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: M3_LFT_FBC
138 codes in list
| Code | Coding system | Description | Entity type | List name | medcode | lft_fbc | |
|---|---|---|---|---|---|---|---|
| 423..00 | Read | Haemoglobin estimation | test | res25: M3_LFT_FBC | 4 | 2 | |
| 4231 | Read | Haemoglobin not estimated | test | res25: M3_LFT_FBC | 39601 | 2 | |
| 423..11 | Read | Hb estimation | test | res25: M3_LFT_FBC | 10404 | 2 | |
| 4232 | Read | Haemoglobin requested | test | res25: M3_LFT_FBC | 33284 | 2 | |
| 4233 | Read | Haemoglobin - sample sent | test | res25: M3_LFT_FBC | 13755 | 2 | |
| 4234 | Read | Haemoglobin very low | test | res25: M3_LFT_FBC | 35749 | 2 | |
| 4235 | Read | Haemoglobin low | test | res25: M3_LFT_FBC | 3942 | 2 | |
| 4236 | Read | Haemoglobin borderline low | test | res25: M3_LFT_FBC | 26910 | 2 | |
| 4237 | Read | Haemoglobin normal | test | res25: M3_LFT_FBC | 26909 | 2 | |
| 4238 | Read | Haemoglobin borderline high | test | res25: M3_LFT_FBC | 26272 | 2 | |
| 4239 | Read | Haemoglobin high | test | res25: M3_LFT_FBC | 26913 | 2 | |
| 423A.00 | Read | Haemoglobin very high | test | res25: M3_LFT_FBC | 41531 | 2 | |
| 423B.00 | Read | Haemoglobin abnormal | test | res25: M3_LFT_FBC | 26908 | 2 | |
| 423C.00 | Read | Haemoglobin H inclusion | test | res25: M3_LFT_FBC | 26911 | 2 | |
| 423Z.00 | Read | Haemoglobin estimation NOS | test | res25: M3_LFT_FBC | 26912 | 2 | |
| 424..00 | Read | Full blood count - FBC | test | res25: M3_LFT_FBC | 13 | 2 | |
| 4241 | Read | Full blood count normal | test | res25: M3_LFT_FBC | 13596 | 2 | |
| 4242 | Read | Full blood count borderline | test | res25: M3_LFT_FBC | 23817 | 2 | |
| 4243 | Read | Full blood count abnormal | test | res25: M3_LFT_FBC | 16387 | 2 | |
| 424Z.00 | Read | Full blood count NOS | test | res25: M3_LFT_FBC | 13860 | 2 | |
| 426..00 | Read | Red blood cell (RBC) count | test | res25: M3_LFT_FBC | 17 | 2 | |
| 4261 | Read | RBC count normal | test | res25: M3_LFT_FBC | 26932 | 2 | |
| 4262 | Read | RBC count borderline low | test | res25: M3_LFT_FBC | 58853 | 2 | |
| 4263 | Read | RBC count low | test | res25: M3_LFT_FBC | 26933 | 2 | |
| 4264 | Read | RBC count raised | test | res25: M3_LFT_FBC | 57136 | 2 | |
| 4265 | Read | RBC count borderline raised | test | res25: M3_LFT_FBC | 70079 | 2 | |
| 4266 | Read | Nucleated red blood cell count | test | res25: M3_LFT_FBC | 13788 | 2 | |
| 4267 | Read | RBC count abnormal | test | res25: M3_LFT_FBC | 44213 | 2 | |
| 426Z.00 | Read | RBC count NOS | test | res25: M3_LFT_FBC | 26931 | 2 | |
| 42b..00 | Read | Percentage cell count | test | res25: M3_LFT_FBC | 46685 | 2 | |
| 42b0.00 | Read | Percentage neutrophils | test | res25: M3_LFT_FBC | 17622 | 2 | |
| 42b1.00 | Read | Percentage lymphocytes | test | res25: M3_LFT_FBC | 17621 | 2 | |
| 42b2.00 | Read | Percentage monocytes | test | res25: M3_LFT_FBC | 13775 | 2 | |
| 42b3.00 | Read | Percentage basophils | test | res25: M3_LFT_FBC | 14096 | 2 | |
| 42b4.00 | Read | Percentage metamyelocytes | test | res25: M3_LFT_FBC | 29223 | 2 | |
