[ { "phenotype_id": "PH664", "phenotype_version_id": 1328, "name": "Thyroid Function Test (M2)", "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": "2021-10-06T16:29:11.575073Z", "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": "2021-10-06T16:29:11.575103Z", "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": 2084, "concept_version_id": 5306, "concept_name": "Thyroid Function Test (M2) - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH664", "phenotype_version_id": 1328, "phenotype_name": "Thyroid Function Test (M2)", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "442..00", "description": "Thyroid hormone tests", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4421", "description": "Thyroid hormone tests normal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442..11", "description": "TRH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4421.11", "description": "Euthyroid", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442..12", "description": "TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442..13", "description": "Thyroid function tests", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442..14", "description": "Thyroxine binding globulin", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4422", "description": "Thyroid hormone tests high", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4423", "description": "Thyroid hormone tests low", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4424", "description": "Serum T3 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4424000", "description": "Serum T3 level normal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4424100", "description": "Serum T3 level high", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4424200", "description": "Serum T3 level low", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4425", "description": "Free T3 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4426", "description": "Serum T4 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4426000", "description": "Serum T4 level normal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4426100", "description": "Serum T4 level abnormal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4427", "description": "Free T4 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4428", "description": "Free thyroxine index", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "4429", "description": "Thyroxine binding globulin-TBG", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442a.00", "description": "Plasma total T4 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442A.00", "description": "TSH - thyroid stim. hormone", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442A000", "description": "Serum TSH level normal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442A100", "description": "Serum TSH level abnormal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442b.00", "description": "Serum total T4 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442B.00", "description": "TRH - thyroid release. hormone", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442c.00", "description": "Plasma free T4 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442C.00", "description": "Thyroid horm tests borderline", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442d.00", "description": "Serum thyroglobulin level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442D.00", "description": "T3 uptake test", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442D000", "description": "T3 uptake test normal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442D100", "description": "T3 uptake test abnormal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442e.00", "description": "Blood spot TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442E.00", "description": "PBI - protein bound iodine estimation", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442f.00", "description": "Serum total T3 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442F.00", "description": "T3 suppression test", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442g.00", "description": "Serum thyroglobulin recovery level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442G.00", "description": "Thyroid hormone tests abnormal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442h.00", "description": "Thyrotropin releasing hormone (TRH) stimulation test", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442H.00", "description": "Thyroid function tests normal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442I.00", "description": "Thyroid function tests abnormal", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442J.00", "description": "Thyroid function test", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442K.00", "description": "30 minute plasma TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442L.00", "description": "60 minute plasma TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442M.00", "description": "90 minute plasma TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442N.00", "description": "120 minute plasma TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442O.00", "description": "150 minute plasma TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442P.00", "description": "30 minute serum TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442Q.00", "description": "60 minute serum TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442S.00", "description": "120 minute serum TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442T.00", "description": "150 minute serum TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442U.00", "description": "Serum free triiodothyronine level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442V.00", "description": "Serum free T4 level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442W.00", "description": "Serum TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442X.00", "description": "Plasma TSH level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442Y.00", "description": "Plasma free triiodothyronine level", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "442Z.00", "description": "Thyroid hormone tests NOS", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } }, { "code": "C134300", "description": "TSH - thyroid-stimulating hormone deficiency", "attributes": { "Entity type": "res25: M2_TFT", "Category": "test", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/v1bd-ga74", "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": 1328, "version_name": "Thyroid Function Test (M2)", "version_date": "2021-10-06T16:29:11.605460Z", "is_published": true, "is_latest": true } ] } ]