Longitudinal step-up and step-down analyses
| Stepping up to stronger opioids | Stepping down from stronger opioids | |||
|---|---|---|---|---|
| Unadjusted OR (95% CI) | Adjusted OR (95% CI) | Unadjusted OR (95% CI) | Adjusted OR (95% CI) | |
| Patient demography | ||||
| Female 18–49 years | 1 | 1 | 1 | 1 |
| Female 50–64 years | 1.05 (0.89 to 1.25) | 0.94 (0.79 to 1.12) | 1.07 (0.84 to 1.35) | 1.07 (0.84 to 1.35) |
| Female 65–100 years | 1.45 (1.25 to 1.69) | 1.17 (1.00 to 1.38) | 1.19 (0.96 to 1.47) | 1.21 (0.97 to 1.50) |
| Male 18–49 years | 0.99 (0.79 to 1.23) | 1.21 (0.96 to 1.52) | 0.55 (0.39 to 0.79) | 0.53 (0.37 to 0.75) |
| Male 50–64 years | 1.02 (0.84 to 1.23) | 0.97 (0.79 to 1.19) | 0.88 (0.66 to 1.16) | 0.90 (0.68 to 1.20) |
| Male 65–100 years | 0.9 (0.74 to 1.09) | 0.77 (0.63 to 0.94) | 1.16 (0.89 to 1.52) | 1.20 (0.91 to 1.58) |
| British | 1 | Random effect | Random effect | |
| Pakistani | 0.36 (0.30 to 0.44) | Random effect | 1.56 (1.22 to 2.00) | Random effect |
| Other | 0.79 (0.67 to 0.94) | Random effect | 1.31 (1.04 to 1.65) | Random effect |
| Unknown | 0.8 (0.70 to 0.90) | Random effect | 1.06 (0.90 to 1.27) | Random effect |
| Patient morbidity, behaviour and healthcare use | ||||
| Mental health problem | 1.25 (0.98 to 1.59) | – | 0.99 (0.69 to 1.43) | – |
| Definitively diagnosed disease | 2.25 (2.02 to 2.50) | 1.64 (1.46 to 1.85) | 1.03 (0.86 to 1.22) | – |
| Clinical presentation without a definite diagnosis | 1.87 (1.69 to 2.06) | 1.60 (1.43 to 1.79) | 0.95 (0.83 to 1.10) | – |
| Pain-associated syndrome | 1.76 (1.13 to 2.74) | – | 0.90 (0.43 to 1.89) | – |
| Alcohol problem | 1.13 (0.69 to 1.84) | – | 0.57 (0.21 to 1.60) | – |
| Smoking | 1.09 (0.93 to 1.26) | – | 0.87 (0.69 to 1.09) | – |
| Body mass index | ||||
| Normal | 1 | 1 | 1 | – |
| Overweight | 0.93 (0.62 to 1.40) | 0.95 (0.62 to 1.45) | 1.05 (0.60 to 1.84) | – |
| Obese | 1.13 (0.77 to 1.67) | 1.08 (0.72 to 1.62) | 1.31 (0.74 to 2.32) | – |
| Underweight | 2.94 (1.39 to 6.22) | 3.26 (1.49 to 7.17) | – | – |
| Weight unrecorded | 0.96 (0.71 to 1.31) | 0.91 (0.66 to 1.25) | 1.07 (0.70 to 1.65) | – |
| Number of repeat prescriptions | ||||
| None | 1 | 1 | 1 | 1 |
| 1–4 | 2.2 (1.75 to 2.76) | 1.66 (1.32 to 2.09) | 0.73 (0.57 to 0.94) | 0.71 (0.55 to 0.91) |
| 5–9 | 3.84 (3.06 to 4.82) | 2.8 (2.21 to 3.54) | 0.68 (0.53 to 0.89) | 0.66 (0.51 to 0.86) |
| 10–56 | 5.86 (4.68 to 7.34) | 4.15 (3.26 to 5.29) | 0.65 (0.50 to 0.83) | 0.60 (0.46 to 0.77) |
| Number of consultations | ||||
| 0–6 | 1 | 1 | 1 | – |
| 7–12 | 1.97 (1.59 to 2.44) | 1.52 (1.22 to 1.88) | 1.07 (0.85 to 1.35) | – |
| 13–366 | 5.42 (4.48 to 6.56) | 3.04 (2.48 to 3.73) | 0.95 (0.77 to 1.16) | – |
| Number of missed appointments | ||||
| 0 | 1 | 1 | 1 | 1 |
| 1–2 | 1.25 (1.12 to 1.39) | – | 1.01 (0.87 to 1.17) | – |
| 3–29 | 1.32 (1.13 to 1.55) | – | 0.84 (0.67 to 1.06) | – |
| Referrals | ||||
| Medical specialty | 1.81 (1.59 to 2.06) | 1.17 (1.02 to 1.34) | 1.01 (0.84 to 1.23) | – |
| Musculoskeletal specialty | 2.39. 2.14 to 2.67) | 1.48 (1.31 to 1.66) | 1.14 (0.97 to 1.36) | – |
| Neurology | 2.97 (2.42 to 3.65) | 1.77 (1.42 to 2.21) | 0.54 (0.34 to 0.83) | 0.59 (0.38 to 0.91) |
| Specialist pain management | 7.72 (6.60 to 9.02) | 5.17 (4.37 to 6.12) | 0.57 (0.42 to 0.77) | 0.61 (0.45 to 0.83) |
| Surgical specialty | 1.83 (1.57 to 2.14) | 1.29 (1.09 to 1.52) | 1.03 (0.81 to 1.31) | – |
| Practice characteristics | ||||
| List size | ||||
| 1500–6999 | 1 | – | 1 | – |
| 7000–10 999 | 1.18 (1.13 to 1.21) | – | 0.79 (0.67 to 0.93) | – |
| 11 000–25 112 | 1.15 (1.12 to 1.19) | 0.83 (0.7 to 0.99) | – | |
| Practice Index of Multiple Deprivation | ||||
| 7–26.7 | 1 | – | 1 | – |
| 26.7–39.5 | 1.01 (0.98 to 1.05) | – | 0.95 (0.79 to 1.12) | – |
| 39.5–57.5 | 0.92 (0.89 to 0.95) | – | 1.22 (1.02 to 1.45) | – |
| Number of GPs | ||||
| 0–4 | 1 | – | 1 | – |
| 5–9 | 1.16 (1.12 to 1.19) | – | 0.83 (0.71 to 0.96) | – |
| 9–20 | 1.14 (1.11 to 1.18) | – | 0.66 (0.54 to 0.8) | – |
| Teaching status | 1.03 (1.01 to 1.06) | – | 1.03 (1.01 to 1.06) | – |
| Total QOF clinical domain points | ||||
| 198–403 | 1 | – | 1 | – |
| 403–655 | 1.18 (1.04 to 1.33) | – | 0.93 (0.78 to 1.11) | – |
| 655–697 | 1.38 (1.22 to 1.55) | – | 0.84 (0.70 to 0.99) | – |
Bold typeface represent odds ratios for which the 95% confidence intervals did not cross 1.
GP, general practitioner; QOF, Quality and Outcomes Framework.