[ { "phenotype_id": "PH686", "phenotype_version_id": 1372, "name": "Glitazone (P5)", "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": "2021-10-06T16:30:11.942961Z", "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": "2021-10-06T16:30:11.942989Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Drug", "value": "3" } ], "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": "GPRD product codes", "value": 14 } ], "event_date_range": "Start - 01/02/2013", "concept_information": [ { "concept_id": 2106, "concept_version_id": 5350, "concept_name": "Glitazone (P5) - Primary Care", "coding_system": { "id": 14, "name": "GPRD product codes", "description": "GPRD product codes" }, "phenotype_id": "PH686", "phenotype_version_id": 1372, "phenotype_name": "Glitazone (P5)", "code_attribute_header": [ "Coding System (CPRD_product_code)", "Entity type", "Category" ], "codes": [ { "code": "10051", "description": "Pioglitazone 45mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11601", "description": "Rosiglitazone 2mg / Metformin 500mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11604", "description": "Rosiglitazone 1mg / Metformin 500mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11609", "description": "Metformin with rosiglitazone 500mg + 1mg Tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11610", "description": "Metformin with rosiglitazone 500mg + 2mg Tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11717", "description": "Rosiglitazone 2mg / Metformin 1g tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11737", "description": "Metformin with rosiglitazone 1000mg + 4mg Tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "11760", "description": "Metformin with rosiglitazone 1000mg + 2mg Tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "14164", "description": "Avandamet 2mg/1000mg tablets (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "15232", "description": "Avandia 8mg tablets (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "17580", "description": "Avandamet 1mg/500mg tablets (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "18220", "description": "Pioglitazone 15mg / Metformin 850mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "19472", "description": "Actos 45mg tablets (Takeda UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "20287", "description": "Actos 15mg tablets (Takeda UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "20889", "description": "Actos 30mg tablets (Takeda UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "30316", "description": "Metformin with pioglitazone 850mg + 15mg Tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "31077", "description": "Competact 15mg/850mg tablets (Takeda UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "37617", "description": "Rosiglitazone 2mg tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "469", "description": "Rosiglitazone 4mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "48120", "description": "Avandia 2mg Tablet (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "48139", "description": "Pioglitazone 30mg tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "5227", "description": "Rosiglitazone 8mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "548", "description": "Pioglitazone 15mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "56208", "description": "Pioglitazone 15mg tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "56376", "description": "Rosiglitazone 4mg with glimepiride 4mg tablet", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "57659", "description": "Pioglitazone 30mg tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "6855", "description": "Avandamet 2mg/500mg tablets (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "7325", "description": "Avandamet 4mg/1000mg tablets (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "7375", "description": "Rosiglitazone 4mg / Metformin 1g tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "9662", "description": "Avandia 4mg tablets (GlaxoSmithKline UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } }, { "code": "9699", "description": "Pioglitazone 30mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P5_glitazone", "Category": "drug" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/mmv7-6s16", "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": 1372, "version_name": "Glitazone (P5)", "version_date": "2021-10-06T16:30:11.970850Z", "is_published": true, "is_latest": true } ] } ]