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Research article:
Examining variations in prescribing safety in UK general practice: a cross-sectional study using the Clinical Practice Research Datalink
Reference:
S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodger, Anthony J Avery, Darren M Ashcroft(2015) Examining variations in prescribing safety in UK general practice: a cross-sectional study using the Clinical Practice Research Datalink. BMJ, doi: 10.1136/bmj.h5501
- Link to fulltext article
- Abstract
- Study question What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices? Methods A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin. Study answer and limitations 49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators.Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in patients receiving warfarin. What this study adds The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention.
- Author for correspondence
- Jill Stocks
- Email for correspondence
- jill.stocks@manchester.ac.uk
Code list: res25: contraceptives
115 codes in list
| Code | Coding system | Description | Entity type | List name | drugsubstance | ||
|---|---|---|---|---|---|---|---|
| 1062 | CPRD_product_code | Ovranette 150microgram/30microgram tablets (Pfizer Ltd) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 1071 | CPRD_product_code | Cilest 250microgram/35microgram tablets (Janssen-Cilag Ltd) | drug | res25: contraceptives | Norgestimate/Ethinylestradiol | ||
| 11910 | CPRD_product_code | Ethinylestradiol 20microgram / Gestodene 75microgram tablets | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 125 | CPRD_product_code | Dianette tablets (Bayer Plc) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 12631 | CPRD_product_code | Ethinylestradiol with levonorgestrel and placebo 30micrograms + 150micrograms Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 13248 | CPRD_product_code | Ethinylestradiol 30microgram / Desogestrel 150microgram tablets | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 1352 | CPRD_product_code | Loestrin 30 tablets (Galen Ltd) | drug | res25: contraceptives | Norethisterone acetate/Ethinylestradiol | ||
| 1354 | CPRD_product_code | Brevinor 500microgram/35microgram tablets (Pfizer Ltd) | drug | res25: contraceptives | Norethisterone/Ethinylestradiol | ||
| 1378 | CPRD_product_code | Mercilon 150microgram/20microgram tablets (Merck Sharp & Dohme Ltd) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 13810 | CPRD_product_code | Ethinylestradiol with levonorgestrel for post-coital contraception 50micrograms + 250micrograms Tabl | drug | res25: contraceptives | Ethinylestradiol | ||
| 1427 | CPRD_product_code | Loestrin 20 tablets (Galen Ltd) | drug | res25: contraceptives | Norethisterone acetate/Ethinylestradiol | ||
| 14459 | CPRD_product_code | Gynovlar 21 Tablet (Schering Health Care Ltd) | drug | res25: contraceptives | Ethinylestradiol | ||
| 14601 | CPRD_product_code | Ethinylestradiol 35microgram / Norgestimate 250microgram tablets | drug | res25: contraceptives | Norgestimate/Ethinylestradiol | ||
| 14670 | CPRD_product_code | Ethinylestradiol with norethisterone - biphasic 7 x 35mcg+500mcg; 14 x 35mcg+1mg Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 14977 | CPRD_product_code | Ethinylestradiol with gestodene - triphasic 6 x 30+50mcg; 5 x 40+70mcg; 10 x 30+100mcg Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 15886 | CPRD_product_code | Ethinylestradiol with levonorgestrel - triphasic 6x30+50mcg; 5x40+75mcg; 10x30+125mcg Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 15987 | CPRD_product_code | Ethinylestradiol with norethisterone - triphasic 7 x 35+500mcg; 7 x 35+750mcg; 7 x 35mcg+1mg Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 1601 | CPRD_product_code | Trinovum tablets (Janssen-Cilag Ltd) | drug | res25: contraceptives | |||
| 16110 | CPRD_product_code | Ethinylestradiol 20microgram / Desogestrel 150microgram tablets | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 1752 | CPRD_product_code | Eugynon 30 tablets (Schering Health Care Ltd) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 17756 | CPRD_product_code | Mestranol 50microgram / Norethisterone 1mg tablets | drug | res25: contraceptives | Norethisterone/Mestranol | ||
