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: P5_glitazone
31 codes in list
| Code | Coding system | Description | Entity type | List name | drugsubstance | ||
|---|---|---|---|---|---|---|---|
| 10051 | CPRD_product_code | Pioglitazone 45mg tablets | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 11601 | CPRD_product_code | Rosiglitazone 2mg / Metformin 500mg tablets | drug | res25: P5_glitazone | Rosiglitazone maleate/Metformin hydrochloride | ||
| 11604 | CPRD_product_code | Rosiglitazone 1mg / Metformin 500mg tablets | drug | res25: P5_glitazone | Rosiglitazone maleate/Metformin hydrochloride | ||
| 11609 | CPRD_product_code | Metformin with rosiglitazone 500mg + 1mg Tablet | drug | res25: P5_glitazone | Metformin Hydrochloride | ||
| 11610 | CPRD_product_code | Metformin with rosiglitazone 500mg + 2mg Tablet | drug | res25: P5_glitazone | Metformin Hydrochloride | ||
| 11717 | CPRD_product_code | Rosiglitazone 2mg / Metformin 1g tablets | drug | res25: P5_glitazone | Metformin hydrochloride/Rosiglitazone maleate | ||
| 11737 | CPRD_product_code | Metformin with rosiglitazone 1000mg + 4mg Tablet | drug | res25: P5_glitazone | Metformin Hydrochloride | ||
| 11760 | CPRD_product_code | Metformin with rosiglitazone 1000mg + 2mg Tablet | drug | res25: P5_glitazone | Metformin Hydrochloride | ||
| 14164 | CPRD_product_code | Avandamet 2mg/1000mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Metformin hydrochloride/Rosiglitazone maleate | ||
| 15232 | CPRD_product_code | Avandia 8mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Rosiglitazone maleate | ||
| 17580 | CPRD_product_code | Avandamet 1mg/500mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Rosiglitazone maleate/Metformin hydrochloride | ||
| 18220 | CPRD_product_code | Pioglitazone 15mg / Metformin 850mg tablets | drug | res25: P5_glitazone | Pioglitazone hydrochloride/Metformin hydrochloride | ||
| 19472 | CPRD_product_code | Actos 45mg tablets (Takeda UK Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 20287 | CPRD_product_code | Actos 15mg tablets (Takeda UK Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 20889 | CPRD_product_code | Actos 30mg tablets (Takeda UK Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 30316 | CPRD_product_code | Metformin with pioglitazone 850mg + 15mg Tablet | drug | res25: P5_glitazone | Metformin | ||
| 31077 | CPRD_product_code | Competact 15mg/850mg tablets (Takeda UK Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride/Metformin hydrochloride | ||
| 37617 | CPRD_product_code | Rosiglitazone 2mg tablet | drug | res25: P5_glitazone | Rosiglitazone Maleate | ||
| 469 | CPRD_product_code | Rosiglitazone 4mg tablets | drug | res25: P5_glitazone | Rosiglitazone maleate | ||
| 48120 | CPRD_product_code | Avandia 2mg Tablet (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Rosiglitazone Maleate | ||
| 48139 | CPRD_product_code | Pioglitazone 30mg tablets (A A H Pharmaceuticals Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 5227 | CPRD_product_code | Rosiglitazone 8mg tablets | drug | res25: P5_glitazone | Rosiglitazone maleate | ||
| 548 | CPRD_product_code | Pioglitazone 15mg tablets | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 56208 | CPRD_product_code | Pioglitazone 15mg tablets (A A H Pharmaceuticals Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 56376 | CPRD_product_code | Rosiglitazone 4mg with glimepiride 4mg tablet | drug | res25: P5_glitazone | Rosiglitazone Maleate | ||
| 57659 | CPRD_product_code | Pioglitazone 30mg tablets (Actavis UK Ltd) | drug | res25: P5_glitazone | Pioglitazone hydrochloride | ||
| 6855 | CPRD_product_code | Avandamet 2mg/500mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Rosiglitazone maleate/Metformin hydrochloride | ||
| 7325 | CPRD_product_code | Avandamet 4mg/1000mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Metformin hydrochloride/Rosiglitazone maleate | ||
| 7375 | CPRD_product_code | Rosiglitazone 4mg / Metformin 1g tablets | drug | res25: P5_glitazone | Metformin hydrochloride/Rosiglitazone maleate | ||
| 9662 | CPRD_product_code | Avandia 4mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P5_glitazone | Rosiglitazone maleate | ||
| 9699 | CPRD_product_code | Pioglitazone 30mg tablets | drug | res25: P5_glitazone | Pioglitazone hydrochloride |
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)