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Background: Prescription opioid use has increased steadily in many Western countries over the past two decades, most notably in the US, Canada, and most European countries, including the Netherlands. Especially the increasing use of prescription opioids for chronic non-cancer pain has raised concerns. Most opioids in the Netherlands are prescribed in general practices. However, little is known about variation in opioid prescribing between general practices. To better understand this, we investigated practice variation in opioid prescribing for non-cancer pain between Dutch general practices. Methods: Data from 2017–2019 of approximately 10% of all Dutch general practices was used. Each year included approximately 1000000 patients distributed over approximately 380 practices. The primary outcome was the proportion of patients with chronic (>90 days) high-dose (≥90 oral morphine equivalents) opioid prescriptions. The secondary outcome was the proportion of patients with chronic (<90 oral morphine equivalents) opioid prescriptions. Practice variation was expressed as the ratio of the 95th/5th percentiles and the ratio of mean top 10/bottom 10. Funnel plots were used to identify outliers. Potential factors associated with unwarranted variation were investigated by comparing outliers on practice size, patient neighbourhood socioeconomic status, and urbanicity. Results: Results were similar across all years. The magnitude of variation for chronic high-dose opioid prescriptions in 2019 was 7.51-fold (95%/5% ratio), and 15.1-fold (top 10/bottom 10 ratio). The percentage of outliers in the funnel plots varied between 13.8% and 21.7%. Practices with high chronichigh-doseopioid prescription proportions were larger, and had more patients from lower income and densely populated areas. Conclusions: There might be unwarranted practice variation in chronic high-dose opioid prescriptions in primary care, pointing at possible inappropriate use of opioids. This appears to be related to socioeconomic status, urbanicity, and practice size. Further investigation of the factors driving practice variation can provide target points for quality improvement and reduce inappropriate care and unwarranted variation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to assess the effectiveness of survey administration as a population-level intervention to increase blood donation., Methods: Study 1 was a randomized controlled trial of new donors comparing 3,518 who received a questionnaire and 3,490 who did not. Study 2 compared matched, randomly selected samples of active donors; 5,789 received a questionnaire, while 6,000 did not. In both studies, the dependent measure was the proportion of donors who attended a blood donation center to give blood within 6 months of survey posting. Study 3 compared data across five similar trials., Results: No difference in volunteering to give blood was observed between those who did and did not receive a questionnaire among either new or active donors, confirming the findings of two other Canadian trials., Conclusions: Despite earlier optimistic findings, there is little evidence to suggest that survey administration per se will be effective in increasing blood supplies. Implications for behavior change mechanisms are discussed.