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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: P13_dementia
96 codes in list
| Code | Coding system | Description | Entity type | List name | medcode | ||
|---|---|---|---|---|---|---|---|
| A411.00 | Read | Jakob-Creutzfeldt disease | diagnostic | res25: P13_dementia | 38286 | ||
| E00..00 | Read | Senile and presenile organic psychotic conditions | diagnostic | res25: P13_dementia | 33707 | ||
| E000.00 | Read | Uncomplicated senile dementia | diagnostic | res25: P13_dementia | 7323 | ||
| E001.00 | Read | Presenile dementia | diagnostic | res25: P13_dementia | 15165 | ||
| E001000 | Read | Uncomplicated presenile dementia | diagnostic | res25: P13_dementia | 42602 | ||
| E00..11 | Read | Senile dementia | diagnostic | res25: P13_dementia | 1916 | ||
| E001100 | Read | Presenile dementia with delirium | diagnostic | res25: P13_dementia | 49513 | ||
| E00..12 | Read | Senile/presenile dementia | diagnostic | res25: P13_dementia | 1350 | ||
| E001200 | Read | Presenile dementia with paranoia | diagnostic | res25: P13_dementia | 30032 | ||
| E001300 | Read | Presenile dementia with depression | diagnostic | res25: P13_dementia | 27677 | ||
| E001z00 | Read | Presenile dementia NOS | diagnostic | res25: P13_dementia | 38438 | ||
| E002.00 | Read | Senile dementia with depressive or paranoid features | diagnostic | res25: P13_dementia | 44674 | ||
| E002000 | Read | Senile dementia with paranoia | diagnostic | res25: P13_dementia | 18386 | ||
| E002100 | Read | Senile dementia with depression | diagnostic | res25: P13_dementia | 21887 | ||
| E002z00 | Read | Senile dementia with depressive or paranoid features NOS | diagnostic | res25: P13_dementia | 41089 | ||
| E003.00 | Read | Senile dementia with delirium | diagnostic | res25: P13_dementia | 37015 | ||
| E004.00 | Read | Arteriosclerotic dementia | diagnostic | res25: P13_dementia | 19477 | ||
| E004000 | Read | Uncomplicated arteriosclerotic dementia | diagnostic | res25: P13_dementia | 43089 | ||
| E004100 | Read | Arteriosclerotic dementia with delirium | diagnostic | res25: P13_dementia | 56912 | ||
| E004.11 | Read | Multi infarct dementia | diagnostic | res25: P13_dementia | 8634 | ||
| E004200 | Read | Arteriosclerotic dementia with paranoia | diagnostic | res25: P13_dementia | 55467 | ||
| E004300 | Read | Arteriosclerotic dementia with depression | diagnostic | res25: P13_dementia | 43292 | ||
| E004z00 | Read | Arteriosclerotic dementia NOS | diagnostic | res25: P13_dementia | 42279 | ||
| E00y.00 | Read | Other senile and presenile organic psychoses | diagnostic | res25: P13_dementia | 15249 | ||
| E00y.11 | Read | Presbyophrenic psychosis | diagnostic | res25: P13_dementia | 51494 | ||
| E00z.00 | Read | Senile or presenile psychoses NOS | diagnostic | res25: P13_dementia | 2882 | ||
| E012.00 | Read | Other alcoholic dementia | diagnostic | res25: P13_dementia | 54505 | ||
| E012000 | Read | Chronic alcoholic brain syndrome | diagnostic | res25: P13_dementia | 37946 | ||
| E012.11 | Read | Alcoholic dementia NOS | diagnostic | res25: P13_dementia | 27342 | ||
| E02y100 | Read | Drug-induced dementia | diagnostic | res25: P13_dementia | 62132 | ||
| E041.00 | Read | Dementia in conditions EC | diagnostic | res25: P13_dementia | 25386 | ||