| 18569 | CPRD_product_code | Gestodene with ethinylestradiol 75microgramwith20microgram Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 18823 | CPRD_product_code | Ethinylestradiol 30microgram / Norethisterone acetate 1.5mg tablets | drug | res25: contraceptives | Norethisterone acetate/Ethinylestradiol | ||
| 19131 | CPRD_product_code | Ethinylestradiol with gestodene and placebo 30micrograms + 75micrograms Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 19551 | CPRD_product_code | Controvlar Tablet (Schering Health Care Ltd) | drug | res25: contraceptives | Ethinylestradiol | ||
| 1988 | CPRD_product_code | Binovum tablets (Janssen-Cilag Ltd) | drug | res25: contraceptives | |||
| 2026 | CPRD_product_code | Logynon ED tablets (Bayer Plc) | drug | res25: contraceptives | |||
| 2084 | CPRD_product_code | Ovran 30 Tablet (Wyeth Pharmaceuticals) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 21343 | CPRD_product_code | Minovlar ed Tablet (Schering Health Care Ltd) | drug | res25: contraceptives | Ethinylestradiol | ||
| 21733 | CPRD_product_code | Gestodene with ethinylestradiol 75microgramwith30microgram Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 22603 | CPRD_product_code | Clairette 2000/35 tablets (Stragen UK Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 23211 | CPRD_product_code | Desogestrel with ethinylestradiol 150micrograms with 30micrograms tablets | drug | res25: contraceptives | Ethinylestradiol | ||
| 23218 | CPRD_product_code | Ethinylestradiol with cyproterone acetate 35microgram with 2mg tablets | drug | res25: contraceptives | Ethinylestradiol | ||
| 2354 | CPRD_product_code | Ovysmen 500microgram/35microgram tablets (Janssen-Cilag Ltd) | drug | res25: contraceptives | Norethisterone/Ethinylestradiol | ||
| 23897 | CPRD_product_code | Ethinylestradiol with levonorgestrel - triphasic with placebo 6x30+50mcg; 5x40+75mcg; 10x30+125mcg T | drug | res25: contraceptives | Ethinylestradiol | ||
| 25124 | CPRD_product_code | Acnocin 2000microgram/35microgram tablets (Sandoz Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 25263 | CPRD_product_code | Norgestimate with ethinylestradiol 250micrograms + 35micrograms Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 2769 | CPRD_product_code | Cyproterone acetate with ethinylestradiol 2mg with 35micrograms tablets | drug | res25: contraceptives | Ethinylestradiol | ||
| 2856 | CPRD_product_code | Norimin 1mg/35microgram tablets (Pfizer Ltd) | drug | res25: contraceptives | Norethisterone/Ethinylestradiol | ||
| 29499 | CPRD_product_code | Ethinylestradiol 33.9micrograms/24hours / Norelgestromin 203micrograms/24hours transdermal patches | drug | res25: contraceptives | Ethinylestradiol/Norelgestromin | ||
| 31528 | CPRD_product_code | Ethinylestradiol with norethisterone - triphasic 7x35+500mcg; 9x35mcg+1mg; 5x35+500mcg Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 31902 | CPRD_product_code | Cicafem 2000/35 tablets (Galen Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 33098 | CPRD_product_code | Diva 2000/35 tablets (Zeroderma Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 3436 | CPRD_product_code | Ortho-novin 1/50 Tablet (Janssen-Cilag Ltd) | drug | res25: contraceptives | Norethisterone/Mestranol | ||
| 3471 | CPRD_product_code | Femodene ED tablets (Bayer Plc) | drug | res25: contraceptives | |||
| 3472 | CPRD_product_code | Trinovum ed ED tablets (Janssen-Cilag Ltd) | drug | res25: contraceptives | Ethinylestradiol | ||
| 3538 | CPRD_product_code | Neocon 1/35 Tablet (Cilag Pharmaceuticals Ltd) | drug | res25: contraceptives | Norethisterone/Ethinylestradiol | ||
| 36829 | CPRD_product_code | Katya 30/75 tablets (Stragen UK Ltd) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 3693 | CPRD_product_code | Triadene tablets (Bayer Plc) | drug | res25: contraceptives | |||
| 37073 | CPRD_product_code | Sunya 20/75 tablets (Stragen UK Ltd) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 38500 | CPRD_product_code | Co-cyprindiol 2000microgram/35microgram tablets (Fannin UK Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 39517 | CPRD_product_code | NuvaRing 0.12mg/0.015mg per day vaginal delivery system (Merck Sharp & Dohme Ltd) | drug | res25: contraceptives | Etonogestrel/Ethinylestradiol | ||
