[ { "phenotype_id": "PH691", "phenotype_version_id": 1382, "name": "Warfarin", "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": "2021-10-06T16:30:22.060030Z", "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": "2021-10-06T16:30:22.060058Z", "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": 2111, "concept_version_id": 5360, "concept_name": "Warfarin - Primary Care", "coding_system": { "id": 14, "name": "GPRD product codes", "description": "GPRD product codes" }, "phenotype_id": "PH691", "phenotype_version_id": 1382, "phenotype_name": "Warfarin", "code_attribute_header": [ "Coding System (CPRD_product_code)", "Entity type", "Category" ], "codes": [ { "code": "13348", "description": "Marevan 5mg tablets (AMCo)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "1781", "description": "Warfarin 5mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "17965", "description": "Marevan 500microgram tablets (AMCo)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "23078", "description": "Warfarin 1mg Tablet (WB Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "30202", "description": "Warfarin wbp 1mg Tablet (Boehringer Ingelheim Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "30203", "description": "Warfarin wbp 3mg Tablet (Boehringer Ingelheim Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "31511", "description": "Warfarin 3mg Tablet (WB Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "31937", "description": "Warfarin 5mg tablets (Teva UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "33711", "description": "Warfarin 5mg Tablet (WB Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34019", "description": "Warfarin 1mg tablets (IVAX Pharmaceuticals UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34086", "description": "Warfarin 3mg Tablet (Celltech Pharma Europe Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34087", "description": "Warfarin 1mg Tablet (Celltech Pharma Europe Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34088", "description": "Warfarin 5mg Tablet (Celltech Pharma Europe Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34095", "description": "Warfarin wbp 5mg Tablet (Boehringer Ingelheim Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34299", "description": "Warfarin 1mg tablets (Teva UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34416", "description": "Warfarin 1mg tablets (Kent Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34417", "description": "Warfarin 3mg tablets (Teva UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34418", "description": "Warfarin 5mg tablets (Generics (UK) Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34517", "description": "Warfarin 1mg tablets (Generics (UK) Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34526", "description": "Warfarin 3mg tablets (Generics (UK) Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34576", "description": "Warfarin 1mg Tablet (Lagap)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34691", "description": "Warfarin 5mg Tablet (Regent Laboratories Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34758", "description": "Warfarin 3mg tablets (IVAX Pharmaceuticals UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34864", "description": "Warfarin 5mg tablets (IVAX Pharmaceuticals UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "34918", "description": "Warfarin 5mg tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "36099", "description": "Warfarin 1mg/5ml oral suspension", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "38041", "description": "Warfarin sodium 5mg/ml oral suspension", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "38044", "description": "Warfarin 5mg/5ml oral solution", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "39866", "description": "Warfarin 1mg tablets (Almus Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "40143", "description": "Warfarin 500microgram tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "43407", "description": "Warfarin 3mg tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "43408", "description": "Warfarin 1mg tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "43409", "description": "Warfarin 5mg tablets (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "43655", "description": "Warfarin sodium oral solution", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "44866", "description": "Warfarin sodium 1mg/ml oral supension SF", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "45", "description": "Warfarin 1mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "47944", "description": "Warfarin 1mg tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "48070", "description": "Warfarin sodium tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "50000", "description": "Warfarin 1mg/ml oral suspension sugar free (A A H Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "51484", "description": "Warfarin 1mg tablets (Bristol Laboratories Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "51496", "description": "Warfarin 1mg tablets (Phoenix Healthcare Distribution Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "51509", "description": "Warfarin 1mg tablets (APC Pharmaceuticals & Chemicals (Europe) Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "53745", "description": "Warfarin 3mg tablets (Bristol Laboratories Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "53752", "description": "Warfarin 1mg tablets (Alliance Healthcare (Distribution) Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "54946", "description": "Warfarin 3mg tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "55316", "description": "Warfarin 3mg/5ml oral suspension", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "56314", "description": "Warfarin 3mg tablets (Kent Pharmaceuticals Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "58519", "description": "Warfarin 1mg tablets (DE Pharmaceuticals)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "58787", "description": "Warfarin 5mg tablets (Alliance Healthcare (Distribution) Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "58962", "description": "Warfarin 3mg tablets (DE Pharmaceuticals)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "59400", "description": "Warfarin 500microgram tablets (Sigma Pharmaceuticals Plc)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "59578", "description": "Warfarin 3mg tablets (Phoenix Healthcare Distribution Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "60589", "description": "Warfarin 500microgram tablets (Actavis UK Ltd)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "61", "description": "Warfarin 3mg tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "6262", "description": "Warfarin 500microgram tablets", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "833", "description": "Warfarin 3mg/5ml oral solution", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "8466", "description": "Marevan 1mg tablets (AMCo)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } }, { "code": "8467", "description": "Marevan 3mg tablets (AMCo)", "attributes": { "Coding System (CPRD_product_code)": "CPRD_product_code", "Entity type": "res25: warfarin", "Category": "drug" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/we5a-mt61", "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": 1382, "version_name": "Warfarin", "version_date": "2021-10-06T16:30:22.095324Z", "is_published": true, "is_latest": true } ] } ]