Guidance impact on primary care prescribing rates of simple analgesia: an interrupted time series analysis in England

Abstract

Background: In March 2018, NHS England published guidance for Clinical Commissioning Groups (CCGs; NHS bodies that commission health services for local areas) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia. Aims: To investigate: the impact of guidance publication on prescribing rates of simple analgesia (oral paracetamol, oral ibuprofen and topical non-steroidal anti-inflammatory drugs [NSAIDS]) in primary care; CCG implementation intentions; and whether it has created a health inequality based on socioeconomic status. Design and Setting: Interrupted time series analysis of primary care prescribing data in England. Methods: Practice-level prescribing data from January 2015 to March 2019 were obtained from NHS Digital. Interrupted time series analyses assessed the association of guidance publication with prescribing rates. The association between practice-level prescribing rates and Index of Multiple Deprivation score (a marker of socioeconomic deprivation) before and after publication was quantified using multivariable Poisson regression. Freedom of information requests were submitted to all CCGs. Results: There was a 4% reduction in prescribing of simple analgesia following guidance publication (adjusted incidence rate ratio [aIRR] 0.96, 95% CI 0.92-0.99, p=0.027), adjusting for underlying time trend and seasonality. Practice-level prescribing rates were greater in more deprived areas. There was considerable diversity across CCGs in whether or how they chose to implement the guidance. Conclusion: Guidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating an additional health inequality.

Macrophages in Renal Injury, Repair, Fibrosis Following Acute Kidney Injury and Targeted Therapy

“…Sasaki et al. ( 99 ) reported that deletion of interferon regulatory factor 4 (IRF4) can prevent kidney fibrosis after ischemic injury by decreased macrophage recruitment and activation in mouse model. Similarly, Chen et al.…”

“…Interferon regulatory factor 4 (IRF4) is a transcription factor from the IRF factor family that exerts regulatory functions in the immune system (98). Sasaki et al (99) reported that deletion of interferon regulatory factor 4 (IRF4) can prevent kidney fibrosis after ischemic injury by decreased macrophage recruitment and activation in mouse model. Similarly, Chen et al ( 100) confirmed that IRF4 deficiency can reduce kidney inflammation and fi brosis after acute kidney injury by suppressing macrophage infiltration.…”