| 40305 | CPRD_product_code | Qlaira tablets (Bayer Plc) | drug | res25: contraceptives | |||
| 4039 | CPRD_product_code | Tri-Minulet tablets (Wyeth Pharmaceuticals) | drug | res25: contraceptives | |||
| 40512 | CPRD_product_code | Ethinylestradiol 2.7mg / Etonogestrel 11.7mg vaginal delivery system | drug | res25: contraceptives | Ethinylestradiol/etonogestrel | ||
| 40618 | CPRD_product_code | Estradiol valerate and (estradiol valerate with dienogest) tablets | drug | res25: contraceptives | Estradiol Valerate | ||
| 40650 | CPRD_product_code | Ethinylestradiol with norethisterone 35micrograms + 750micrograms Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 41 | CPRD_product_code | Microgynon 30 tablets (Bayer Plc) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 42510 | CPRD_product_code | Ethinylestradiol with levonorgestrel Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 43003 | CPRD_product_code | Levest 150/30 tablets (Morningside Healthcare Ltd) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 43009 | CPRD_product_code | Minovlar 21 Tablet (Schering Health Care Ltd) | drug | res25: contraceptives | Ethinylestradiol | ||
| 44046 | CPRD_product_code | Rigevidon tablets (Consilient Health Ltd) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 441 | CPRD_product_code | Ovran tablets (Wyeth Pharmaceuticals) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 44229 | CPRD_product_code | Millinette 20microgram/75microgram tablets (Consilient Health Ltd) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 44278 | CPRD_product_code | TriRegol tablets (Consilient Health Ltd) | drug | res25: contraceptives | |||
| 443 | CPRD_product_code | Desogestrel with ethinylestradiol 150micrograms with 20micrograms tablets | drug | res25: contraceptives | Ethinylestradiol | ||
| 44336 | CPRD_product_code | Gedarel 30microgram/150microgram tablets (Consilient Health Ltd) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 44457 | CPRD_product_code | Gedarel 20microgram/150microgram tablets (Consilient Health Ltd) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 44994 | CPRD_product_code | Millinette 30microgram/75microgram tablets (Consilient Health Ltd) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 45059 | CPRD_product_code | Ethinylestradiol with levonorgestrel 30micrograms + 50micrograms Tablet | drug | res25: contraceptives | Ethinylestradiol | ||
| 45557 | CPRD_product_code | Levest 150/30 tablets (Actavis UK Ltd) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 4608 | CPRD_product_code | Dianette tablets (Generics (UK) Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 47057 | CPRD_product_code | Yasminelle 3mg+20microgram Tablet (Bayer Plc) | drug | res25: contraceptives | Ethinylestradiol | ||
| 47132 | CPRD_product_code | Co-cyprindiol 2mg+35microgram Tablet (Sandoz Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 47281 | CPRD_product_code | Elevin 150microgram/30microgram tablets (MedRx Healthcare LLP) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 4917 | CPRD_product_code | Microgynon 30 ED tablets (Bayer Plc) | drug | res25: contraceptives | |||
| 49214 | CPRD_product_code | Cilest 250microgram/35microgram tablets (Mawdsley-Brooks & Company Ltd) | drug | res25: contraceptives | Norgestimate/Ethinylestradiol | ||
| 4964 | CPRD_product_code | Femodette tablets (Bayer Plc) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 49700 | CPRD_product_code | Marvelon tablets (DE Pharmaceuticals) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 51482 | CPRD_product_code | Generic Microgynon 30 ED tablets | drug | res25: contraceptives | |||
| 52443 | CPRD_product_code | Microgynon 30 tablets (Mawdsley-Brooks & Company Ltd) | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 52818 | CPRD_product_code | Yasmin tablets (Mawdsley-Brooks & Company Ltd) | drug | res25: contraceptives | Drospirenone/Ethinylestradiol | ||
| 53201 | CPRD_product_code | Dianette tablets (Lexon (UK) Ltd) | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 5576 | CPRD_product_code | Synphase tablets (Pfizer Ltd) | drug | res25: contraceptives | |||
