[ { "phenotype_id": "PH899", "phenotype_version_id": 1877, "name": "Lower respiratory tract infection (LRTI)", "definition": "Objectives: \n\nTo examine variations across general practices and factors associated with antibiotic prescribing for common infections in UK primary care to identify potential targets for improvement and optimization of prescribing.\n\n\nMethods: \n\nOral antibiotic prescribing for common infections was analysed using anonymized UK primary care electronic health records between 2000 and 2015 using the Clinical Practice Research Datalink (CPRD). The rate of prescribing for each condition was observed over time and mean change points were compared with national guideline updates. Any correlation between the rate of prescribing for each infectious condition was estimated within a practice. Predictors of prescribing were estimated using logistic regression in a matched patient cohort (1:1 by age, sex and calendar time).\n\n\nResults: \n\nOver 8 million patient records were examined in 587 UK general practices. Practices varied considerably in their propensity to prescribe antibiotics and this variance increased over time. Change points in prescribing did not reflect updates to national guidelines. Prescribing levels within practices were not consistent for different infectious conditions. A history of antibiotic use significantly increased the risk of receiving a subsequent antibiotic (by 22%–48% for patients with three or more antibiotic prescriptions in the past 12months), as did higher BMI, history of smoking and flu vaccinations. Other drivers for receiving an antibiotic varied considerably for each condition.\n\n\nConclusions: \n\nLarge variability in antibiotic prescribing between practices and within practices was observed. Prescribing guidelines alone do not positively influence a change in prescribing, suggesting more targeted interventions are required to optimize antibiotic prescribing in the UK.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Victoria Palin, Anna Molter, Darren M Ashcroft, Andrew White, William Welfare, Tjeerd van Staa, Antibiotic prescribing for common infections in UK general practice variability and drivers. Journal of Antimicrobial Chemotherapy, 74:2440-2450, 2019." } ], "validation": "", "citation_requirements": "", "created": "2022-04-04T07:09:13.791163Z", "author": "Victoria Palin, Anna Molter, Miguel Belmonte, Darren M Ashcroft, Andrew White, William Welfare, Tjeerd van Staa", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2022-04-04T07:09:13.791188Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "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": "01/01/2000 - 30/06/2015", "concept_information": [ { "concept_id": 2671, "concept_version_id": 6755, "concept_name": "Lower respiratory tract infection (LRTI) - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH899", "phenotype_version_id": 1877, "phenotype_name": "Lower respiratory tract infection (LRTI)", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "H06..00", "description": "Acute bronchitis and bronchiolitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060.00", "description": "Acute bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060000", "description": "Acute fibrinous bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060.11", "description": "Acute wheezy bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060300", "description": "Acute purulent bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060400", "description": "Acute croupous bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060500", "description": "Acute tracheobronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060600", "description": "Acute pneumococcal bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060700", "description": "Acute streptococcal bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060800", "description": "Acute haemophilus influenzae bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060A00", "description": "Acute bronchitis due to mycoplasma pneumoniae", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060x00", "description": "Acute bacterial bronchitis unspecified", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H060z00", "description": "Acute bronchitis NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H061.00", "description": "Acute bronchiolitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H061000", "description": "Acute capillary bronchiolitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H061200", "description": "Acute bronchiolitis with bronchospasm", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H061300", "description": "Acute exudative bronchiolitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H061z00", "description": "Acute bronchiolitis NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H062.00", "description": "Acute lower respiratory tract infection", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z.00", "description": "Acute bronchitis or bronchiolitis NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z000", "description": "Chest infection NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z011", "description": "Chest infection", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z100", "description": "Lower resp tract infection", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z111", "description": "Respiratory tract infection", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z112", "description": "Acute lower respiratory tract infection", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H06z200", "description": "Recurrent chest infection", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H24..11", "description": "Chest infection with infectious disease EC", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H30..00", "description": "Bronchitis unspecified", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H300.00", "description": "Tracheobronchitis NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H301.00", "description": "Laryngotracheobronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H30..11", "description": "Chest infection - unspecified bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H30..12", "description": "Recurrent wheezy bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H302.00", "description": "Wheezy bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H30z.00", "description": "Bronchitis NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H34..00", "description": "Bronchiectasis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H340.00", "description": "Recurrent bronchiectasis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H341.00", "description": "Post-infective bronchiectasis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H34z.00", "description": "Bronchiectasis NOS", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H50..00", "description": "Empyema", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H500100", "description": "Empyema with bronchopleural fistula", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H501200", "description": "Pleural empyema", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H501400", "description": "Purulent pleurisy", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H51..00", "description": "Pleurisy", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H510300", "description": "Acute dry pleurisy", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H510900", "description": "Pneumococcal pleurisy", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "H583200", "description": "Eosinophilic bronchitis", "attributes": { "Entity type": "res70: LRTI", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/zpvd-8897", "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": 1877, "version_name": "Lower respiratory tract infection (LRTI)", "version_date": "2022-04-04T07:09:13.818005Z", "is_published": true, "is_latest": true } ] } ]