| 42b5.00 | Read | Percentage blast cells | test | res25: M3_LFT_FBC | 29224 | 2 | |
| 42b6.00 | Read | Percentage smear cells | test | res25: M3_LFT_FBC | 17290 | 2 | |
| 42b7.00 | Read | Percentage granulocytes | test | res25: M3_LFT_FBC | 23115 | 2 | |
| 42b8.00 | Read | Percentage nucleated Red Blood Cells | test | res25: M3_LFT_FBC | 27123 | 2 | |
| 42b9.00 | Read | Percentage eosinophils | test | res25: M3_LFT_FBC | 19760 | 2 | |
| 42bA.00 | Read | Percentage myelocyte count | test | res25: M3_LFT_FBC | 19839 | 2 | |
| 42bB.00 | Read | Percentage promyelocyte count | test | res25: M3_LFT_FBC | 18569 | 2 | |
| 42bC.00 | Read | Percentage reticulocyte count | test | res25: M3_LFT_FBC | 19838 | 2 | |
| 42bD.00 | Read | T cell total % | test | res25: M3_LFT_FBC | 48571 | 2 | |
| 42bE.00 | Read | Percentage hypochromic cells | test | res25: M3_LFT_FBC | 23242 | 2 | |
| 42H..00 | Read | Total white cell count | test | res25: M3_LFT_FBC | 15 | 2 | |
| 42H1.00 | Read | White cell count normal | test | res25: M3_LFT_FBC | 26948 | 2 | |
| 42H..11 | Read | White blood count | test | res25: M3_LFT_FBC | 13817 | 2 | |
| 42H..12 | Read | White cell count | test | res25: M3_LFT_FBC | 13818 | 2 | |
| 42H2.00 | Read | Leucopenia - low white count | test | res25: M3_LFT_FBC | 26325 | 2 | |
| 42H2.11 | Read | Leucopenia | test | res25: M3_LFT_FBC | 1955 | 2 | |
| 42H3.00 | Read | Leucocytosis -high white count | test | res25: M3_LFT_FBC | 22293 | 2 | |
| 42H3.11 | Read | Leucocytosis | test | res25: M3_LFT_FBC | 18516 | 2 | |
| 42H4.00 | Read | Agranulocytosis | test | res25: M3_LFT_FBC | 21258 | 2 | |
| 42H5.00 | Read | White cell count abnormal | test | res25: M3_LFT_FBC | 4996 | 2 | |
| 42H6.00 | Read | Polymorphonuclear leukocyte count | test | res25: M3_LFT_FBC | 48341 | 2 | |
| 42H7.00 | Read | Total white blood count | test | res25: M3_LFT_FBC | 26947 | 2 | |
| 42H8.00 | Read | Total WBC (IMM) | test | res25: M3_LFT_FBC | 48015 | 2 | |
| 42HZ.00 | Read | Total white cell count NOS | test | res25: M3_LFT_FBC | 26946 | 2 | |
| 42I..00 | Read | Differential white cell count | test | res25: M3_LFT_FBC | 14246 | 2 | |
| 42I1.00 | Read | Diff. white cell count normal | test | res25: M3_LFT_FBC | 45115 | 2 | |
| 42I..11 | Read | WCC - differential | test | res25: M3_LFT_FBC | 14247 | 2 | |
| 42I2.00 | Read | Diff. white count abnormal | test | res25: M3_LFT_FBC | 55361 | 2 | |
| 42IZ.00 | Read | Diff. white cell count NOS | test | res25: M3_LFT_FBC | 29240 | 2 | |
| 42MG.00 | Read | Leucocyte count | test | res25: M3_LFT_FBC | 38198 | 2 | |
| 42P..00 | Read | Platelet count | test | res25: M3_LFT_FBC | 7 | 2 | |
| 42P1.00 | Read | Platelet count normal | test | res25: M3_LFT_FBC | 26927 | 2 | |
| 42P2.00 | Read | Thrombocytopenia | test | res25: M3_LFT_FBC | 4006 | 2 | |
| 42P2.11 | Read | Auto-immune thrombocytopenia | test | res25: M3_LFT_FBC | 16420 | 2 | |
| 42P3.00 | Read | Thrombocythaemia | test | res25: M3_LFT_FBC | 3320 | 2 | |
| 42P4.00 | Read | Platelet count abnormal | test | res25: M3_LFT_FBC | 4415 | 2 | |
