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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: P3_peptic
129 codes in list
| Code | Coding system | Description | Entity type | List name | medcode | ||
|---|---|---|---|---|---|---|---|
| 14C1.00 | Read | H/O: peptic ulcer | diagnostic | res25: P3_peptic | 2812 | ||
| 14C1.11 | Read | H/O: duodenal ulcer | diagnostic | res25: P3_peptic | 6321 | ||
| 14C1.12 | Read | H/O: gastric ulcer | diagnostic | res25: P3_peptic | 7108 | ||
| 7612500 | Read | Resection of gastric ulcer by cautery | diagnostic | res25: P3_peptic | 64710 | ||
| 761D500 | Read | Endoscopic injection haemostasis of duodenal ulcer | diagnostic | res25: P3_peptic | 45981 | ||
| 761D600 | Read | Endoscopic injection haemostasis of gastric ulcer | diagnostic | res25: P3_peptic | 63718 | ||
| 761J.00 | Read | Operations on gastric ulcer | diagnostic | res25: P3_peptic | 23688 | ||
| 761J000 | Read | Closure of perforated gastric ulcer | diagnostic | res25: P3_peptic | 20677 | ||
| 761J100 | Read | Closure of gastric ulcer NEC | diagnostic | res25: P3_peptic | 64014 | ||
| 761J.11 | Read | Stomach ulcer operations | diagnostic | res25: P3_peptic | 6865 | ||
| 761J111 | Read | Suture of ulcer of stomach NEC | diagnostic | res25: P3_peptic | 70005 | ||
| 761Jy00 | Read | Other specified operation on gastric ulcer | diagnostic | res25: P3_peptic | 94104 | ||
| 761Jz00 | Read | Operation on gastric ulcer NOS | diagnostic | res25: P3_peptic | 33914 | ||
| 7627y00 | Read | Other specified operation on duodenal ulcer | diagnostic | res25: P3_peptic | 56005 | ||
| 7627z00 | Read | Operation on duodenal ulcer NOS | diagnostic | res25: P3_peptic | 55933 | ||
| J102000 | Read | Peptic ulcer of oesophagus | diagnostic | res25: P3_peptic | 24021 | ||
| J11..00 | Read | Gastric ulcer - (GU) | diagnostic | res25: P3_peptic | 1262 | ||
| J110.00 | Read | Acute gastric ulcer | diagnostic | res25: P3_peptic | 24040 | ||
| J110000 | Read | Acute gastric ulcer without mention of complication | diagnostic | res25: P3_peptic | 64165 | ||
| J110100 | Read | Acute gastric ulcer with haemorrhage | diagnostic | res25: P3_peptic | 30054 | ||
| J110111 | Read | Bleeding acute gastric ulcer | diagnostic | res25: P3_peptic | 11124 | ||
| J110200 | Read | Acute gastric ulcer with perforation | diagnostic | res25: P3_peptic | 14671 | ||
| J110300 | Read | Acute gastric ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 71403 | ||
| J110y00 | Read | Acute gastric ulcer unspecified | diagnostic | res25: P3_peptic | 24342 | ||
| J110z00 | Read | Acute gastric ulcer NOS | diagnostic | res25: P3_peptic | 44324 | ||
| J111.00 | Read | Chronic gastric ulcer | diagnostic | res25: P3_peptic | 18654 | ||
| J111000 | Read | Chronic gastric ulcer without mention of complication | diagnostic | res25: P3_peptic | 48946 | ||
| J11..11 | Read | Prepyloric ulcer | diagnostic | res25: P3_peptic | 6333 | ||
| J111100 | Read | Chronic gastric ulcer with haemorrhage | diagnostic | res25: P3_peptic | 63582 | ||
| J111111 | Read | Bleeding chronic gastric ulcer | diagnostic | res25: P3_peptic | 36583 | ||
| J11..12 | Read | Pyloric ulcer | diagnostic | res25: P3_peptic | 3101 | ||
