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Lft Fbc (M3)

S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Aschroft

ID
PH665
Version ID
1330
Type
Biomarker
Data Sources
Valid event data range
Start - 01/02/2013
Sex
♀  Female ♂  Male
Agreement Date
2015-11-03
Coding system
Read codes v2
Collections
ClinicalCodes Repository Phenotype Library
Tags
No tags

Definition

Study question:

What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?

Methods:

A 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.

Study answer and limitations:

49 927 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.

What this study adds:

The 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.

Publications

  • 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.

Clinical Code List

Rows: 138
Code Description Entity type Category Coding System (Read)
423..00 Haemoglobin estimation res25: M3_LFT_FBC test Read
423..11 Hb estimation res25: M3_LFT_FBC test Read
4231 Haemoglobin not estimated res25: M3_LFT_FBC test Read
4232 Haemoglobin requested res25: M3_LFT_FBC test Read
4233 Haemoglobin - sample sent res25: M3_LFT_FBC test Read
4234 Haemoglobin very low res25: M3_LFT_FBC test Read
4235 Haemoglobin low res25: M3_LFT_FBC test Read
4236 Haemoglobin borderline low res25: M3_LFT_FBC test Read
4237 Haemoglobin normal res25: M3_LFT_FBC test Read
4238 Haemoglobin borderline high res25: M3_LFT_FBC test Read
4239 Haemoglobin high res25: M3_LFT_FBC test Read
423A.00 Haemoglobin very high res25: M3_LFT_FBC test Read
423B.00 Haemoglobin abnormal res25: M3_LFT_FBC test Read
423C.00 Haemoglobin H inclusion res25: M3_LFT_FBC test Read
423Z.00 Haemoglobin estimation NOS res25: M3_LFT_FBC test Read
424..00 Full blood count - FBC res25: M3_LFT_FBC test Read
4241 Full blood count normal res25: M3_LFT_FBC test Read
4242 Full blood count borderline res25: M3_LFT_FBC test Read
4243 Full blood count abnormal res25: M3_LFT_FBC test Read
424Z.00 Full blood count NOS res25: M3_LFT_FBC test Read
426..00 Red blood cell (RBC) count res25: M3_LFT_FBC test Read
4261 RBC count normal res25: M3_LFT_FBC test Read
4262 RBC count borderline low res25: M3_LFT_FBC test Read
4263 RBC count low res25: M3_LFT_FBC test Read
4264 RBC count raised res25: M3_LFT_FBC test Read
4265 RBC count borderline raised res25: M3_LFT_FBC test Read
4266 Nucleated red blood cell count res25: M3_LFT_FBC test Read
4267 RBC count abnormal res25: M3_LFT_FBC test Read
426Z.00 RBC count NOS res25: M3_LFT_FBC test Read
42H..00 Total white cell count res25: M3_LFT_FBC test Read
42H..11 White blood count res25: M3_LFT_FBC test Read
42H..12 White cell count res25: M3_LFT_FBC test Read
42H1.00 White cell count normal res25: M3_LFT_FBC test Read
42H2.00 Leucopenia - low white count res25: M3_LFT_FBC test Read
42H2.11 Leucopenia res25: M3_LFT_FBC test Read
42H3.00 Leucocytosis -high white count res25: M3_LFT_FBC test Read
42H3.11 Leucocytosis res25: M3_LFT_FBC test Read
42H4.00 Agranulocytosis res25: M3_LFT_FBC test Read
42H5.00 White cell count abnormal res25: M3_LFT_FBC test Read
42H6.00 Polymorphonuclear leukocyte count res25: M3_LFT_FBC test Read
42H7.00 Total white blood count res25: M3_LFT_FBC test Read
42H8.00 Total WBC (IMM) res25: M3_LFT_FBC test Read
42HZ.00 Total white cell count NOS res25: M3_LFT_FBC test Read
42I..00 Differential white cell count res25: M3_LFT_FBC test Read
