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.
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 | Coding System (CPRD_product_code) | Entity type | Category |
---|---|---|---|---|
13348 | Marevan 5mg tablets (AMCo) | CPRD_product_code | res25: warfarin | drug |
1781 | Warfarin 5mg tablets | CPRD_product_code | res25: warfarin | drug |
17965 | Marevan 500microgram tablets (AMCo) | CPRD_product_code | res25: warfarin | drug |
23078 | Warfarin 1mg Tablet (WB Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
30202 | Warfarin wbp 1mg Tablet (Boehringer Ingelheim Ltd) | CPRD_product_code | res25: warfarin | drug |
30203 | Warfarin wbp 3mg Tablet (Boehringer Ingelheim Ltd) | CPRD_product_code | res25: warfarin | drug |
31511 | Warfarin 3mg Tablet (WB Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
31937 | Warfarin 5mg tablets (Teva UK Ltd) | CPRD_product_code | res25: warfarin | drug |
33711 | Warfarin 5mg Tablet (WB Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
34019 | Warfarin 1mg tablets (IVAX Pharmaceuticals UK Ltd) | CPRD_product_code | res25: warfarin | drug |
34086 | Warfarin 3mg Tablet (Celltech Pharma Europe Ltd) | CPRD_product_code | res25: warfarin | drug |
34087 | Warfarin 1mg Tablet (Celltech Pharma Europe Ltd) | CPRD_product_code | res25: warfarin | drug |
34088 | Warfarin 5mg Tablet (Celltech Pharma Europe Ltd) | CPRD_product_code | res25: warfarin | drug |
34095 | Warfarin wbp 5mg Tablet (Boehringer Ingelheim Ltd) | CPRD_product_code | res25: warfarin | drug |
34299 | Warfarin 1mg tablets (Teva UK Ltd) | CPRD_product_code | res25: warfarin | drug |
34416 | Warfarin 1mg tablets (Kent Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
34417 | Warfarin 3mg tablets (Teva UK Ltd) | CPRD_product_code | res25: warfarin | drug |
34418 | Warfarin 5mg tablets (Generics (UK) Ltd) | CPRD_product_code | res25: warfarin | drug |
34517 | Warfarin 1mg tablets (Generics (UK) Ltd) | CPRD_product_code | res25: warfarin | drug |
34526 | Warfarin 3mg tablets (Generics (UK) Ltd) | CPRD_product_code | res25: warfarin | drug |
34576 | Warfarin 1mg Tablet (Lagap) | CPRD_product_code | res25: warfarin | drug |
34691 | Warfarin 5mg Tablet (Regent Laboratories Ltd) | CPRD_product_code | res25: warfarin | drug |
34758 | Warfarin 3mg tablets (IVAX Pharmaceuticals UK Ltd) | CPRD_product_code | res25: warfarin | drug |
34864 | Warfarin 5mg tablets (IVAX Pharmaceuticals UK Ltd) | CPRD_product_code | res25: warfarin | drug |
34918 | Warfarin 5mg tablets (Actavis UK Ltd) | CPRD_product_code | res25: warfarin | drug |
36099 | Warfarin 1mg/5ml oral suspension | CPRD_product_code | res25: warfarin | drug |
38041 | Warfarin sodium 5mg/ml oral suspension | CPRD_product_code | res25: warfarin | drug |
38044 | Warfarin 5mg/5ml oral solution | CPRD_product_code | res25: warfarin | drug |
39866 | Warfarin 1mg tablets (Almus Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
40143 | Warfarin 500microgram tablets (A A H Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
43407 | Warfarin 3mg tablets (A A H Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
43408 | Warfarin 1mg tablets (A A H Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
43409 | Warfarin 5mg tablets (A A H Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
43655 | Warfarin sodium oral solution | CPRD_product_code | res25: warfarin | drug |
44866 | Warfarin sodium 1mg/ml oral supension SF | CPRD_product_code | res25: warfarin | drug |
45 | Warfarin 1mg tablets | CPRD_product_code | res25: warfarin | drug |
47944 | Warfarin 1mg tablets (Actavis UK Ltd) | CPRD_product_code | res25: warfarin | drug |
48070 | Warfarin sodium tablets | CPRD_product_code | res25: warfarin | drug |
50000 | Warfarin 1mg/ml oral suspension sugar free (A A H Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
51484 | Warfarin 1mg tablets (Bristol Laboratories Ltd) | CPRD_product_code | res25: warfarin | drug |
51496 | Warfarin 1mg tablets (Phoenix Healthcare Distribution Ltd) | CPRD_product_code | res25: warfarin | drug |
51509 | Warfarin 1mg tablets (APC Pharmaceuticals & Chemicals (Europe) Ltd) | CPRD_product_code | res25: warfarin | drug |
53745 | Warfarin 3mg tablets (Bristol Laboratories Ltd) | CPRD_product_code | res25: warfarin | drug |
53752 | Warfarin 1mg tablets (Alliance Healthcare (Distribution) Ltd) | CPRD_product_code | res25: warfarin | drug |
54946 | Warfarin 3mg tablets (Actavis UK Ltd) | CPRD_product_code | res25: warfarin | drug |
55316 | Warfarin 3mg/5ml oral suspension | CPRD_product_code | res25: warfarin | drug |
56314 | Warfarin 3mg tablets (Kent Pharmaceuticals Ltd) | CPRD_product_code | res25: warfarin | drug |
58519 | Warfarin 1mg tablets (DE Pharmaceuticals) | CPRD_product_code | res25: warfarin | drug |
58787 | Warfarin 5mg tablets (Alliance Healthcare (Distribution) Ltd) | CPRD_product_code | res25: warfarin | drug |
58962 | Warfarin 3mg tablets (DE Pharmaceuticals) | CPRD_product_code | res25: warfarin | drug |
59400 | Warfarin 500microgram tablets (Sigma Pharmaceuticals Plc) | CPRD_product_code | res25: warfarin | drug |
59578 | Warfarin 3mg tablets (Phoenix Healthcare Distribution Ltd) | CPRD_product_code | res25: warfarin | drug |
60589 | Warfarin 500microgram tablets (Actavis UK Ltd) | CPRD_product_code | res25: warfarin | drug |
61 | Warfarin 3mg tablets | CPRD_product_code | res25: warfarin | drug |
6262 | Warfarin 500microgram tablets | CPRD_product_code | res25: warfarin | drug |
833 | Warfarin 3mg/5ml oral solution | CPRD_product_code | res25: warfarin | drug |
8466 | Marevan 1mg tablets (AMCo) | CPRD_product_code | res25: warfarin | drug |
8467 | Marevan 3mg tablets (AMCo) | CPRD_product_code | res25: warfarin | drug |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH691/version/1382/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH691/version/1382/detail/?format=json |
R Package |
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To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH691/version/1382/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH691/version/1382/export/codes/?format=json |
CSV | site_root/phenotypes/PH691/version/1382/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1382 | Warfarin | ieuan.scanlon | 2021-10-06 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
Print - Print page.