| 42P5.00 | Read | Platelet distribution width | test | res25: M3_LFT_FBC | 33285 | 2 | |
| 42P6.00 | Read | Platelet/neutrophil ratio | test | res25: M3_LFT_FBC | 52641 | 2 | |
| 42P7.00 | Read | Percentage reticulated platelet count | test | res25: M3_LFT_FBC | 18880 | 2 | |
| 42P8.00 | Read | Heparin induced thrombocytopenia screening test | test | res25: M3_LFT_FBC | 47751 | 2 | |
| 42P9.00 | Read | Plateletcrit | test | res25: M3_LFT_FBC | 47530 | 2 | |
| 42PA.00 | Read | Immature platelet fraction | test | res25: M3_LFT_FBC | 104610 | 2 | |
| 42PZ.00 | Read | Platelet count NOS | test | res25: M3_LFT_FBC | 26926 | 2 | |
| 44D..00 | Read | Liver function tests - general | test | res25: M3_LFT_FBC | 7117 | 1 | |
| 44D1.00 | Read | Liver function tests normal | test | res25: M3_LFT_FBC | 13867 | 1 | |
| 44D..11 | Read | Liver function tests | test | res25: M3_LFT_FBC | 3217 | 1 | |
| 44D2.00 | Read | Liver function tests abnormal | test | res25: M3_LFT_FBC | 2926 | 1 | |
| 44D3.00 | Read | Blood ammonia level | test | res25: M3_LFT_FBC | 13869 | 1 | |
| 44D4.00 | Read | Serum pyruvate | test | res25: M3_LFT_FBC | 64840 | 1 | |
| 44D5.00 | Read | Serum lactate | test | res25: M3_LFT_FBC | 23147 | 1 | |
| 44D6.00 | Read | Liver function test | test | res25: M3_LFT_FBC | 50 | 1 | |
| 44D7.00 | Read | Serum bile salt level | test | res25: M3_LFT_FBC | 13868 | 1 | |
| 44D8.00 | Read | Plasma lactate level | test | res25: M3_LFT_FBC | 26978 | 1 | |
| 44D9.00 | Read | Whole blood pyruvate level | test | res25: M3_LFT_FBC | 95980 | 1 | |
| 44DZ.00 | Read | Liver function tests NOS | test | res25: M3_LFT_FBC | 26979 | 1 | |
| 44F..00 | Read | Serum alkaline phosphatase | test | res25: M3_LFT_FBC | 24 | 1 | |
| 44F1.00 | Read | Serum alk. phos. normal | test | res25: M3_LFT_FBC | 13712 | 1 | |
| 44F2.00 | Read | Serum alk. phos. raised | test | res25: M3_LFT_FBC | 35544 | 1 | |
| 44F3.00 | Read | Total alkaline phosphatase | test | res25: M3_LFT_FBC | 13711 | 1 | |
| 44F4.00 | Read | Alk. phos. - liver isoenzyme | test | res25: M3_LFT_FBC | 43256 | 1 | |
| 44F5.00 | Read | Alk. phos. - bone isoenzyme | test | res25: M3_LFT_FBC | 43018 | 1 | |
| 44F5000 | Read | Alkaline phosphatase bone isoenzyme raised | test | res25: M3_LFT_FBC | 94114 | 1 | |
| 44F6.00 | Read | Alk. phos. - bile isoenzyme | test | res25: M3_LFT_FBC | 23108 | 1 | |
| 44F7.00 | Read | Alkaline phosphatase isoenzyme studies | test | res25: M3_LFT_FBC | 18542 | 1 | |
| 44F8.00 | Read | Plasma alkaline phosphatase bile isoenzyme level | test | res25: M3_LFT_FBC | 59997 | 1 | |
| 44F9.00 | Read | Plasma alkaline phosphatase bone isoenzyme level | test | res25: M3_LFT_FBC | 35543 | 1 | |
| 44FA.00 | Read | Plasma alkaline phosphatase liver isoenzyme level | test | res25: M3_LFT_FBC | 26895 | 1 | |
| 44FB.00 | Read | Serum alkaline phosphatase bile isoenzyme level | test | res25: M3_LFT_FBC | 54618 | 1 | |
| 44FC.00 | Read | Serum alkaline phosphatase bone isoenzyme level | test | res25: M3_LFT_FBC | 26894 | 1 | |
| 44FD.00 | Read | Serum alkaline phosphatase liver isoenzyme level | test | res25: M3_LFT_FBC | 46359 | 1 | |
