[ { "phenotype_id": "PH689", "phenotype_version_id": 1378, "name": "Digoxin (P9)", "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": "2021-10-06T16:30:16.624786Z", "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": "2021-10-06T16:30:16.624812Z", "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": 2109, "concept_version_id": 5356, "concept_name": "Digoxin (P9) - Primary Care", "coding_system": { "id": 14, "name": "GPRD product codes", "description": "GPRD product codes" }, "phenotype_id": "PH689", "phenotype_version_id": 1378, "phenotype_name": "Digoxin (P9)", "code_attribute_header": [ "Coding System (CPRD_product_code)", "Entity type", "Category" ], "codes": [ { "code": "16366", "description": "Digamex 125microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "17169", "description": "Digitalis 60mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "20844", "description": "Digoxin 250microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "20944", "description": "Digoxin 62.5microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "2302", "description": "Lanoxin -pg 62.5microgram Tablet (Wellcome Medical Division)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "24719", "description": "DIGOXIN", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "25043", "description": "DIGOXIN", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "2511", "description": "Lanoxin 125 tablets (Aspen Pharma Trading Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "25238", "description": "Digamex 250microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "27523", "description": "Lanoxin 500micrograms/2ml solution for infusion ampoules (Aspen Pharma Trading Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "27547", "description": "DIGOXIN", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "29282", "description": "Digamex 62.5microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "3181", "description": "Lanoxin 250microgram Tablet (Wellcome Medical Division)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "3286", "description": "Digoxin 50micrograms/ml oral solution", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "3308", "description": "DIGOXIN .25 MG TAB", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "33080", "description": "Digoxin 125microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "33274", "description": "Digoxin 100micrograms/1ml solution for injection ampoules", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "333", "description": "Digitalis 30mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "33612", "description": "Digoxin 250microgram tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "33675", "description": "Digoxin 125microgram tablets (Approved Prescription Services Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34017", "description": "Digoxin 125microgram Tablet (IVAX Pharmaceuticals UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34023", "description": "Digoxin 62.5microgram tablets (IVAX Pharmaceuticals UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34024", "description": "Digoxin 250microgram tablets (IVAX Pharmaceuticals UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34327", "description": "Digoxin 62.5microgram tablets (Teva UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34328", "description": "Digoxin 250micrograms tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34519", "description": "Digoxin 125microgram tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "34948", "description": "Digoxin 62.5microgram tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "36", "description": "Digoxin 125microgram tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "3705", "description": "Lanoxin -pg 50microgram/ml Oral solution (Wellcome Medical Division)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "40245", "description": "Digoxin 250microgram tablets (Teva UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "42989", "description": "Lanoxin PG 62.5microgram tablets (Aspen Pharma Trading Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "42990", "description": "Lanoxin 250microgram tablets (Aspen Pharma Trading Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "43577", "description": "Lanoxin PG 50micrograms/ml elixir (Aspen Pharma Trading Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "47813", "description": "Digoxin 62.5microgram Tablet (Celltech Pharma Europe Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "48587", "description": "Digoxin 50micrograms/ml oral solution", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "54117", "description": "Digoxin 125micrograms/5ml oral solution", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "792", "description": "Digoxin 62.5microgram tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "94", "description": "Digoxin 250microgram tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } }, { "code": "9522", "description": "Digoxin 500micrograms/2ml solution for infusion ampoules", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: P9_digoxin", "Category": "drug" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/hhgr-6271", "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": 1378, "version_name": "Digoxin (P9)", "version_date": "2021-10-06T16:30:16.665306Z", "is_published": true, "is_latest": true } ] } ]