ClinicalCodes.org
An online clinical codes repository to improve validity and reproducibility of medical database research
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: M2_TFT
58 codes in list
| Code | Coding system | Description | Entity type | List name | medcode | ||
|---|---|---|---|---|---|---|---|
| 442..00 | Read | Thyroid hormone tests | test | res25: M2_TFT | 2698 | ||
| 4421 | Read | Thyroid hormone tests normal | test | res25: M2_TFT | 13609 | ||
| 442..11 | Read | TRH level | test | res25: M2_TFT | 26995 | ||
| 4421.11 | Read | Euthyroid | test | res25: M2_TFT | 4877 | ||
| 442..12 | Read | TSH level | test | res25: M2_TFT | 13598 | ||
| 442..13 | Read | Thyroid function tests | test | res25: M2_TFT | 11367 | ||
| 442..14 | Read | Thyroxine binding globulin | test | res25: M2_TFT | 26991 | ||
| 4422 | Read | Thyroid hormone tests high | test | res25: M2_TFT | 27278 | ||
| 4423 | Read | Thyroid hormone tests low | test | res25: M2_TFT | 33292 | ||
| 4424 | Read | Serum T3 level | test | res25: M2_TFT | 13791 | ||
| 4424000 | Read | Serum T3 level normal | test | res25: M2_TFT | 19787 | ||
| 4424100 | Read | Serum T3 level high | test | res25: M2_TFT | 26936 | ||
| 4424200 | Read | Serum T3 level low | test | res25: M2_TFT | 35547 | ||
| 4425 | Read | Free T3 level | test | res25: M2_TFT | 13602 | ||
| 4426 | Read | Serum T4 level | test | res25: M2_TFT | 941 | ||
| 4426000 | Read | Serum T4 level normal | test | res25: M2_TFT | 19767 | ||
| 4426100 | Read | Serum T4 level abnormal | test | res25: M2_TFT | 20983 | ||
| 4427 | Read | Free T4 level | test | res25: M2_TFT | 14459 | ||
| 4428 | Read | Free thyroxine index | test | res25: M2_TFT | 26994 | ||
| 4429 | Read | Thyroxine binding globulin-TBG | test | res25: M2_TFT | 48565 | ||
| 442a.00 | Read | Plasma total T4 level | test | res25: M2_TFT | 19789 | ||
| 442A.00 | Read | TSH - thyroid stim. hormone | test | res25: M2_TFT | 13811 | ||
| 442A000 | Read | Serum TSH level normal | test | res25: M2_TFT | 19769 | ||
| 442A100 | Read | Serum TSH level abnormal | test | res25: M2_TFT | 3900 | ||
| 442b.00 | Read | Serum total T4 level | test | res25: M2_TFT | 19788 | ||
| 442B.00 | Read | TRH - thyroid release. hormone | test | res25: M2_TFT | 33293 | ||
| 442c.00 | Read | Plasma free T4 level | test | res25: M2_TFT | 27228 | ||
| 442C.00 | Read | Thyroid horm tests borderline | test | res25: M2_TFT | 27807 | ||
| 442d.00 | Read | Serum thyroglobulin level | test | res25: M2_TFT | 18178 | ||
| 442D.00 | Read | T3 uptake test | test | res25: M2_TFT | 26993 | ||
| 442D000 | Read | T3 uptake test normal | test | res25: M2_TFT | 55155 | ||
| 442D100 | Read | T3 uptake test abnormal | test | res25: M2_TFT | 59072 | ||
| 442e.00 | Read | Blood spot TSH level | test | res25: M2_TFT | 37210 | ||
| 442E.00 | Read | PBI - protein bound iodine estimation | test | res25: M2_TFT | 26992 | ||
| 442f.00 | Read | Serum total T3 level | test | res25: M2_TFT | 35554 | ||
| 442F.00 | Read | T3 suppression test | test | res25: M2_TFT | 42347 | ||
| 442g.00 | Read | Serum thyroglobulin recovery level | test | res25: M2_TFT | 68378 | ||
| 442G.00 | Read | Thyroid hormone tests abnormal | test | res25: M2_TFT | 20970 | ||
| 442h.00 | Read | Thyrotropin releasing hormone (TRH) stimulation test | test | res25: M2_TFT | 94927 | ||
| 442H.00 | Read | Thyroid function tests normal | test | res25: M2_TFT | 13907 | ||
| 442I.00 | Read | Thyroid function tests abnormal | test | res25: M2_TFT | 18598 | ||
| 442J.00 | Read | Thyroid function test | test | res25: M2_TFT | 13906 | ||
| 442K.00 | Read | 30 minute plasma TSH level | test | res25: M2_TFT | 26942 | ||
| 442L.00 | Read | 60 minute plasma TSH level | test | res25: M2_TFT | 63031 | ||
| 442M.00 | Read | 90 minute plasma TSH level | test | res25: M2_TFT | 66215 | ||
| 442N.00 | Read | 120 minute plasma TSH level | test | res25: M2_TFT | 67108 | ||
| 442O.00 | Read | 150 minute plasma TSH level | test | res25: M2_TFT | 100259 | ||
| 442P.00 | Read | 30 minute serum TSH level | test | res25: M2_TFT | 93724 | ||
| 442Q.00 | Read | 60 minute serum TSH level | test | res25: M2_TFT | 65083 | ||
| 442S.00 | Read | 120 minute serum TSH level | test | res25: M2_TFT | 68780 | ||
| 442T.00 | Read | 150 minute serum TSH level | test | res25: M2_TFT | 53286 | ||
| 442U.00 | Read | Serum free triiodothyronine level | test | res25: M2_TFT | 19866 | ||
| 442V.00 | Read | Serum free T4 level | test | res25: M2_TFT | 14460 | ||
| 442W.00 | Read | Serum TSH level | test | res25: M2_TFT | 63 | ||
| 442X.00 | Read | Plasma TSH level | test | res25: M2_TFT | 19770 | ||
| 442Y.00 | Read | Plasma free triiodothyronine level | test | res25: M2_TFT | 34597 | ||
| 442Z.00 | Read | Thyroid hormone tests NOS | test | res25: M2_TFT | 16122 | ||
| C134300 | Read | TSH - thyroid-stimulating hormone deficiency | test | res25: M2_TFT | 11146 |
Please log in to leave a comment.
Code list links:
ClinicalCodes is a project at the University of Manchester Institute of Population Health
The ClinicalCodes project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR)