Linked primary and secondary health care data are important for comprehensive medication safety surveillance. |
Medication prescribing and monitoring should be treated as different statistical processes. |
1 Introduction
2 Methods
2.1 Data Source
2.2 Indicator Definition
ID | Potential hazard/at-risk patient group (1 April 2012) | Prevalence | ICC | |
---|---|---|---|---|
Prescribing | P1 | Prescribed aspirin or clopidogrel/patients not prescribed gastro-protection who have a history of peptic ulcer | 12.31 % (216/1755) | 0.004 |
P2 | Prescribed aspirin/patients prescribed warfarin without co-prescription of gastro-protection | 4.52 % (77/1705) | 0 | |
P3 | Prescribed an NSAID/patients prescribed warfarin | 5.20 % (159/3060) | 0.006 | |
P4 | Prescribed an NSAID/patients not prescribed gastro-protection who have a history of peptic ulcer | 5.53 % (97/1755) | 0 | |
P5 | Prescribed an NSAID/patients aged 65 or older without prescription of gastro-protection | 6.20 % (1563/25,228) | 0.023 | |
P6 | Prescribed an NSAID/patients with diagnosis of CKD (3b, 4, 5) or with latest eGFR <45 | 3.03 % (108/3570) | 0.013 | |
P7 | Prescribed an NSAID/patients with diagnosis of CKD (3b, 4, 5) or with latest eGFR <45 who have been prescribed an ACEi | 4.01 % (70/1746) | 0.021 | |
P8 | Prescribed an NSAID/patients with diagnosis of CKD (3b, 4, 5) or with latest eGFR <45 who are prescribed an ACEi and a loop diuretic | 3.99 % (27/677) | 0 | |
P9 | Prescribed metformin/patients with diagnosis of CKD (4, 5) or with latest eGFR <30 | 3.71 % (46/1241) | 0 | |
P10 | Prescribed digoxin at a daily dose of >125/patients with a diagnosis of CKD (3b, 4, 5) or with latest eGFR <45 | 0.31 % (11/3570) | 0 | |
P11 | Prescribed an NSAID/patients with heart failure | 3.17 % (94/2964) | 0.003 | |
P12 | Prescribed glitazone/patients with heart failure | 1.89 % (56/2964) | 0.001 | |
P13 | Prescribed β-blockers/patients with unresolved asthma | 4.73 % (1258/26,607) | 0.002 | |
P14 | Not prescribed inhaled corticosteroid/patients with asthma prescribed a long-acting β-agonist | 1.65 % (79/4796) | 0.007 | |
P15 | Prescribed combined hormonal contraceptive/women with history of venous or arterial thrombosis | 0.13 % (14/10,889) | 0 | |
P16 | Prescribed combined hormonal contraceptive/women with a body mass index of ≥40 | 2.78 % (109/3927) | 0.012 | |
P17 | Prescribed combined hormonal contraceptive/women aged ≥35 who are current smokers | 1.12 % (171/15,286) | 0.004 | |
P18 | Prescribed oral or transdermal oestrogens/women with a history of breast cancer | 1.33 % (23/1724) | 0.002 | |
Monitoring | M1 | Missing renal function and electrolytes in the past 15 months/patients aged ≥75 on a long-term ACEi or loop diuretic | 5.06 % (411/8123) | 0.037 |
M2 | Missing full blood count or liver function test in the past 3 months/patients receiving repeat methotrexate | 6.74 % (31/460) | 0.079 | |
M3 | Missing International Normalised Ratio test in the past 3 months/patients receiving repeat warfarin | 9.95 % (244/2452) | 0.213 | |
M4 | Missing thyroid function test in the past 6 months/patients receiving repeat amiodarone | 38.01 % (103/271) | 0.047 |
2.3 Covariates
2.4 Statistical Methods
3 Results
All | Monitoring | Prescribing | Monitoring and prescribing | ||||
---|---|---|---|---|---|---|---|
No hazards* | At least one hazard | No hazards* | At least one hazard | No hazards* | At least one combination of monitoring and prescribing hazard | ||
Number | 205,519 | 9353 | 775 | 66,537 | 3833 | 7338 | 71 |
Age | 46.21 (19.3) | 79.03 (9.53) | 75.72 (13.95) | 56.92 (20.19) | 65.33 (16.03) | 79.42 (9.23) | 74.68 (13.46) |
IMD | 35.17 (18.83) | 33.56 (18.47) | 36.65 (18.97) | 35.22 (18.82) | 34.47 (18.97) | 33.64 (18.44) | 36.68 (20.65) |
Polypharmacy | 2.1 (3.5) | 8.63 (4.33) | 7.59 (4.27) | 3.73 (4.28) | 7.12 (5.14) | 8.42 (4.31) | 8.55 (4.16) |
