[ { "phenotype_id": "PH676", "phenotype_version_id": 1352, "name": "Current Smoker (P18)", "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": "2021-10-06T16:29:44.458416Z", "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": "2021-10-06T16:29:44.458444Z", "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": 2096, "concept_version_id": 5330, "concept_name": "Current Smoker (P18) - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH676", "phenotype_version_id": 1352, "phenotype_name": "Current Smoker (P18)", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "137..11", "description": "Smoker - amount smoked", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1372", "description": "Trivial smoker - < 1 cig/day", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1372.11", "description": "Occasional smoker", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1373", "description": "Light smoker - 1-9 cigs/day", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1374", "description": "Moderate smoker - 10-19 cigs/d", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1375", "description": "Heavy smoker - 20-39 cigs/day", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1376", "description": "Very heavy smoker - 40+cigs/d", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137b.00", "description": "Ready to stop smoking", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137c.00", "description": "Thinking about stopping smoking", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137C.00", "description": "Keeps trying to stop smoking", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137D.00", "description": "Admitted tobacco cons untrue ?", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137e.00", "description": "Smoking restarted", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137G.00", "description": "Trying to give up smoking", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137h.00", "description": "Minutes from waking to first tobacco consumption", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137H.00", "description": "Pipe smoker", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137J.00", "description": "Cigar smoker", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137m.00", "description": "Failed attempt to stop smoking", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137M.00", "description": "Rolls own cigarettes", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137P.00", "description": "Cigarette smoker", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137P.11", "description": "Smoker", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Q.00", "description": "Smoking started", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Q.11", "description": "Smoking restarted", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137R.00", "description": "Current smoker", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137V.00", "description": "Smoking reduced", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137X.00", "description": "Cigarette consumption", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Y.00", "description": "Cigar consumption", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Z.00", "description": "Tobacco consumption NOS", "attributes": { "Entity type": "res25: P18_current_smoker", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/x20x-c109", "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": 1352, "version_name": "Current Smoker (P18)", "version_date": "2021-10-06T16:29:44.480535Z", "is_published": true, "is_latest": true } ] } ]