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Lithium (M4)

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

ID
PH668
Version ID
1336
Type
Drug
Data Sources
Valid event data range
Start - 01/02/2013
Sex
♀  Female ♂  Male
Agreement Date
2015-11-03
Coding system
GPRD product codes
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: 25
Code Description Coding System (CPRD_product_code) Entity type Category
10809 Priadel 520mg/5ml liquid (Sanofi) CPRD_product_code res25: M4_lithium drug
10937 Lithium citrate 509mg/5ml oral solution CPRD_product_code res25: M4_lithium drug
11491 Lithium citrate 520mg/5ml oral solution sugar free CPRD_product_code res25: M4_lithium drug
12402 Camcolit 250 tablets (Norgine Pharmaceuticals Ltd) CPRD_product_code res25: M4_lithium drug
12403 Camcolit 400 modified-release tablets (Norgine Pharmaceuticals Ltd) CPRD_product_code res25: M4_lithium drug
12648 Lithium citrate 1.018g/5ml oral solution CPRD_product_code res25: M4_lithium drug
13601 Lithium citrate 564mg modified-release tablets CPRD_product_code res25: M4_lithium drug
13654 Litarex 564mg modified-release tablets (Actavis UK Ltd) CPRD_product_code res25: M4_lithium drug
1447 Lithium carbonate 400mg modified-release tablets CPRD_product_code res25: M4_lithium drug
14954 Lithium carbonate 450mg modified-release tablets CPRD_product_code res25: M4_lithium drug
15388 Phasal 300mg Tablet (Lagap) CPRD_product_code res25: M4_lithium drug
16250 Lithonate 400mg modified-release tablets (Teva UK Ltd) CPRD_product_code res25: M4_lithium drug
22018 Li-Liquid 509mg/5ml oral solution (Rosemont Pharmaceuticals Ltd) CPRD_product_code res25: M4_lithium drug
25344 Lithium carbonate 400mg Modified-release tablet (Approved Prescription Services Ltd) CPRD_product_code res25: M4_lithium drug
25345 Li-Liquid 1.018g/5ml oral solution (Rosemont Pharmaceuticals Ltd) CPRD_product_code res25: M4_lithium drug
3352 Liskonum 450mg modified-release tablets (GlaxoSmithKline UK Ltd) CPRD_product_code res25: M4_lithium drug
3359 Priadel 200mg modified-release tablets (Sanofi) CPRD_product_code res25: M4_lithium drug
51401 Priadel 400mg modified-release tablets (Necessity Supplies Ltd) CPRD_product_code res25: M4_lithium drug
53459 Priadel 400mg modified-release tablets (Doncaster Pharmaceuticals Ltd) CPRD_product_code res25: M4_lithium drug
56427 Lithium citrate 509mg/5ml oral solution (Cubic Pharmaceuticals Ltd) CPRD_product_code res25: M4_lithium drug
56435 Lithium carbonate 200mg/5ml oral suspension CPRD_product_code res25: M4_lithium drug
760 Lithium carbonate 200mg modified-release tablets CPRD_product_code res25: M4_lithium drug
8041 Lithium carbonate 250mg tablets CPRD_product_code res25: M4_lithium drug
872 Priadel 400mg modified-release tablets (Sanofi) CPRD_product_code res25: M4_lithium drug
8827 Lithium carbonate 300mg Modified-release tablet CPRD_product_code res25: M4_lithium drug

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH668/version/1336/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH668/version/1336/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('PH668', '1336', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH668/version/1336/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH668/version/1336/export/codes/?format=json
CSV site_root/phenotypes/PH668/version/1336/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('PH668', '1336', api_client=client)

Version History

Version
ID
Name Owner Publish date
1336 Lithium (M4) 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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