Males (%) | 51 | 44 | 43 | 39 | 44 | 44 | 52 |
3.1 Prevalence and Variation Between Practices for Each Indicator
3.2 Covariate Effects
Variable/type
|
Monitoring indicators
|
Prescribing indicators
| ||||
---|---|---|---|---|---|---|
Prevalence | Univariate odds ratio | Adjusted odds ratio | Prevalence | Univariate odds ratio | Adjusted odds ratio | |
Patient-level covariates | ||||||
Age | ||||||
18–50 | 19.77 % (52/263) | 1 | 1 | 2.56 % (675/26,410) | 1 | 1 |
51–60 | 18.53 % (58/313) | 0.73 (0.47, 1.13) | 0.94 (0.59, 1.48) | 3.6 % (304/8448) | 1.63 (1.41, 1.89) | 0.86 (0.74, 1) |
61–70 | 11.66 % (75/643) | 0.35 (0.23, 0.53) | 0.46 (0.3, 0.71) | 8.62 % (1228/14,238) | 3.7 (3.3, 4.15) | 1.66 (1.47, 1.88) |
71–80 | 6.34 % (274/4322) | 0.27 (0.18, 0.4) | 0.38 (0.25, 0.56) | 8.72 % (1096/12,567) | 3.4 (3.02, 3.84) | 1.28 (1.12, 1.45) |
>80 | 6.89 % (316/4587) | 0.29 (0.19, 0.42) | 0.4 (0.27, 0.6) | 6.09 % (530/8707) | 2.18 (1.9, 2.49) | 0.81 (0.7, 0.94) |
Polypharmacy | ||||||
0–1 | 14.92 % (37/248) | 1 | 1 | 2.05 % (680/33,172) | 1 | 1 |
2–4 | 10.33 % (209/2023) | 0.98 (0.57, 1.68) | 1.25 (0.71, 2.17) | 6.1 % (999/16,375) | 3.25 (2.89, 3.66) | 3.17 (2.81, 3.58) |
5–7 | 7.66 % (259/3381) | 0.65 (0.38, 1.11) | 0.87 (0.5, 1.51) | 8.44 % (914/10,830) | 4.63 (4.1, 5.22) | 4.58 (4.04, 5.2) |
8–10 | 5.98 % (148/2476) | 0.39 (0.23, 0.67) | 0.53 (0.3, 0.93) | 11.01 % (639/5803) | 6.68 (5.88, 7.59) | 6.74 (5.89, 7.72) |
>10 | 6.1 % (122/2000) | 0.27 (0.16, 0.47] | 0.36 (0.21, 0.64] | 14.34 % (601/4190) | 9.97 (8.81, 11.3) | 10 (8.73, 11.46) |
Gender | ||||||
Female | 7.76 % (439/5660) | 1 | 1 | 5.01 % (2136/42,650) | 1 | – |
Male | 7.52 % (336/4468) | 0.81 (0.69, 0.95) | 0.75 (0.64, 0.88) | 6.12 % (1697/27,720) | 0.97 (0.9, 1.04) | – |
Patient IMD | ||||||
≤20 | 6.36 % (174/2738) | 1 | – | 5.72 % (1007/17,616) | 1 | 1 |
>20–≤32 | 7.06 % (175/2477) | 1.11 (0.88, 1.4) | – | 5.37 % (890/16,579) | 0.99 (0.9, 1.1) | 0.96 (0.86, 1.06) |
>32–≤50 | 8.39 % (228/2716) | 1.13 (0.9, 1.43) | – | 5.45 % (1040/19,079) | 1.05 (0.95, 1.16) | 0.96 (0.87, 1.06) |
>50 | 9.01 % (198/2197) | 1.08 (0.84, 1.39) | – | 5.24 % (896/17,096) | 0.99 (0.89, 1.1) | 0.85 (0.76, 0.96) |
General practice-level covariates | ||||||
Training | ||||||
No | 8.22 % (602/7325) | 1 | 1 | 5.54 % (2769/50,009) | 1 | – |
Yes | 6.17 % (173/2803) | 0.6 (0.32, 1.13) | 0.5 (0.29, 0.88) | 5.23 % (1064/20,361) | 0.97 (0.73, 1.3) | – |
Practice IMD | ||||||
≤28.9 | 6.04 % (235/3890) | 1 | 1 | 6.04 % (1558/25,781) | 1 | – |
>28.9–≤36.5 | 6.27 % (142/2265) | 1.11 (0.61, 2.02) | 1.09 (0.6, 1.96) | 4.59 % (629/13,703) | 0.77 (0.58, 1.04) | – |
>36.5–≤46.1 | 7.84 % (171/2181) | 1.22 (0.67, 2.25) | 1.3 (0.72, 2.35) | 5.33 % (883/16,561) | 0.98 (0.73, 1.31) | – |
>46.1 | 12.67 % (227/1792) | 2.78 (1.54, 5.01) | 3.1 (1.74, 5.53) | 5.33 % (763/14,325) | 1.02 (0.76, 1.37) | – |
GP system | ||||||
EMIS | 8.14 % (162/1991) | 1 | – | 6.55 % (940/14,341) | 1 | 1 |
Vision | 7.53 % (613/8137) | 0.92 (0.53, 1.62) | – | 5.16 % (2893/56,029) | 0.81 (0.64, 1.04) | 0.8 (0.63, 1.02) |
List size | ||||||
≤2.4 K | 11.77 % (121/1028) | 1 | – | 5.62 % (373/6637) | 1 | – |
>2.4 K–≤3.29 K | 10.76 % (127/1180) | 0.73 (0.37, 1.43) | – | 6.06 % (561/9255) | 1.13 (0.82, 1.55) | – |
>3.29 K–≤6.47 K | 5.52 % (152/2753) | 0.4 (0.21, 0.77) | – | 5.63 % (1008/17,915) | 0.98 (0.72, 1.33) | – |
>6.47 K | 7.26 % (375/5167) | 0.57 (0.3, 1.08) | – | 5.17 % (1891/36,563) | 0.91 (0.67, 1.23) | – |
Mean age | ||||||
≤35.5 | 8.31 % (113/1360) | 1 | – | 4.17 % (525/12,584) | 1 | – |
>35.5–≤39.0 | 8.53 % (177/2075) | 0.77 (0.37, 1.59) | – | 5.56 % (902/16,220) | 1.42 (1.03, 1.95) | – |
>39.0–≤41.2 | 7.5 % (239/3187) | 0.88 (0.43, 1.8) | – | 5.59 % (1199/21,432) | 1.32 (0.96, 1.81) | – |
>41.2 | 7.02 % (246/3506) | 0.66 (0.32, 1.36) | – | 5.99 % (1207/20,134) | 1.31 (0.95, 1.79) | – |