| Eu00.00 | Read | [X]Dementia in Alzheimer's disease | diagnostic | res25: P13_dementia | 7664 | ||
| Eu00000 | Read | [X]Dementia in Alzheimer's disease with early onset | diagnostic | res25: P13_dementia | 49263 | ||
| Eu00011 | Read | [X]Presenile dementia,Alzheimer's type | diagnostic | res25: P13_dementia | 25704 | ||
| Eu00012 | Read | [X]Primary degen dementia, Alzheimer's type, presenile onset | diagnostic | res25: P13_dementia | 60059 | ||
| Eu00013 | Read | [X]Alzheimer's disease type 2 | diagnostic | res25: P13_dementia | 61528 | ||
| Eu00100 | Read | [X]Dementia in Alzheimer's disease with late onset | diagnostic | res25: P13_dementia | 38678 | ||
| Eu00111 | Read | [X]Alzheimer's disease type 1 | diagnostic | res25: P13_dementia | 46762 | ||
| Eu00112 | Read | [X]Senile dementia,Alzheimer's type | diagnostic | res25: P13_dementia | 11379 | ||
| Eu00113 | Read | [X]Primary degen dementia of Alzheimer's type, senile onset | diagnostic | res25: P13_dementia | 43346 | ||
| Eu00200 | Read | [X]Dementia in Alzheimer's dis, atypical or mixed type | diagnostic | res25: P13_dementia | 30706 | ||
| Eu00z00 | Read | [X]Dementia in Alzheimer's disease, unspecified | diagnostic | res25: P13_dementia | 29386 | ||
| Eu00z11 | Read | [X]Alzheimer's dementia unspec | diagnostic | res25: P13_dementia | 8195 | ||
| Eu01.00 | Read | [X]Vascular dementia | diagnostic | res25: P13_dementia | 6578 | ||
| Eu01000 | Read | [X]Vascular dementia of acute onset | diagnostic | res25: P13_dementia | 46488 | ||
| Eu01100 | Read | [X]Multi-infarct dementia | diagnostic | res25: P13_dementia | 11175 | ||
| Eu01.11 | Read | [X]Arteriosclerotic dementia | diagnostic | res25: P13_dementia | 9565 | ||
| Eu01111 | Read | [X]Predominantly cortical dementia | diagnostic | res25: P13_dementia | 55838 | ||
| Eu01200 | Read | [X]Subcortical vascular dementia | diagnostic | res25: P13_dementia | 8934 | ||
| Eu01300 | Read | [X]Mixed cortical and subcortical vascular dementia | diagnostic | res25: P13_dementia | 31016 | ||
| Eu01y00 | Read | [X]Other vascular dementia | diagnostic | res25: P13_dementia | 55313 | ||
| Eu01z00 | Read | [X]Vascular dementia, unspecified | diagnostic | res25: P13_dementia | 19393 | ||
| Eu02.00 | Read | [X]Dementia in other diseases classified elsewhere | diagnostic | res25: P13_dementia | 12621 | ||
| Eu02000 | Read | [X]Dementia in Pick's disease | diagnostic | res25: P13_dementia | 28402 | ||
| Eu02100 | Read | [X]Dementia in Creutzfeldt-Jakob disease | diagnostic | res25: P13_dementia | 54106 | ||
| Eu02200 | Read | [X]Dementia in Huntington's disease | diagnostic | res25: P13_dementia | 37014 | ||
| Eu02300 | Read | [X]Dementia in Parkinson's disease | diagnostic | res25: P13_dementia | 9509 | ||
| Eu02400 | Read | [X]Dementia in human immunodef virus [HIV] disease | diagnostic | res25: P13_dementia | 41185 | ||
| Eu02500 | Read | [X]Lewy body dementia | diagnostic | res25: P13_dementia | 26270 | ||
| Eu02y00 | Read | [X]Dementia in other specified diseases classif elsewhere | diagnostic | res25: P13_dementia | 64267 | ||
| Eu02z00 | Read | [X] Unspecified dementia | diagnostic | res25: P13_dementia | 4693 | ||
| Eu02z11 | Read | [X] Presenile dementia NOS | diagnostic | res25: P13_dementia | 48501 | ||
| Eu02z12 | Read | [X] Presenile psychosis NOS | diagnostic | res25: P13_dementia | 47619 | ||
