that stand in the way of guideline-compliant provision of opioid analgesics