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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: P8_metformin
92 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 11601 | CPRD_product_code | Rosiglitazone 2mg / Metformin 500mg tablets | drug | res25: P8_metformin | |||
| 11604 | CPRD_product_code | Rosiglitazone 1mg / Metformin 500mg tablets | drug | res25: P8_metformin | |||
| 11609 | CPRD_product_code | Metformin with rosiglitazone 500mg + 1mg Tablet | drug | res25: P8_metformin | |||
| 11610 | CPRD_product_code | Metformin with rosiglitazone 500mg + 2mg Tablet | drug | res25: P8_metformin | |||
| 11717 | CPRD_product_code | Rosiglitazone 2mg / Metformin 1g tablets | drug | res25: P8_metformin | |||
| 11737 | CPRD_product_code | Metformin with rosiglitazone 1000mg + 4mg Tablet | drug | res25: P8_metformin | |||
| 11760 | CPRD_product_code | Metformin with rosiglitazone 1000mg + 2mg Tablet | drug | res25: P8_metformin | |||
| 11990 | CPRD_product_code | Metformin 500mg/5ml oral solution sugar free | drug | res25: P8_metformin | |||
| 14164 | CPRD_product_code | Avandamet 2mg/1000mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P8_metformin | |||
| 16044 | CPRD_product_code | Glucophage SR 500mg tablets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 17580 | CPRD_product_code | Avandamet 1mg/500mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P8_metformin | |||
| 18220 | CPRD_product_code | Pioglitazone 15mg / Metformin 850mg tablets | drug | res25: P8_metformin | |||
| 23 | CPRD_product_code | Metformin 500mg tablets | drug | res25: P8_metformin | |||
| 25678 | CPRD_product_code | Glucamet 500mg Tablet (Opus Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 26258 | CPRD_product_code | Glucamet 850mg Tablet (Opus Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 27501 | CPRD_product_code | Orabet 500mg Tablet (Lagap) | drug | res25: P8_metformin | |||
| 30316 | CPRD_product_code | Metformin with pioglitazone 850mg + 15mg Tablet | drug | res25: P8_metformin | |||
| 31077 | CPRD_product_code | Competact 15mg/850mg tablets (Takeda UK Ltd) | drug | res25: P8_metformin | |||
| 31146 | CPRD_product_code | Metsol 500mg/5ml oral solution (Kappin Ltd) | drug | res25: P8_metformin | |||
| 33087 | CPRD_product_code | Metformin 500mg tablets (Actavis UK Ltd) | drug | res25: P8_metformin | |||
| 33674 | CPRD_product_code | Metformin 850mg tablets (A A H Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 34004 | CPRD_product_code | Metformin 500mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res25: P8_metformin | |||
| 34020 | CPRD_product_code | Metformin 850mg tablets (IVAX Pharmaceuticals UK Ltd) | drug | res25: P8_metformin | |||
| 34135 | CPRD_product_code | Metformin 500mg Tablet (M & A Pharmachem Ltd) | drug | res25: P8_metformin | |||
| 34323 | CPRD_product_code | Metformin 500mg tablets (A A H Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 34504 | CPRD_product_code | Metformin 500mg tablets (Wockhardt UK Ltd) | drug | res25: P8_metformin | |||
| 34598 | CPRD_product_code | Metformin 500mg tablets (Generics (UK) Ltd) | drug | res25: P8_metformin | |||
| 34697 | CPRD_product_code | Metformin 850mg tablets (Wockhardt UK Ltd) | drug | res25: P8_metformin | |||
| 34742 | CPRD_product_code | Metformin 850mg tablets (Teva UK Ltd) | drug | res25: P8_metformin | |||
| 34836 | CPRD_product_code | Metformin 850mg tablets (Actavis UK Ltd) | drug | res25: P8_metformin | |||
