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Digoxin (P9)

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

Type
Drug
ID
PH689
Version ID
1378
Data Sources
Valid event data range
Start - 01/02/2013
Sex
Female, Male
Agreement Date
2015-11-03
Coding system
GPRD product codes
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 Coding System (CPRD_product_code) Entity type Category
16366 Digamex 125microgram tablets (Actavis UK Ltd) CPRD_product_code res25: P9_digoxin drug
17169 Digitalis 60mg tablets CPRD_product_code res25: P9_digoxin drug
20844 Digoxin 250microgram tablets (Actavis UK Ltd) CPRD_product_code res25: P9_digoxin drug
20944 Digoxin 62.5microgram tablets (Actavis UK Ltd) CPRD_product_code res25: P9_digoxin drug
2302 Lanoxin -pg 62.5microgram Tablet (Wellcome Medical Division) CPRD_product_code res25: P9_digoxin drug
24719 DIGOXIN CPRD_product_code res25: P9_digoxin drug
25043 DIGOXIN CPRD_product_code res25: P9_digoxin drug
2511 Lanoxin 125 tablets (Aspen Pharma Trading Ltd) CPRD_product_code res25: P9_digoxin drug
25238 Digamex 250microgram tablets (Actavis UK Ltd) CPRD_product_code res25: P9_digoxin drug
27523 Lanoxin 500micrograms/2ml solution for infusion ampoules (Aspen Pharma Trading Ltd) CPRD_product_code res25: P9_digoxin drug
27547 DIGOXIN CPRD_product_code res25: P9_digoxin drug
29282 Digamex 62.5microgram tablets (Actavis UK Ltd) CPRD_product_code res25: P9_digoxin drug
3181 Lanoxin 250microgram Tablet (Wellcome Medical Division) CPRD_product_code res25: P9_digoxin drug
3286 Digoxin 50micrograms/ml oral solution CPRD_product_code res25: P9_digoxin drug
3308 DIGOXIN .25 MG TAB CPRD_product_code res25: P9_digoxin drug
33080 Digoxin 125microgram tablets (Actavis UK Ltd) CPRD_product_code res25: P9_digoxin drug
33274 Digoxin 100micrograms/1ml solution for injection ampoules CPRD_product_code res25: P9_digoxin drug
333 Digitalis 30mg tablets CPRD_product_code res25: P9_digoxin drug
33612 Digoxin 250microgram tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: P9_digoxin drug
33675 Digoxin 125microgram tablets (Approved Prescription Services Ltd) CPRD_product_code res25: P9_digoxin drug
34017 Digoxin 125microgram Tablet (IVAX Pharmaceuticals UK Ltd) CPRD_product_code res25: P9_digoxin drug
34023 Digoxin 62.5microgram tablets (IVAX Pharmaceuticals UK Ltd) CPRD_product_code res25: P9_digoxin drug
34024 Digoxin 250microgram tablets (IVAX Pharmaceuticals UK Ltd) CPRD_product_code res25: P9_digoxin drug
34327 Digoxin 62.5microgram tablets (Teva UK Ltd) CPRD_product_code res25: P9_digoxin drug
34328 Digoxin 250micrograms tablets CPRD_product_code res25: P9_digoxin drug
34519 Digoxin 125microgram tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: P9_digoxin drug
34948 Digoxin 62.5microgram tablets (A A H Pharmaceuticals Ltd) CPRD_product_code res25: P9_digoxin drug
36 Digoxin 125microgram tablets CPRD_product_code res25: P9_digoxin drug
3705 Lanoxin -pg 50microgram/ml Oral solution (Wellcome Medical Division) CPRD_product_code res25: P9_digoxin drug
40245 Digoxin 250microgram tablets (Teva UK Ltd) CPRD_product_code res25: P9_digoxin drug
42989 Lanoxin PG 62.5microgram tablets (Aspen Pharma Trading Ltd) CPRD_product_code res25: P9_digoxin drug
42990 Lanoxin 250microgram tablets (Aspen Pharma Trading Ltd) CPRD_product_code res25: P9_digoxin drug
43577 Lanoxin PG 50micrograms/ml elixir (Aspen Pharma Trading Ltd) CPRD_product_code res25: P9_digoxin drug
47813 Digoxin 62.5microgram Tablet (Celltech Pharma Europe Ltd) CPRD_product_code res25: P9_digoxin drug
48587 Digoxin 50micrograms/ml oral solution CPRD_product_code res25: P9_digoxin drug
54117 Digoxin 125micrograms/5ml oral solution CPRD_product_code res25: P9_digoxin drug
792 Digoxin 62.5microgram tablets CPRD_product_code res25: P9_digoxin drug
94 Digoxin 250microgram tablets CPRD_product_code res25: P9_digoxin drug
9522 Digoxin 500micrograms/2ml solution for infusion ampoules CPRD_product_code res25: P9_digoxin drug

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH689/version/1378/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH689/version/1378/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('PH689', '1378', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH689/version/1378/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH689/version/1378/export/codes/?format=json
CSV site_root/phenotypes/PH689/version/1378/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('PH689', '1378', api_client=client)

Version History

Version
ID
Name Owner Publish date
1378 Digoxin (P9) 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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