42I..11 WCC - differential res25: M3_LFT_FBC test Read
42I1.00 Diff. white cell count normal res25: M3_LFT_FBC test Read
42I2.00 Diff. white count abnormal res25: M3_LFT_FBC test Read
42IZ.00 Diff. white cell count NOS res25: M3_LFT_FBC test Read
42MG.00 Leucocyte count res25: M3_LFT_FBC test Read
42P..00 Platelet count res25: M3_LFT_FBC test Read
42P1.00 Platelet count normal res25: M3_LFT_FBC test Read
42P2.00 Thrombocytopenia res25: M3_LFT_FBC test Read
42P2.11 Auto-immune thrombocytopenia res25: M3_LFT_FBC test Read
42P3.00 Thrombocythaemia res25: M3_LFT_FBC test Read
42P4.00 Platelet count abnormal res25: M3_LFT_FBC test Read
42P5.00 Platelet distribution width res25: M3_LFT_FBC test Read
42P6.00 Platelet/neutrophil ratio res25: M3_LFT_FBC test Read
42P7.00 Percentage reticulated platelet count res25: M3_LFT_FBC test Read
42P8.00 Heparin induced thrombocytopenia screening test res25: M3_LFT_FBC test Read
42P9.00 Plateletcrit res25: M3_LFT_FBC test Read
42PA.00 Immature platelet fraction res25: M3_LFT_FBC test Read
42PZ.00 Platelet count NOS res25: M3_LFT_FBC test Read
42b..00 Percentage cell count res25: M3_LFT_FBC test Read
42b0.00 Percentage neutrophils res25: M3_LFT_FBC test Read
42b1.00 Percentage lymphocytes res25: M3_LFT_FBC test Read
42b2.00 Percentage monocytes res25: M3_LFT_FBC test Read
42b3.00 Percentage basophils res25: M3_LFT_FBC test Read
42b4.00 Percentage metamyelocytes res25: M3_LFT_FBC test Read
42b5.00 Percentage blast cells res25: M3_LFT_FBC test Read
42b6.00 Percentage smear cells res25: M3_LFT_FBC test Read
42b7.00 Percentage granulocytes res25: M3_LFT_FBC test Read
42b8.00 Percentage nucleated Red Blood Cells res25: M3_LFT_FBC test Read
42b9.00 Percentage eosinophils res25: M3_LFT_FBC test Read
42bA.00 Percentage myelocyte count res25: M3_LFT_FBC test Read
42bB.00 Percentage promyelocyte count res25: M3_LFT_FBC test Read
42bC.00 Percentage reticulocyte count res25: M3_LFT_FBC test Read
42bD.00 T cell total % res25: M3_LFT_FBC test Read
42bE.00 Percentage hypochromic cells res25: M3_LFT_FBC test Read
44D..00 Liver function tests - general res25: M3_LFT_FBC test Read
44D..11 Liver function tests res25: M3_LFT_FBC test Read
44D1.00 Liver function tests normal res25: M3_LFT_FBC test Read
44D2.00 Liver function tests abnormal res25: M3_LFT_FBC test Read
44D3.00 Blood ammonia level res25: M3_LFT_FBC test Read
44D4.00 Serum pyruvate res25: M3_LFT_FBC test Read
44D5.00 Serum lactate res25: M3_LFT_FBC test Read
44D6.00 Liver function test res25: M3_LFT_FBC test Read
44D7.00 Serum bile salt level res25: M3_LFT_FBC test Read
44D8.00 Plasma lactate level res25: M3_LFT_FBC test Read
44D9.00 Whole blood pyruvate level res25: M3_LFT_FBC test Read
44DZ.00 Liver function tests NOS res25: M3_LFT_FBC test Read
44F..00 Serum alkaline phosphatase res25: M3_LFT_FBC test Read
44F1.00 Serum alk. phos. normal res25: M3_LFT_FBC test Read
44F2.00 Serum alk. phos. raised res25: M3_LFT_FBC test Read
44F3.00 Total alkaline phosphatase res25: M3_LFT_FBC test Read
44F4.00 Alk. phos. - liver isoenzyme res25: M3_LFT_FBC test Read
44F5.00 Alk. phos. - bone isoenzyme res25: M3_LFT_FBC test Read
44F5000 Alkaline phosphatase bone isoenzyme raised res25: M3_LFT_FBC test Read
44F6.00 Alk. phos. - bile isoenzyme res25: M3_LFT_FBC test Read
44F7.00 Alkaline phosphatase isoenzyme studies res25: M3_LFT_FBC test Read
