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?
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.
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.
|Code||Description||Entity type||Category||Coding System (Read)|
|B34..00||Malignant neoplasm of female breast||res25: P19_brca||diagnostic||Read|
|B34..11||Ca female breast||res25: P19_brca||diagnostic||Read|
|B340.00||Malignant neoplasm of nipple and areola of female breast||res25: P19_brca||diagnostic||Read|
|B340000||Malignant neoplasm of nipple of female breast||res25: P19_brca||diagnostic||Read|
|B340100||Malignant neoplasm of areola of female breast||res25: P19_brca||diagnostic||Read|
|B340z00||Malignant neoplasm of nipple or areola of female breast NOS||res25: P19_brca||diagnostic||Read|
|B341.00||Malignant neoplasm of central part of female breast||res25: P19_brca||diagnostic||Read|
|B342.00||Malignant neoplasm of upper-inner quadrant of female breast||res25: P19_brca||diagnostic||Read|
|B343.00||Malignant neoplasm of lower-inner quadrant of female breast||res25: P19_brca||diagnostic||Read|
|B344.00||Malignant neoplasm of upper-outer quadrant of female breast||res25: P19_brca||diagnostic||Read|
|B345.00||Malignant neoplasm of lower-outer quadrant of female breast||res25: P19_brca||diagnostic||Read|
|B346.00||Malignant neoplasm of axillary tail of female breast||res25: P19_brca||diagnostic||Read|
|B347.00||Malignant neoplasm, overlapping lesion of breast||res25: P19_brca||diagnostic||Read|
|B34y.00||Malignant neoplasm of other site of female breast||res25: P19_brca||diagnostic||Read|
|B34y000||Malignant neoplasm of ectopic site of female breast||res25: P19_brca||diagnostic||Read|
|B34yz00||Malignant neoplasm of other site of female breast NOS||res25: P19_brca||diagnostic||Read|
|B34z.00||Malignant neoplasm of female breast NOS||res25: P19_brca||diagnostic||Read|
|B83..00||Carcinoma in situ of breast and genitourinary system||res25: P19_brca||diagnostic||Read|
|B830.00||Carcinoma in situ of breast||res25: P19_brca||diagnostic||Read|
|B830000||Lobular carcinoma in situ of breast||res25: P19_brca||diagnostic||Read|
|B830100||Intraductal carcinoma in situ of breast||res25: P19_brca||diagnostic||Read|
|BB9J.00||[M]Paget's disease, mammary||res25: P19_brca||diagnostic||Read|
|BB9J.11||[M]Paget's disease, breast||res25: P19_brca||diagnostic||Read|
|BB9K.00||[M]Paget's disease and infiltrating breast duct carcinoma||res25: P19_brca||diagnostic||Read|
|BB9K000||[M]Paget's disease and intraductal carcinoma of breast||res25: P19_brca||diagnostic||Read|
|Byu6.00||[X]Malignant neoplasm of breast||res25: P19_brca||diagnostic||Read|
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|1356||Breast Cancer Gene (P19)||ieuan.scanlon||2021-10-06||currently shown|
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