| J111200 | Read | Chronic gastric ulcer with perforation | diagnostic | res25: P3_peptic | 53336 | ||
| J111211 | Read | Perforated chronic gastric ulcer | diagnostic | res25: P3_peptic | 11104 | ||
| J111300 | Read | Chronic gastric ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 71897 | ||
| J111400 | Read | Chronic gastric ulcer with obstruction | diagnostic | res25: P3_peptic | 67356 | ||
| J111y00 | Read | Chronic gastric ulcer unspecified | diagnostic | res25: P3_peptic | 64556 | ||
| J111z00 | Read | Chronic gastric ulcer NOS | diagnostic | res25: P3_peptic | 44309 | ||
| J112.00 | Read | Anti-platelet induced gastric ulcer | diagnostic | res25: P3_peptic | 63001 | ||
| J112z00 | Read | Anti-platelet induced gastric ulcer NOS | diagnostic | res25: P3_peptic | 89227 | ||
| J113.00 | Read | Non steroidal anti inflammatory drug induced gastric ulcer | diagnostic | res25: P3_peptic | 89023 | ||
| J113z00 | Read | Non steroidal anti inflammatory drug induced gastric ulc NOS | diagnostic | res25: P3_peptic | 97993 | ||
| J11y.00 | Read | Unspecified gastric ulcer | diagnostic | res25: P3_peptic | 53081 | ||
| J11y000 | Read | Unspecified gastric ulcer without mention of complication | diagnostic | res25: P3_peptic | 73338 | ||
| J11y100 | Read | Unspecified gastric ulcer with haemorrhage | diagnostic | res25: P3_peptic | 57958 | ||
| J11y200 | Read | Unspecified gastric ulcer with perforation | diagnostic | res25: P3_peptic | 36461 | ||
| J11y400 | Read | Unspecified gastric ulcer with obstruction | diagnostic | res25: P3_peptic | 73697 | ||
| J11yy00 | Read | Unspec gastric ulcer; unspec haemorrhage and/or perforation | diagnostic | res25: P3_peptic | 94397 | ||
| J11yz00 | Read | Unspecified gastric ulcer NOS | diagnostic | res25: P3_peptic | 44284 | ||
| J11z.00 | Read | Gastric ulcer NOS | diagnostic | res25: P3_peptic | 29771 | ||
| J11z.11 | Read | Gastric erosions | diagnostic | res25: P3_peptic | 2877 | ||
| J11z.12 | Read | Multiple gastric ulcers | diagnostic | res25: P3_peptic | 52323 | ||
| J12..00 | Read | Duodenal ulcer - (DU) | diagnostic | res25: P3_peptic | 352 | ||
| J120.00 | Read | Acute duodenal ulcer | diagnostic | res25: P3_peptic | 18027 | ||
| J120000 | Read | Acute duodenal ulcer without mention of complication | diagnostic | res25: P3_peptic | 44335 | ||
| J120100 | Read | Acute duodenal ulcer with haemorrhage | diagnostic | res25: P3_peptic | 18001 | ||
| J120200 | Read | Acute duodenal ulcer with perforation | diagnostic | res25: P3_peptic | 18324 | ||
| J120300 | Read | Acute duodenal ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 48730 | ||
| J120400 | Read | Acute duodenal ulcer with obstruction | diagnostic | res25: P3_peptic | 73417 | ||
| J120y00 | Read | Acute duodenal ulcer unspecified | diagnostic | res25: P3_peptic | 53822 | ||
| J120z00 | Read | Acute duodenal ulcer NOS | diagnostic | res25: P3_peptic | 53797 | ||
| J121.00 | Read | Chronic duodenal ulcer | diagnostic | res25: P3_peptic | 9853 | ||
| J121000 | Read | Chronic duodenal ulcer without mention of complication | diagnostic | res25: P3_peptic | 33438 | ||
| J121100 | Read | Chronic duodenal ulcer with haemorrhage | diagnostic | res25: P3_peptic | 48951 | ||
