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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: P5_heart_failure
26 codes in list
| Code | Coding system | Description | Entity type | List name | medcode | ||
|---|---|---|---|---|---|---|---|
| G1yz100 | Read | Rheumatic left ventricular failure | diagnostic | res25: P5_heart_failure | 22262 | ||
| G58..00 | Read | Heart failure | diagnostic | res25: P5_heart_failure | 2062 | ||
| G580.00 | Read | Congestive heart failure | diagnostic | res25: P5_heart_failure | 398 | ||
| G580000 | Read | Acute congestive heart failure | diagnostic | res25: P5_heart_failure | 23707 | ||
| G580100 | Read | Chronic congestive heart failure | diagnostic | res25: P5_heart_failure | 32671 | ||
| G580.11 | Read | Congestive cardiac failure | diagnostic | res25: P5_heart_failure | 2906 | ||
| G580.12 | Read | Right heart failure | diagnostic | res25: P5_heart_failure | 10079 | ||
| G580.13 | Read | Right ventricular failure | diagnostic | res25: P5_heart_failure | 10154 | ||
| G580.14 | Read | Biventricular failure | diagnostic | res25: P5_heart_failure | 9524 | ||
| G580200 | Read | Decompensated cardiac failure | diagnostic | res25: P5_heart_failure | 27884 | ||
| G580300 | Read | Compensated cardiac failure | diagnostic | res25: P5_heart_failure | 11424 | ||
| G580400 | Read | Congestive heart failure due to valvular disease | diagnostic | res25: P5_heart_failure | 94870 | ||
| G581.00 | Read | Left ventricular failure | diagnostic | res25: P5_heart_failure | 884 | ||
| G581000 | Read | Acute left ventricular failure | diagnostic | res25: P5_heart_failure | 5255 | ||
| G58..11 | Read | Cardiac failure | diagnostic | res25: P5_heart_failure | 1223 | ||
| G581.11 | Read | Asthma - cardiac | diagnostic | res25: P5_heart_failure | 23481 | ||
| G581.12 | Read | Pulmonary oedema - acute | diagnostic | res25: P5_heart_failure | 43618 | ||
| G581.13 | Read | Impaired left ventricular function | diagnostic | res25: P5_heart_failure | 5942 | ||
| G582.00 | Read | Acute heart failure | diagnostic | res25: P5_heart_failure | 27964 | ||
| G583.00 | Read | Heart failure with normal ejection fraction | diagnostic | res25: P5_heart_failure | 101138 | ||
| G583.11 | Read | HFNEF - heart failure with normal ejection fraction | diagnostic | res25: P5_heart_failure | 101137 | ||
| G583.12 | Read | Heart failure with preserved ejection fraction | diagnostic | res25: P5_heart_failure | 106897 | ||
| G584.00 | Read | Right ventricular failure | diagnostic | res25: P5_heart_failure | 104275 | ||
| G58z.00 | Read | Heart failure NOS | diagnostic | res25: P5_heart_failure | 4024 | ||
| G58z.11 | Read | Weak heart | diagnostic | res25: P5_heart_failure | 12590 | ||
| G58z.12 | Read | Cardiac failure NOS | diagnostic | res25: P5_heart_failure | 17278 |
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