| Eu02z13 | Read | [X] Primary degenerative dementia NOS | diagnostic | res25: P13_dementia | 34944 | ||
| Eu02z14 | Read | [X] Senile dementia NOS | diagnostic | res25: P13_dementia | 4357 | ||
| Eu02z15 | Read | [X] Senile psychosis NOS | diagnostic | res25: P13_dementia | 27935 | ||
| Eu02z16 | Read | [X] Senile dementia, depressed or paranoid type | diagnostic | res25: P13_dementia | 27759 | ||
| Eu04100 | Read | [X]Delirium superimposed on dementia | diagnostic | res25: P13_dementia | 53446 | ||
| Eu05700 | Read | [X]Mild cognitive disorder | diagnostic | res25: P13_dementia | 11936 | ||
| F110.00 | Read | Alzheimer's disease | diagnostic | res25: P13_dementia | 1917 | ||
| F110000 | Read | Alzheimer's disease with early onset | diagnostic | res25: P13_dementia | 16797 | ||
| F110100 | Read | Alzheimer's disease with late onset | diagnostic | res25: P13_dementia | 32057 | ||
| F111.00 | Read | Pick's disease | diagnostic | res25: P13_dementia | 11136 | ||
| F1110A | Read | diagnostic | res25: P13_dementia | 89580 | |||
| F112.00 | Read | Senile degeneration of brain | diagnostic | res25: P13_dementia | 29512 | ||
| F116.00 | Read | Lewy body disease | diagnostic | res25: P13_dementia | 7572 | ||
| F118.00 | Read | diagnostic | res25: P13_dementia | 104534 | |||
| F11x.00 | Read | Cerebral degeneration in other disease EC | diagnostic | res25: P13_dementia | 97422 | ||
| F11x000 | Read | Cerebral degeneration due to alcoholism | diagnostic | res25: P13_dementia | 47555 | ||
| F11x011 | Read | Alcoholic encephalopathy | diagnostic | res25: P13_dementia | 36748 | ||
| F11x200 | Read | Cerebral degeneration due to cerebrovascular disease | diagnostic | res25: P13_dementia | 54744 | ||
| F11x400 | Read | Cerebral degeneration due to neoplastic disease | diagnostic | res25: P13_dementia | 70957 | ||
| F11x500 | Read | Cerebral degeneration due to myxoedema | diagnostic | res25: P13_dementia | 47658 | ||
| F11x600 | Read | Cerebral degeneration due to vitamin B12 deficiency | diagnostic | res25: P13_dementia | 24581 | ||
| F11x700 | Read | Cerebral degeneration due to Jakob - Creutzfeldt disease | diagnostic | res25: P13_dementia | 48531 | ||
| F11x800 | Read | Cerebral degeneration due to multifocal leucoencephalopathy | diagnostic | res25: P13_dementia | 99684 | ||
| F11x900 | Read | Cerebral degeneration in Parkinson's disease | diagnostic | res25: P13_dementia | 96860 | ||
| F11xz00 | Read | Cerebral degeneration other disease NOS | diagnostic | res25: P13_dementia | 44592 | ||
| F11y.00 | Read | Other cerebral degeneration | diagnostic | res25: P13_dementia | 34976 | ||
| F11y000 | Read | Reye's syndrome | diagnostic | res25: P13_dementia | 33353 | ||
| F11y100 | Read | Cerebral ataxia | diagnostic | res25: P13_dementia | 15261 | ||
| F11yz00 | Read | Other cerebral degeneration NOS | diagnostic | res25: P13_dementia | 31524 | ||
| F11z.00 | Read | Cerebral degeneration NOS | diagnostic | res25: P13_dementia | 5651 | ||
| F11z.11 | Read | Cerebral atrophy | diagnostic | res25: P13_dementia | 2731 | ||
| F134.00 | Read | Huntington's chorea | diagnostic | res25: P13_dementia | 3591 | ||
| Fyu3000 | Read | [X]Other Alzheimer's disease | diagnostic | res25: P13_dementia | 59122 |
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