44F8.00 Plasma alkaline phosphatase bile isoenzyme level res25: M3_LFT_FBC test Read
44F9.00 Plasma alkaline phosphatase bone isoenzyme level res25: M3_LFT_FBC test Read
44FA.00 Plasma alkaline phosphatase liver isoenzyme level res25: M3_LFT_FBC test Read
44FB.00 Serum alkaline phosphatase bile isoenzyme level res25: M3_LFT_FBC test Read
44FC.00 Serum alkaline phosphatase bone isoenzyme level res25: M3_LFT_FBC test Read
44FD.00 Serum alkaline phosphatase liver isoenzyme level res25: M3_LFT_FBC test Read
44FE.00 Serum alkaline phosphatase electrophoresis res25: M3_LFT_FBC test Read
44FF.00 Serum alkaline phosphatase intestinal enzyme level res25: M3_LFT_FBC test Read
44FG.00 Alkaline phosphatase - bile isoenzyme level res25: M3_LFT_FBC test Read
44FH.00 Alkaline phosphatase liver isoenzyme level res25: M3_LFT_FBC test Read
44FI.00 Alkaline phosphatase - bone isoenzyme level res25: M3_LFT_FBC test Read
44FZ.00 Serum alkaline phosphatase NOS res25: M3_LFT_FBC test Read
44G..00 Liver enzymes res25: M3_LFT_FBC test Read
44G..11 ALT - blood level res25: M3_LFT_FBC test Read
44G..12 SGPT - blood level res25: M3_LFT_FBC test Read
44G1.00 Liver enzymes normal res25: M3_LFT_FBC test Read
44G2.00 Liver enzymes abnormal res25: M3_LFT_FBC test Read
44G3.00 ALT/SGPT serum level res25: M3_LFT_FBC test Read
44G3000 ALT/SGPT level normal res25: M3_LFT_FBC test Read
44G3100 ALT/SGPT level abnormal res25: M3_LFT_FBC test Read
44G4.00 Gamma - G.T. level res25: M3_LFT_FBC test Read
44G4000 Gamma glutamyl transferase level normal res25: M3_LFT_FBC test Read
44G4100 Gamma glutamyl transferase level abnormal res25: M3_LFT_FBC test Read
44G5.00 Serum 5 - nucleotidase res25: M3_LFT_FBC test Read
44G5000 Serum 5-nucleotidase level normal res25: M3_LFT_FBC test Read
44G5200 Serum 5-nucleotidase level raised res25: M3_LFT_FBC test Read
44G6.00 Plasma hydroxybutyrate dehydrogenase level res25: M3_LFT_FBC test Read
44G7.00 Plasma gamma-glutamyl transferase level res25: M3_LFT_FBC test Read
44G8.00 Serum hydroxybutyrate dehydrogenase level res25: M3_LFT_FBC test Read
44G9.00 Serum gamma-glutamyl transferase level res25: M3_LFT_FBC test Read
44GA.00 Plasma alanine aminotransferase level res25: M3_LFT_FBC test Read
44GB.00 Serum alanine aminotransferase level res25: M3_LFT_FBC test Read
44GZ.00 Liver enzymes NOS res25: M3_LFT_FBC test Read
44H5.00 AST - aspartate transam.(SGOT) res25: M3_LFT_FBC test Read
44H5.11 AST serum level res25: M3_LFT_FBC test Read
44H5.12 SGOT serum level res25: M3_LFT_FBC test Read
44H5000 AST/SGOT level normal res25: M3_LFT_FBC test Read
44H5100 AST/SGOT level abnormal res25: M3_LFT_FBC test Read
44H5200 AST/SGOT level raised res25: M3_LFT_FBC test Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH665/version/1330/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH665/version/1330/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH665', '1330', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH665/version/1330/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH665/version/1330/export/codes/?format=json
CSV site_root/phenotypes/PH665/version/1330/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH665', '1330', api_client=client)

Version History

Version
ID
Name Owner Publish date
1330 Lft Fbc (M3) ieuan.scanlon 2021-10-06 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

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