| 44FE.00 | Read | Serum alkaline phosphatase electrophoresis | test | res25: M3_LFT_FBC | 18859 | 1 | |
| 44FF.00 | Read | Serum alkaline phosphatase intestinal enzyme level | test | res25: M3_LFT_FBC | 54519 | 1 | |
| 44FG.00 | Read | Alkaline phosphatase - bile isoenzyme level | test | res25: M3_LFT_FBC | 60149 | 1 | |
| 44FH.00 | Read | Alkaline phosphatase liver isoenzyme level | test | res25: M3_LFT_FBC | 41433 | 1 | |
| 44FI.00 | Read | Alkaline phosphatase - bone isoenzyme level | test | res25: M3_LFT_FBC | 50939 | 1 | |
| 44FZ.00 | Read | Serum alkaline phosphatase NOS | test | res25: M3_LFT_FBC | 23107 | 1 | |
| 44G..00 | Read | Liver enzymes | test | res25: M3_LFT_FBC | 19194 | 1 | |
| 44G1.00 | Read | Liver enzymes normal | test | res25: M3_LFT_FBC | 19633 | 1 | |
| 44G..11 | Read | ALT - blood level | test | res25: M3_LFT_FBC | 10565 | 1 | |
| 44G..12 | Read | SGPT - blood level | test | res25: M3_LFT_FBC | 14346 | 1 | |
| 44G2.00 | Read | Liver enzymes abnormal | test | res25: M3_LFT_FBC | 4742 | 1 | |
| 44G3.00 | Read | ALT/SGPT serum level | test | res25: M3_LFT_FBC | 35 | 1 | |
| 44G3000 | Read | ALT/SGPT level normal | test | res25: M3_LFT_FBC | 13716 | 1 | |
| 44G3100 | Read | ALT/SGPT level abnormal | test | res25: M3_LFT_FBC | 26020 | 1 | |
| 44G4.00 | Read | Gamma - G.T. level | test | res25: M3_LFT_FBC | 5214 | 1 | |
| 44G4000 | Read | Gamma glutamyl transferase level normal | test | res25: M3_LFT_FBC | 13752 | 1 | |
| 44G4100 | Read | Gamma glutamyl transferase level abnormal | test | res25: M3_LFT_FBC | 5891 | 1 | |
| 44G5.00 | Read | Serum 5 - nucleotidase | test | res25: M3_LFT_FBC | 40206 | 1 | |
| 44G5000 | Read | Serum 5-nucleotidase level normal | test | res25: M3_LFT_FBC | 58966 | 1 | |
| 44G5200 | Read | Serum 5-nucleotidase level raised | test | res25: M3_LFT_FBC | 69539 | 1 | |
| 44G6.00 | Read | Plasma hydroxybutyrate dehydrogenase level | test | res25: M3_LFT_FBC | 60663 | 1 | |
| 44G7.00 | Read | Plasma gamma-glutamyl transferase level | test | res25: M3_LFT_FBC | 13754 | 1 | |
| 44G8.00 | Read | Serum hydroxybutyrate dehydrogenase level | test | res25: M3_LFT_FBC | 58662 | 1 | |
| 44G9.00 | Read | Serum gamma-glutamyl transferase level | test | res25: M3_LFT_FBC | 13753 | 1 | |
| 44GA.00 | Read | Plasma alanine aminotransferase level | test | res25: M3_LFT_FBC | 13717 | 1 | |
| 44GB.00 | Read | Serum alanine aminotransferase level | test | res25: M3_LFT_FBC | 38197 | 1 | |
| 44GZ.00 | Read | Liver enzymes NOS | test | res25: M3_LFT_FBC | 27206 | 1 | |
| 44H5.00 | Read | AST - aspartate transam.(SGOT) | test | res25: M3_LFT_FBC | 13718 | 1 | |
| 44H5000 | Read | AST/SGOT level normal | test | res25: M3_LFT_FBC | 13720 | 1 | |
| 44H5100 | Read | AST/SGOT level abnormal | test | res25: M3_LFT_FBC | 18368 | 1 | |
| 44H5.11 | Read | AST serum level | test | res25: M3_LFT_FBC | 13719 | 1 | |
| 44H5.12 | Read | SGOT serum level | test | res25: M3_LFT_FBC | 40896 | 1 | |
| 44H5200 | Read | AST/SGOT level raised | test | res25: M3_LFT_FBC | 18502 | 1 |
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)