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Asthma (P1)

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

Type
Disease or Syndrome
ID
PH680
Version ID
1360
Data Sources
Valid event data range
Start - 01/02/2013
Sex
Female, Male
Agreement Date
2015-11-03
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

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: 39
Code Description Entity type Category Coding System (Read)
14B4.00 H/O: asthma res25: P1asthma diagnostic Read
173d.00 Work aggravated asthma res25: P1asthma diagnostic Read
1O2..00 Asthma confirmed res25: P1asthma diagnostic Read
2126200 Asthma resolved res25: P1asthma diagnostic Read
212G.00 Asthma resolved res25: P1asthma diagnostic Read
8H2P.00 Emergency admission, asthma res25: P1asthma diagnostic Read
H312000 Chronic asthmatic bronchitis res25: P1asthma diagnostic Read
H312011 Chronic wheezy bronchitis res25: P1asthma diagnostic Read
H33..00 Asthma res25: P1asthma diagnostic Read
H33..11 Bronchial asthma res25: P1asthma diagnostic Read
H330.00 Extrinsic (atopic) asthma res25: P1asthma diagnostic Read
H330.11 Allergic asthma res25: P1asthma diagnostic Read
H330.12 Childhood asthma res25: P1asthma diagnostic Read
H330.13 Hay fever with asthma res25: P1asthma diagnostic Read
H330.14 Pollen asthma res25: P1asthma diagnostic Read
H330000 Extrinsic asthma without status asthmaticus res25: P1asthma diagnostic Read
H330011 Hay fever with asthma res25: P1asthma diagnostic Read
H330100 Extrinsic asthma with status asthmaticus res25: P1asthma diagnostic Read
H330111 Extrinsic asthma with asthma attack res25: P1asthma diagnostic Read
H330z00 Extrinsic asthma NOS res25: P1asthma diagnostic Read
H331.00 Intrinsic asthma res25: P1asthma diagnostic Read
H331.11 Late onset asthma res25: P1asthma diagnostic Read
H331000 Intrinsic asthma without status asthmaticus res25: P1asthma diagnostic Read
H331100 Intrinsic asthma with status asthmaticus res25: P1asthma diagnostic Read
H331111 Intrinsic asthma with asthma attack res25: P1asthma diagnostic Read
H331z00 Intrinsic asthma NOS res25: P1asthma diagnostic Read
H332.00 Mixed asthma res25: P1asthma diagnostic Read
H333.00 Acute exacerbation of asthma res25: P1asthma diagnostic Read
H334.00 Brittle asthma res25: P1asthma diagnostic Read
H33z.00 Asthma unspecified res25: P1asthma diagnostic Read
H33z000 Status asthmaticus NOS res25: P1asthma diagnostic Read
H33z011 Severe asthma attack res25: P1asthma diagnostic Read
H33z100 Asthma attack res25: P1asthma diagnostic Read
H33z111 Asthma attack NOS res25: P1asthma diagnostic Read
H33z200 Late-onset asthma res25: P1asthma diagnostic Read
H33zz00 Asthma NOS res25: P1asthma diagnostic Read
H33zz11 Exercise induced asthma res25: P1asthma diagnostic Read
H33zz12 Allergic asthma NEC res25: P1asthma diagnostic Read
H47y000 Detergent asthma res25: P1asthma diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH680/version/1360/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH680/version/1360/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('PH680', '1360', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH680/version/1360/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH680/version/1360/export/codes/?format=json
CSV site_root/phenotypes/PH680/version/1360/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('PH680', '1360', api_client=client)

Version History

Version
ID
Name Owner Publish date
1360 Asthma (P1) 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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