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Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink

Stocks, S. Jill; Kontopantelis, Evangelos; Akbarov, Artur; Rodgers, Sarah; Avery, Anthony J.; Ashcroft, Darren M.

Authors

S. Jill Stocks

Evangelos Kontopantelis

Artur Akbarov

Sarah Rodgers

Anthony J. Avery

Darren M. Ashcroft



Abstract

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.

Funding, competing interests, data sharing: National Institute for Health Research through the Greater Manchester Primary Care Patient Safety Translational Research Centre (grant No GMPSTRC-2012-1). Data from CPRD cannot be shared because of licensing restrictions.

Citation

Stocks, S. J., Kontopantelis, E., Akbarov, A., Rodgers, S., Avery, A. J., & Ashcroft, D. M. (2015). Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink. BMJ, 351, https://doi.org/10.1136/bmj.h5501

Journal Article Type Article
Acceptance Date Oct 4, 2015
Publication Date Nov 3, 2015
Deposit Date Mar 20, 2017
Publicly Available Date Mar 20, 2017
Journal BMJ
Print ISSN 0959-8138
Electronic ISSN 1756-1833
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 351
Article Number h5501
DOI https://doi.org/10.1136/bmj.h5501
Public URL http://eprints.nottingham.ac.uk/id/eprint/41375
Publisher URL http://www.bmj.com/content/351/bmj.h5501
Related Public URLs https://creativecommons.org/licenses/by/4.0/
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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