| J121111 | Read | Bleeding chronic duodenal ulcer | diagnostic | res25: P3_peptic | 18625 | ||
| J121200 | Read | Chronic duodenal ulcer with perforation | diagnostic | res25: P3_peptic | 37643 | ||
| J121211 | Read | Perforated chronic duodenal ulcer | diagnostic | res25: P3_peptic | 23087 | ||
| J121300 | Read | Chronic duodenal ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 71881 | ||
| J121400 | Read | Chronic duodenal ulcer with obstruction | diagnostic | res25: P3_peptic | 44073 | ||
| J121y00 | Read | Chronic duodenal ulcer unspecified | diagnostic | res25: P3_peptic | 52138 | ||
| J121z00 | Read | Chronic duodenal ulcer NOS | diagnostic | res25: P3_peptic | 51406 | ||
| J122.00 | Read | Duodenal ulcer disease | diagnostic | res25: P3_peptic | 22918 | ||
| J123.00 | Read | Duodenal erosion | diagnostic | res25: P3_peptic | 3462 | ||
| J124.00 | Read | Recurrent duodenal ulcer | diagnostic | res25: P3_peptic | 29317 | ||
| J125.00 | Read | Anti-platelet induced duodenal ulcer | diagnostic | res25: P3_peptic | 89234 | ||
| J126.00 | Read | Non steroidal anti inflammatory drug induced duodenal ulcer | diagnostic | res25: P3_peptic | 85989 | ||
| J12y.00 | Read | Unspecified duodenal ulcer | diagnostic | res25: P3_peptic | 53669 | ||
| J12y000 | Read | Unspecified duodenal ulcer without mention of complication | diagnostic | res25: P3_peptic | 71150 | ||
| J12y100 | Read | Unspecified duodenal ulcer with haemorrhage | diagnostic | res25: P3_peptic | 2814 | ||
| J12y200 | Read | Unspecified duodenal ulcer with perforation | diagnostic | res25: P3_peptic | 657 | ||
| J12y300 | Read | Unspecified duodenal ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 93436 | ||
| J12y400 | Read | Unspecified duodenal ulcer with obstruction | diagnostic | res25: P3_peptic | 71904 | ||
| J12yy00 | Read | Unspec duodenal ulcer; unspec haemorrhage and/or perforation | diagnostic | res25: P3_peptic | 28366 | ||
| J12yz00 | Read | Unspecified duodenal ulcer NOS | diagnostic | res25: P3_peptic | 65737 | ||
| J12z.00 | Read | Duodenal ulcer NOS | diagnostic | res25: P3_peptic | 15175 | ||
| J13..00 | Read | Peptic ulcer - (PU) site unspecified | diagnostic | res25: P3_peptic | 670 | ||
| J130.00 | Read | Acute peptic ulcer | diagnostic | res25: P3_peptic | 32856 | ||
| J130000 | Read | Acute peptic ulcer without mention of complication | diagnostic | res25: P3_peptic | 68661 | ||
| J130100 | Read | Acute peptic ulcer with haemorrhage | diagnostic | res25: P3_peptic | 44637 | ||
| J130200 | Read | Acute peptic ulcer with perforation | diagnostic | res25: P3_peptic | 5521 | ||
| J130300 | Read | Acute peptic ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 45304 | ||
| J130y00 | Read | Acute peptic ulcer unspecified | diagnostic | res25: P3_peptic | 67711 | ||
| J130z00 | Read | Acute peptic ulcer NOS | diagnostic | res25: P3_peptic | 50048 | ||
| J131.00 | Read | Chronic peptic ulcer | diagnostic | res25: P3_peptic | 40997 | ||
| J131000 | Read | Chronic peptic ulcer without mention of complication | diagnostic | res25: P3_peptic | 99430 | ||
| J13..11 | Read | Stress ulcer NOS | diagnostic | res25: P3_peptic | 15821 | ||
| J131100 | Read | Chronic peptic ulcer with haemorrhage | diagnostic | res25: P3_peptic | 53126 | ||
