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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: M4_lithium
25 codes in list
| Code | Coding system | Description | Entity type | List name | drugsubstance | ||
|---|---|---|---|---|---|---|---|
| 10809 | CPRD_product_code | Priadel 520mg/5ml liquid (Sanofi) | drug | res25: M4_lithium | Lithium citrate | ||
| 10937 | CPRD_product_code | Lithium citrate 509mg/5ml oral solution | drug | res25: M4_lithium | Lithium citrate | ||
| 11491 | CPRD_product_code | Lithium citrate 520mg/5ml oral solution sugar free | drug | res25: M4_lithium | Lithium citrate | ||
| 12402 | CPRD_product_code | Camcolit 250 tablets (Norgine Pharmaceuticals Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 12403 | CPRD_product_code | Camcolit 400 modified-release tablets (Norgine Pharmaceuticals Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 12648 | CPRD_product_code | Lithium citrate 1.018g/5ml oral solution | drug | res25: M4_lithium | Lithium citrate | ||
| 13601 | CPRD_product_code | Lithium citrate 564mg modified-release tablets | drug | res25: M4_lithium | Lithium citrate | ||
| 13654 | CPRD_product_code | Litarex 564mg modified-release tablets (Actavis UK Ltd) | drug | res25: M4_lithium | Lithium citrate | ||
| 1447 | CPRD_product_code | Lithium carbonate 400mg modified-release tablets | drug | res25: M4_lithium | Lithium carbonate | ||
| 14954 | CPRD_product_code | Lithium carbonate 450mg modified-release tablets | drug | res25: M4_lithium | Lithium carbonate | ||
| 15388 | CPRD_product_code | Phasal 300mg Tablet (Lagap) | drug | res25: M4_lithium | Lithium Carbonate | ||
| 16250 | CPRD_product_code | Lithonate 400mg modified-release tablets (Teva UK Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 22018 | CPRD_product_code | Li-Liquid 509mg/5ml oral solution (Rosemont Pharmaceuticals Ltd) | drug | res25: M4_lithium | Lithium citrate | ||
| 25344 | CPRD_product_code | Lithium carbonate 400mg Modified-release tablet (Approved Prescription Services Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 25345 | CPRD_product_code | Li-Liquid 1.018g/5ml oral solution (Rosemont Pharmaceuticals Ltd) | drug | res25: M4_lithium | Lithium citrate | ||
| 3352 | CPRD_product_code | Liskonum 450mg modified-release tablets (GlaxoSmithKline UK Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 3359 | CPRD_product_code | Priadel 200mg modified-release tablets (Sanofi) | drug | res25: M4_lithium | Lithium carbonate | ||
| 51401 | CPRD_product_code | Priadel 400mg modified-release tablets (Necessity Supplies Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 53459 | CPRD_product_code | Priadel 400mg modified-release tablets (Doncaster Pharmaceuticals Ltd) | drug | res25: M4_lithium | Lithium carbonate | ||
| 56427 | CPRD_product_code | Lithium citrate 509mg/5ml oral solution (Cubic Pharmaceuticals Ltd) | drug | res25: M4_lithium | Lithium citrate | ||
| 56435 | CPRD_product_code | Lithium carbonate 200mg/5ml oral suspension | drug | res25: M4_lithium | Lithium carbonate | ||
| 760 | CPRD_product_code | Lithium carbonate 200mg modified-release tablets | drug | res25: M4_lithium | Lithium carbonate | ||
| 8041 | CPRD_product_code | Lithium carbonate 250mg tablets | drug | res25: M4_lithium | Lithium carbonate | ||
| 872 | CPRD_product_code | Priadel 400mg modified-release tablets (Sanofi) | drug | res25: M4_lithium | Lithium carbonate | ||
| 8827 | CPRD_product_code | Lithium carbonate 300mg Modified-release tablet | drug | res25: M4_lithium | Lithium Carbonate |
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