Trends in musculoskeletal consultations and prescribing: an electronic primary care records study

Abstract

Background: Rheumatic and musculoskeletal diseases (RMDs) are common and generally managed in primary care through supported self-care, physiotherapy, analgesia, and specialist referral where indicated. The COVID-19 pandemic led to abrupt changes in primary care delivery including moves to remote consulting, pauses on group-based self-care, and restricted referrals. Aim: To describe how patterns of UK primary healthcare consultations and analgesic prescribing relating to RMDs changed during the COVID-19 pandemic. Design and Setting: Observational study using routinely collected national primary care electronic health record data from the Clinical Practice Research Datalink between 01/04/17 and 01/10/21. Method: RMD and analgesic SNOMED codes were derived through consensus and published work. Prevalent and incident RMD-related consultations were determined, and RMD consultations matched to prevalent and incident analgesia prescriptions. Joinpoint Regression described trends over time. Results: Prevalent and incident RMD consultations steadily increased until March 2020 when a substantial drop occurred as pandemic-related restrictions were introduced; levels had not recovered to pre-pandemic highs by October 2021. Whilst incident and prevalent analgesic prescribing also reduced around March 2020, the proportion of patients with an RMD consultation prescribed any analgesic increased from 27.72% in February 2020 to 38.15% in April 2020 with increases across all analgesic groups. A higher proportion of strong opioid prescriptions was seen in the most deprived areas. Conclusion: Pandemic-associated restrictions led to fewer primary care consultations and relative increases in analgesic prescribing, including strong opioids, for RMDs in the UK. Policy makers must consider the impact of these changes in future healthcare resource planning.