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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: P9_digoxin
39 codes in list
| Code | Coding system | Description | Entity type | List name | drugsubstance | ||
|---|---|---|---|---|---|---|---|
| 16366 | CPRD_product_code | Digamex 125microgram tablets (Actavis UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 17169 | CPRD_product_code | Digitalis 60mg tablets | drug | res25: P9_digoxin | Digitalis | ||
| 20844 | CPRD_product_code | Digoxin 250microgram tablets (Actavis UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 20944 | CPRD_product_code | Digoxin 62.5microgram tablets (Actavis UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 2302 | CPRD_product_code | Lanoxin -pg 62.5microgram Tablet (Wellcome Medical Division) | drug | res25: P9_digoxin | Digoxin | ||
| 24719 | CPRD_product_code | DIGOXIN | drug | res25: P9_digoxin | |||
| 25043 | CPRD_product_code | DIGOXIN | drug | res25: P9_digoxin | |||
| 2511 | CPRD_product_code | Lanoxin 125 tablets (Aspen Pharma Trading Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 25238 | CPRD_product_code | Digamex 250microgram tablets (Actavis UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 27523 | CPRD_product_code | Lanoxin 500micrograms/2ml solution for infusion ampoules (Aspen Pharma Trading Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 27547 | CPRD_product_code | DIGOXIN | drug | res25: P9_digoxin | |||
| 29282 | CPRD_product_code | Digamex 62.5microgram tablets (Actavis UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 3181 | CPRD_product_code | Lanoxin 250microgram Tablet (Wellcome Medical Division) | drug | res25: P9_digoxin | Digoxin | ||
| 3286 | CPRD_product_code | Digoxin 50micrograms/ml oral solution | drug | res25: P9_digoxin | Digoxin | ||
| 3308 | CPRD_product_code | DIGOXIN .25 MG TAB | drug | res25: P9_digoxin | |||
| 33080 | CPRD_product_code | Digoxin 125microgram tablets (Actavis UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 33274 | CPRD_product_code | Digoxin 100micrograms/1ml solution for injection ampoules | drug | res25: P9_digoxin | Digoxin | ||
| 333 | CPRD_product_code | Digitalis 30mg tablets | drug | res25: P9_digoxin | Digitalis | ||
| 33612 | CPRD_product_code | Digoxin 250microgram tablets (A A H Pharmaceuticals Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 33675 | CPRD_product_code | Digoxin 125microgram tablets (Approved Prescription Services Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 34017 | CPRD_product_code | Digoxin 125microgram Tablet (IVAX Pharmaceuticals UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 34023 | CPRD_product_code | Digoxin 62.5microgram tablets (IVAX Pharmaceuticals UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 34024 | CPRD_product_code | Digoxin 250microgram tablets (IVAX Pharmaceuticals UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 34327 | CPRD_product_code | Digoxin 62.5microgram tablets (Teva UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 34328 | CPRD_product_code | Digoxin 250micrograms tablets | drug | res25: P9_digoxin | Digoxin | ||
| 34519 | CPRD_product_code | Digoxin 125microgram tablets (A A H Pharmaceuticals Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 34948 | CPRD_product_code | Digoxin 62.5microgram tablets (A A H Pharmaceuticals Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 36 | CPRD_product_code | Digoxin 125microgram tablets | drug | res25: P9_digoxin | Digoxin | ||
| 3705 | CPRD_product_code | Lanoxin -pg 50microgram/ml Oral solution (Wellcome Medical Division) | drug | res25: P9_digoxin | Digoxin | ||
| 40245 | CPRD_product_code | Digoxin 250microgram tablets (Teva UK Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 42989 | CPRD_product_code | Lanoxin PG 62.5microgram tablets (Aspen Pharma Trading Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 42990 | CPRD_product_code | Lanoxin 250microgram tablets (Aspen Pharma Trading Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 43577 | CPRD_product_code | Lanoxin PG 50micrograms/ml elixir (Aspen Pharma Trading Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 47813 | CPRD_product_code | Digoxin 62.5microgram Tablet (Celltech Pharma Europe Ltd) | drug | res25: P9_digoxin | Digoxin | ||
| 48587 | CPRD_product_code | Digoxin 50micrograms/ml oral solution | drug | res25: P9_digoxin | Digoxin | ||
| 54117 | CPRD_product_code | Digoxin 125micrograms/5ml oral solution | drug | res25: P9_digoxin | |||
| 792 | CPRD_product_code | Digoxin 62.5microgram tablets | drug | res25: P9_digoxin | Digoxin | ||
| 94 | CPRD_product_code | Digoxin 250microgram tablets | drug | res25: P9_digoxin | Digoxin | ||
| 9522 | CPRD_product_code | Digoxin 500micrograms/2ml solution for infusion ampoules | drug | res25: P9_digoxin | Digoxin |
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