Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates:a controlled interrupted time series analysis

Background: Opioids can be effective analgesics, but long-term use may be associated with harms. In 2013, the first national, comprehensive, evidence-based pain management guideline was published, from the Scottish Intercollegiate Guideline Network (SIGN 136: Management of Chronic Pain) with key recommendations on analgesic prescribing. This study aimed to examine the potential impact on national opioid prescribing rates in Scotland. Methods: Trends in national and regional community opioid prescribing data for Scotland were analysed from quarter one (Q1) 2005 to Q2 2020. Interrupted time series regression examined the association of SIGN 136 publication with prescribing rates for opioid-containing drugs. Gabapentinoid prescribing was used as a comparison drug. Results: After a positive prescribing trend pre-publication, the timing of SIGN 136 publication was associated with a negative change in the trend of opioid prescribing rates (−2.82 items per 1000 population per quarter [PTPPQ]; P < 0.01). By Q2 2020, the relative reduction in the opioid prescribing rate was −20.67% (95% CI: −23.61, −17.76). This persisted after correcting for gabapentinoid prescribing and was mainly driven by the reduction in weak opioids, whereas strong opioid prescribing rates continued to rise. Gabapentinoid prescribing showed a significant rise in level (8.00 items per 1000 population; P = 0.01) and trend (0.27 items PTPPQ; P = 0.01) following SIGN 136 publication. Conclusions: The publication of SIGN 136 was associated with a reduction in opioid prescribing rates. This suggests that changes in clinical policy through evidence-based national clinical guidelines may affect community opioid prescribing, though this may be partially replaced by gabapentinoids, and other factors may also contribute

The Research Excellence Framework (REF) in the UK: processes, consequences and incentives to engage

Governments around the world have introduced various forms of research evaluation and accountability systems. These developments have been widely interpreted as evidence of the incursion of neoliberal discipline and governance into university procedures and management. This article reflects on the example of the U.K. Research Excellence Framework (REF). The article reviews the development and current operation of the REF, particularly in the field of Education; reflects on some of the issues it raises including intended and unintended consequences; and identifies why it has been so insidiously successful in colonizing U.K. academic life. The article is significant for linking critiques of neoliberalism with the lived realities of managing the REF

Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland

Background: Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ~7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006–2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs. Methods: National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases. Results: From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 ‘recurrent users’ (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08–2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription. Conclusions: Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication

Data as Entanglement: New Definitions and Uses of Data in Qualitative Research, Policy, and Neoliberal Governance

Data is an increasingly contested term and concept in qualitative research, but its definition and use is also changing in social policy development and public service management. The article will explore these parallel and apparently independent developments and argue that, while deriving from different fields and aspirations, these developments have elements in common and data is a term now as much applied to and used in political governance, as it is in (what used to be seen as) disinterested science

Assessing quality of life in a clinical study on heart rehabilitation patients: how well do value sets based on given or experienced health states reflect patients' valuations?

Background: Quality of life as an endpoint in a clinical study may be sensitive to the value set used to derive a single score. Focusing on patients' actual valuations in a clinical study, we compare different value sets for the EQ-5D-3L and assess how well they reproduce patients' reported results. Methods: A clinical study comparing inpatient (n = 98) and outpatient (n = 47) rehabilitation of patients after an acute coronary event is re-analyzed. Value sets include: 1. Given health states and time-trade-off valuation (GHS-TTO) rendering economic utilities;2. Experienced health states and valuation by visual analog scale (EHS-VAS). Valuations are compared with patient-reported VAS rating. Accuracy is assessed by mean absolute error (MAE) and by Pearson's correlation.. External validity is tested by correlation with established MacNew global scores. Drivers of differences between value sets and VAS are analyzed using repeated measures regression. Results: EHS-VAS had smaller MAEs and higher. in all patients and in the inpatient group, and correlated best with MacNew global score. Quality-adjusted survival was more accurately reflected by EHS-VAS. Younger, better educated patients reported lower VAS at admission than the EHS-based value set. EHS-based estimates were mostly able to reproduce patient-reported valuation. Economic utility measurement is conceptually different, produced results less strongly related to patients' reports, and resulted in about 20 % longer quality-adjusted survival. Conclusion: Decision makers should take into account the impact of choosing value sets on effectiveness results. For transferring the results of heart rehabilitation patients from another country or from another valuation method, the EHS-based value set offers a promising estimation option for those decision makers who prioritize patient-reported valuation. Yet, EHS-based estimates may not fully reflect patient-reported VAS in all situations

Blaming the victim: assessment, examinations, and the responsibilisation of students and teachers in neo-liberal governance

Historically, for a period of a hundred years or more from the 1860s to the 1960s, assessment developed as an educational technology for selecting and certificating small numbers of individual students. This process was largely focused on excluding the majority. Over the last 30–40 years, the focus and purpose of assessment has changed. The emphasis is now on education for all and the development of a fit-for-purpose assessment system as a system, that is, as part of an integrated approach to national human resource development. These changes have been both driven by, and contributed to, the development of the knowledge economy and neo-liberalism. Students and teachers have been ‘responsibilised’ for the quality and outcomes of education, with assessment and examinations providing the quintessential vehicle for individualising and responsibilising success and failure in relation to achievement and social mobility

The Return to Final Paper Examining in English National Curriculum Assessment and School Examinations: Issues of Validity, Accountability and Politics

There are sound educational and examining reasons for the use of coursework assessment and practical assessment of student work by teachers in schools for purposes of reporting examination grades. Coursework and practical work test a range of different curriculum goals to final papers and increase the validity and reliability of the result. However, the use of coursework and practical work in tests and examinations has been a matter of constant political as well as educational debate in England over the last 30 years. The paper reviews these debates and developments and argues that as accountability pressures increase, the evidence base for published results is becoming narrower and less valid as the system moves back to wholly end-of-course testing

Experimenting With Qualitative Inquiry

Qualitative inquiry largely stands outside the current policy focus on experimental results—the “what works” agenda. Yet thinking and doing things differently—another form of experiment—could be more prominent in critical qualitative inquiry. The article will look at the ways in which qualitative inquiry is currently positioned in policy debate and reflect on whether or not a different form of “experimentalism” could generate a different form of knowledge about what “might work.