[ { "phenotype_id": "PH662", "phenotype_version_id": 1324, "name": "Urea and Electrolytes (M1)", "definition": "Study question:\n\nWhat is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?\n\n\nMethods:\n\nA 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.\n\n\nStudy answer and limitations:\n\n49 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.\n\n\nWhat this study adds:\n\nThe 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.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Ashcroft, Examining variations in prescribing safety in UK general practice cross sectional study using the Clinical Practice Research Datalink. BMJ, 351(h5501), 2015." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:29:08.638003Z", "author": "S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Aschroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:29:08.638031Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Biomarker", "value": "1" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "Start - 01/02/2013", "concept_information": [ { "concept_id": 2082, "concept_version_id": 5302, "concept_name": "Urea and Electrolytes (M1) - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH662", "phenotype_version_id": 1324, "phenotype_name": "Urea and Electrolytes (M1)", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "4412000", "description": "Urea and electrolytes normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4412100", "description": "Urea and electrolytes abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h..00", "description": "Blood electrolyte levels", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h0.00", "description": "Blood potassium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h1.00", "description": "Blood sodium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h2.00", "description": "Blood chloride level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h3.00", "description": "Blood bicarbonate level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h4.00", "description": "Blood calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h5.00", "description": "Blood inorganic phosphate level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h6.00", "description": "Plasma sodium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h7.00", "description": "Plasma calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h8.00", "description": "Plasma potassium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44h9.00", "description": "Plasma corrected calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44hA.00", "description": "Blood total carbon dioxide (calculated)", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44hB.00", "description": "Actual bicarbonate level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44hC.00", "description": "Standard bicarbonate level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44hD.00", "description": "Blood ionised calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44i..00", "description": "Plasma electrolyte levels", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I..00", "description": "Serum electrolytes", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44i0.00", "description": "Plasma bicarbonate level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I0.00", "description": "", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44i1.00", "description": "Plasma chloride level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I1.00", "description": "Blood sent for electrolytes", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44i2.00", "description": "Plasma inorganic phosphate level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I2.00", "description": "Electrolytes normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I3.00", "description": "Electrolytes abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I4.00", "description": "Serum potassium", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I4000", "description": "Normal serum potassium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I4100", "description": "Raised serum potassium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I4200", "description": "Low serum potassium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I5.00", "description": "Serum sodium", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I5000", "description": "Serum sodium level normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I5100", "description": "Serum sodium level abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I6.00", "description": "Serum chloride", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I6000", "description": "Serum chloride level normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I6100", "description": "Serum chloride level abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I7.00", "description": "Serum bicarbonate", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I7000", "description": "Serum bicarbonate level normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I7100", "description": "Serum bicarbonate level abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I8.00", "description": "Serum calcium", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I8000", "description": "Normal serum calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I8100", "description": "Raised serum calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I9.00", "description": "Serum inorganic phosphate", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I9000", "description": "Serum phosphate level normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44I9100", "description": "Serum phosphate level abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IA.00", "description": "Plasma anion gap", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IB.00", "description": "Serum anion gap", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IC.00", "description": "Corrected serum calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IC.11", "description": "Adjusted serum calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44ID.00", "description": "Serum ionised calcium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IE.00", "description": "Serum ionized calcium (pH 7.4) level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IF.00", "description": "Urine chromatography", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44IZ.00", "description": "Serum electrolytes NOS", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J..00", "description": "Blood urea/renal function", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J1.00", "description": "Blood urea normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J..11", "description": "Urea - blood", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J..12", "description": "Urea and electrolytes", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J..13", "description": "Serum urea level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J2.00", "description": "Blood urea abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3.00", "description": "Serum creatinine", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3000", "description": "Serum creatinine abnormal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3100", "description": "Serum creatinine low", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3200", "description": "Serum creatinine normal", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3300", "description": "Serum creatinine raised", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J3z00", "description": "Serum creatinine NOS", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J4.00", "description": "Serum osmolality", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J5.00", "description": "Renal profile", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J6.00", "description": "Albumin excretion rate", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J7.00", "description": "Albumin / creatinine ratio", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J8.00", "description": "Blood urea", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J8.11", "description": "Urea - blood", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44J9.00", "description": "Serum urea level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JA.00", "description": "Plasma urea level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JB.00", "description": "Urea and electrolytes", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JC.00", "description": "Corrected plasma creatinine level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JD.00", "description": "Corrected serum creatinine level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JE.00", "description": "Peritoneal equilibration test", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JF.00", "description": "Plasma creatinine level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JG.00", "description": "Overnight albumin excretion rate", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JH.00", "description": "Plasma osmolality", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "44JZ.00", "description": "Blood urea/renal function NOS", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4513", "description": "Creatinine clearance-glom filt", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4513.11", "description": "Creatinine clearance", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "451E.00", "description": "GFR calculated abbreviated MDRD", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "451F.00", "description": "Glomerular filtration rate", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "451G.00", "description": "GFR calculated abbreviated MDRD adj for African Americ orign", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4Q40.00", "description": "Creatinine level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4Q42.00", "description": "Potassium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4Q43.00", "description": "Sodium level", "attributes": { "Entity type": "res25: M1_U&E", "Category": "test", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/n754-n517", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1324, "version_name": "Urea and Electrolytes (M1)", "version_date": "2021-10-06T16:29:08.666709Z", "is_published": true, "is_latest": true } ] } ]