| J131200 | Read | Chronic peptic ulcer with perforation | diagnostic | res25: P3_peptic | 37620 | ||
| J131400 | Read | Chronic peptic ulcer with obstruction | diagnostic | res25: P3_peptic | 52313 | ||
| J131y00 | Read | Chronic peptic ulcer unspecified | diagnostic | res25: P3_peptic | 70390 | ||
| J131z00 | Read | Chronic peptic ulcer NOS | diagnostic | res25: P3_peptic | 69663 | ||
| J13y.00 | Read | Unspecified peptic ulcer | diagnostic | res25: P3_peptic | 50497 | ||
| J13y000 | Read | Unspecified peptic ulcer without mention of complication | diagnostic | res25: P3_peptic | 67082 | ||
| J13y100 | Read | Unspecified peptic ulcer with haemorrhage | diagnostic | res25: P3_peptic | 70456 | ||
| J13y200 | Read | Unspecified peptic ulcer with perforation | diagnostic | res25: P3_peptic | 64111 | ||
| J13y300 | Read | Unspecified peptic ulcer with haemorrhage and perforation | diagnostic | res25: P3_peptic | 96622 | ||
| J13y400 | Read | Unspecified peptic ulcer with obstruction | diagnostic | res25: P3_peptic | 99670 | ||
| J13yz00 | Read | Unspecified peptic ulcer NOS | diagnostic | res25: P3_peptic | 60249 | ||
| J13z.00 | Read | Peptic ulcer NOS | diagnostic | res25: P3_peptic | 19928 | ||
| J14..00 | Read | Gastrojejunal ulcer (GJU) | diagnostic | res25: P3_peptic | 23082 | ||
| J140.00 | Read | Acute gastrojejunal ulcer | diagnostic | res25: P3_peptic | 45184 | ||
| J140100 | Read | Acute gastrojejunal ulcer with haemorrhage | diagnostic | res25: P3_peptic | 96628 | ||
| J140200 | Read | Acute gastrojejunal ulcer with perforation | diagnostic | res25: P3_peptic | 102177 | ||
| J140z00 | Read | Acute gastrojejunal ulcer NOS | diagnostic | res25: P3_peptic | 42274 | ||
| J141.00 | Read | Chronic gastrojejunal ulcer | diagnostic | res25: P3_peptic | 96090 | ||
| J14..11 | Read | Anastomotic ulcer | diagnostic | res25: P3_peptic | 23487 | ||
| J14..12 | Read | Gastrocolic ulcer | diagnostic | res25: P3_peptic | 64913 | ||
| J14..13 | Read | Jejunal ulcer | diagnostic | res25: P3_peptic | 9981 | ||
| J14..14 | Read | Marginal ulcer | diagnostic | res25: P3_peptic | 4316 | ||
| J14..15 | Read | Stomal ulcer | diagnostic | res25: P3_peptic | 1295 | ||
| J14y.00 | Read | Unspecified gastrojejunal ulcer | diagnostic | res25: P3_peptic | 63482 | ||
| J14y100 | Read | Unspecified gastrojejunal ulcer with haemorrhage | diagnostic | res25: P3_peptic | 60346 | ||
| J14y200 | Read | Unspecified gastrojejunal ulcer with perforation | diagnostic | res25: P3_peptic | 15979 | ||
| J14yz00 | Read | Unspecified gastrojejunal ulcer NOS | diagnostic | res25: P3_peptic | 66092 | ||
| J14z.00 | Read | Gastrojejunal ulcer NOS | diagnostic | res25: P3_peptic | 15403 | ||
| J173300 | Read | Duodenal scar | diagnostic | res25: P3_peptic | 15847 | ||
| J17y700 | Read | Deformed duodenal cap (bulb) | diagnostic | res25: P3_peptic | 3876 | ||
| J17y800 | Read | Healed gastric ulcer leaving a scar | diagnostic | res25: P3_peptic | 18319 | ||
| ZV12700 | Read | [V]Personal history of digestive system disease | diagnostic | res25: P3_peptic | 30995 | ||
| ZV12C00 | Read | [V] Personal history of gastric ulcer | diagnostic | res25: P3_peptic | 41271 |
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