| 34917 | CPRD_product_code | Metformin 500mg tablets (Teva UK Ltd) | drug | res25: P8_metformin | |||
| 37874 | CPRD_product_code | Vildagliptin 50mg / Metformin 850mg tablets | drug | res25: P8_metformin | |||
| 37902 | CPRD_product_code | Vildagliptin 50mg / Metformin 1g tablets | drug | res25: P8_metformin | |||
| 38355 | CPRD_product_code | Metformin 750mg modified-release tablets | drug | res25: P8_metformin | |||
| 38400 | CPRD_product_code | Glucophage SR 750mg tablets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 38551 | CPRD_product_code | Eucreas 50mg/1000mg tablets (Novartis Pharmaceuticals UK Ltd) | drug | res25: P8_metformin | |||
| 39203 | CPRD_product_code | Eucreas 50mg/850mg tablets (Novartis Pharmaceuticals UK Ltd) | drug | res25: P8_metformin | |||
| 39560 | CPRD_product_code | Bolamyn SR 500mg tablets (Teva UK Ltd) | drug | res25: P8_metformin | |||
| 39598 | CPRD_product_code | Metformin 1g modified-release tablets | drug | res25: P8_metformin | |||
| 39729 | CPRD_product_code | Glucophage SR 1000mg tablets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 39988 | CPRD_product_code | Metformin 500mg oral powder sachets sugar free | drug | res25: P8_metformin | |||
| 40007 | CPRD_product_code | Glucophage 1000mg oral powder sachets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 40110 | CPRD_product_code | Glucophage 500mg oral powder sachets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 40233 | CPRD_product_code | Metformin 1g oral powder sachets sugar free | drug | res25: P8_metformin | |||
| 42161 | CPRD_product_code | Orabet 500mg Tablet (Sandoz Ltd) | drug | res25: P8_metformin | |||
| 43270 | CPRD_product_code | Metformin 500mg/5ml oral solution sugar free (Rosemont Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 43619 | CPRD_product_code | Metformin 1g / Sitagliptin 50mg tablets | drug | res25: P8_metformin | |||
| 43684 | CPRD_product_code | Janumet 50mg/1000mg tablets (Merck Sharp & Dohme Ltd) | drug | res25: P8_metformin | |||
| 44250 | CPRD_product_code | Metformin 500mg/5ml Oral solution (Hillcross Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 45581 | CPRD_product_code | Metabet SR 500mg tablets (Morningside Healthcare Ltd) | drug | res25: P8_metformin | |||
| 46989 | CPRD_product_code | Metabet SR 1000mg tablets (Morningside Healthcare Ltd) | drug | res25: P8_metformin | |||
| 47939 | CPRD_product_code | Glucient SR 500mg tablets (Consilient Health Ltd) | drug | res25: P8_metformin | |||
| 48149 | CPRD_product_code | Metformin 500mg tablets (Almus Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 49502 | CPRD_product_code | Glucophage SR 500mg tablets (Mawdsley-Brooks & Company Ltd) | drug | res25: P8_metformin | |||
| 49738 | CPRD_product_code | Metformin 1g modified-release tablets (A A H Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 50570 | CPRD_product_code | Glucophage SR 500mg tablets (Lexon (UK) Ltd) | drug | res25: P8_metformin | |||
| 50821 | CPRD_product_code | Metformin 850mg tablets (Pfizer Ltd) | drug | res25: P8_metformin | |||
| 50970 | CPRD_product_code | Metformin 500mg tablets (Bristol Laboratories Ltd) | drug | res25: P8_metformin | |||
| 51080 | CPRD_product_code | Metabet SR 1000mg tablets (Actavis UK Ltd) | drug | res25: P8_metformin | |||
| 51135 | CPRD_product_code | Metformin 500mg modified-release tablets (A A H Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 51527 | CPRD_product_code | Metformin 500mg tablets (Boston Healthcare Ltd) | drug | res25: P8_metformin | |||