| 56311 | CPRD_product_code | Yaz tablets (Imported (United States)) | drug | res25: contraceptives | |||
| 56483 | CPRD_product_code | Generic Tri-Minulet tablets | drug | res25: contraceptives | |||
| 56539 | CPRD_product_code | Zoely 2.5mg/1.5mg tablets (Merck Sharp & Dohme Ltd) | drug | res25: contraceptives | Estradiol hemihydrate/Nomegestrol | ||
| 56553 | CPRD_product_code | Generic Trinovum tablets | drug | res25: contraceptives | |||
| 56868 | CPRD_product_code | Generic Logynon ED tablets | drug | res25: contraceptives | |||
| 57181 | CPRD_product_code | Lizinna 250microgram/35microgram tablets (Morningside Healthcare Ltd) | drug | res25: contraceptives | Norgestimate/Ethinylestradiol | ||
| 57264 | CPRD_product_code | Estradiol 1.5mg / Nomegestrol 2.5mg tablets | drug | res25: contraceptives | Estradiol hemihydrate/Nomegestrol | ||
| 5862 | CPRD_product_code | Norinyl-1 tablets (Pfizer Ltd) | drug | res25: contraceptives | Norethisterone/Mestranol | ||
| 58642 | CPRD_product_code | Cimizt 30microgram/150microgram tablets (Morningside Healthcare Ltd) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 59149 | CPRD_product_code | Generic Qlaira tablets | drug | res25: contraceptives | |||
| 59383 | CPRD_product_code | Lestramyl 30microgram/150microgram tablets (Generics (UK) Ltd) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 59503 | CPRD_product_code | Lucette 0.03mg/3mg tablets (Consilient Health Ltd) | drug | res25: contraceptives | Drospirenone/Ethinylestradiol | ||
| 6166 | CPRD_product_code | Evra transdermal patches (Janssen-Cilag Ltd) | drug | res25: contraceptives | Ethinylestradiol/Norelgestromin | ||
| 6431 | CPRD_product_code | Co-cyprindiol 2000microgram/35microgram tablets | drug | res25: contraceptives | Cyproterone acetate/Ethinylestradiol | ||
| 6596 | CPRD_product_code | Norelgestromin with ethinylestradiol 203micrograms + 33.9micrograms/24hours Transdermal patch | drug | res25: contraceptives | Ethinylestradiol | ||
| 6686 | CPRD_product_code | Ethinylestradiol 30microgram / Levonorgestrel 150microgram tablets | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 6716 | CPRD_product_code | Ethinylestradiol 30microgram / Drospirenone 3mg tablets | drug | res25: contraceptives | Drospirenone/Ethinylestradiol | ||
| 697 | CPRD_product_code | Yasmin tablets (Bayer Plc) | drug | res25: contraceptives | Drospirenone/Ethinylestradiol | ||
| 7699 | CPRD_product_code | Levonorgestrel 250microgram / Ethinylestradiol 30microgram tablets | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 7776 | CPRD_product_code | Ethinylestradiol 30microgram / Gestodene 75microgram tablets | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 7814 | CPRD_product_code | Ethinylestradiol 35microgram / Norethisterone 500microgram tablets | drug | res25: contraceptives | Norethisterone/Ethinylestradiol | ||
| 8103 | CPRD_product_code | Conova 30 Tablet (Pharmacia Ltd) | drug | res25: contraceptives | Ethinylestradiol | ||
| 8176 | CPRD_product_code | Ethinylestradiol 20microgram / Norethisterone acetate 1mg tablets | drug | res25: contraceptives | Norethisterone acetate/Ethinylestradiol | ||
| 8482 | CPRD_product_code | Ethinylestradiol 35microgram / Norethisterone 1mg tablets | drug | res25: contraceptives | Norethisterone/Ethinylestradiol | ||
| 8718 | CPRD_product_code | Levonorgestrel 250microgram / Ethinylestradiol 50microgram tablets | drug | res25: contraceptives | Levonorgestrel/Ethinylestradiol | ||
| 9119 | CPRD_product_code | Minilyn Tablet (Organon Laboratories Ltd) | drug | res25: contraceptives | Lynestrenol | ||
| 935 | CPRD_product_code | Marvelon tablets (Merck Sharp & Dohme Ltd) | drug | res25: contraceptives | Desogestrel/Ethinylestradiol | ||
| 936 | CPRD_product_code | Femodene tablets (Bayer Plc) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 937 | CPRD_product_code | Trinordiol tablets (Wyeth Pharmaceuticals) | drug | res25: contraceptives | |||
| 977 | CPRD_product_code | Minulet tablets (Wyeth Pharmaceuticals) | drug | res25: contraceptives | Gestodene/Ethinylestradiol | ||
| 978 | CPRD_product_code | Logynon tablets (Bayer Plc) | drug | res25: contraceptives |
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