| 52221 | CPRD_product_code | Diagemet XL 500mg tablets (Thornton & Ross Ltd) | drug | res25: P8_metformin | |||
| 52442 | CPRD_product_code | Metformin 500mg tablets (Pfizer Ltd) | drug | res25: P8_metformin | |||
| 52634 | CPRD_product_code | Glucophage SR 500mg tablets (DE Pharmaceuticals) | drug | res25: P8_metformin | |||
| 53478 | CPRD_product_code | Metformin 500mg modified-release tablets (Kent Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 53774 | CPRD_product_code | Metabet SR 500mg tablets (Actavis UK Ltd) | drug | res25: P8_metformin | |||
| 53867 | CPRD_product_code | Metformin 500mg tablets (Zentiva) | drug | res25: P8_metformin | |||
| 54150 | CPRD_product_code | Jentadueto 2.5mg/850mg tablets (Boehringer Ingelheim Ltd) | drug | res25: P8_metformin | |||
| 54442 | CPRD_product_code | Metformin (roi) 1000mg Tablet | drug | res25: P8_metformin | |||
| 54891 | CPRD_product_code | Saxagliptin 2.5mg / Metformin 1g tablets | drug | res25: P8_metformin | |||
| 54898 | CPRD_product_code | Metformin 850mg tablets (Almus Pharmaceuticals Ltd) | drug | res25: P8_metformin | |||
| 55270 | CPRD_product_code | Duformin 500mg Tablet (Dumex Ltd) | drug | res25: P8_metformin | |||
| 55711 | CPRD_product_code | Metformin 500mg tablets (Alliance Healthcare (Distribution) Ltd) | drug | res25: P8_metformin | |||
| 55739 | CPRD_product_code | Metformin 500mg tablets (Tillomed Laboratories Ltd) | drug | res25: P8_metformin | |||
| 56965 | CPRD_product_code | Komboglyze 2.5mg/1000mg tablets (AstraZeneca UK Ltd) | drug | res25: P8_metformin | |||
| 57147 | CPRD_product_code | Bolamyn SR 1000mg tablets (Teva UK Ltd) | drug | res25: P8_metformin | |||
| 57457 | CPRD_product_code | Metformin 500mg tablets (Aurobindo Pharma Ltd) | drug | res25: P8_metformin | |||
| 58051 | CPRD_product_code | Metformin 500mg/5ml oral solution | drug | res25: P8_metformin | |||
| 58607 | CPRD_product_code | Metformin 500mg/5ml oral solution sugar free (Zentiva) | drug | res25: P8_metformin | |||
| 59620 | CPRD_product_code | Glucophage SR 500mg tablets (Waymade Healthcare Plc) | drug | res25: P8_metformin | |||
| 60012 | CPRD_product_code | Dapagliflozin 5mg / Metformin 1g tablets | drug | res25: P8_metformin | |||
| 60074 | CPRD_product_code | Metformin 1g modified-release tablets (Waymade Healthcare Plc) | drug | res25: P8_metformin | |||
| 60286 | CPRD_product_code | Metformin 500mg/5ml oral suspension | drug | res25: P8_metformin | |||
| 60643 | CPRD_product_code | Xigduo 5mg/1000mg tablets (AstraZeneca UK Ltd) | drug | res25: P8_metformin | |||
| 6855 | CPRD_product_code | Avandamet 2mg/500mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P8_metformin | |||
| 7048 | CPRD_product_code | Metformin 500mg modified-release tablets | drug | res25: P8_metformin | |||
| 7166 | CPRD_product_code | Glucophage 500mg tablets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 7325 | CPRD_product_code | Avandamet 4mg/1000mg tablets (GlaxoSmithKline UK Ltd) | drug | res25: P8_metformin | |||
| 735 | CPRD_product_code | Metformin 100mg/ml Oral solution | drug | res25: P8_metformin | |||
| 7375 | CPRD_product_code | Rosiglitazone 4mg / Metformin 1g tablets | drug | res25: P8_metformin | |||
| 7610 | CPRD_product_code | Glucophage 850mg tablets (Merck Serono Ltd) | drug | res25: P8_metformin | |||
| 93 | CPRD_product_code | Metformin 850mg tablets | drug | res25: P8_metformin |
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