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Changes in English medication safety indicators throughout the COVID-19 pandemic: a federated analysis of 57 million patients’ primary care records in situ using OpenSAFELY

Description
Pharmacist-led information technology intervention (PINCER) is an effective way to reduce errors in prescription and medication monitoring which are responsible for a large proportion of adverse drug events. This is achieved through the monitoring of 13 PINCER measures. The purpose of this notebook is observe changes in adherence to each of the PINCER measures at the practice level during the pandemic. This analysis uses federated analytics on 57 million patients' primary care records, including all patients registered at either a TPP or EMIS practice (>95% of English practices). A regularly updated monthly dashboard is linked below (TPP practices only).
Authors
Louis Fisher, Lisa E. M. Hopcroft, Sarah Rodgers, James Barrett, Kerry Oliver, Anthony J. Avery, Dai Evans, Helen Curtis, Richard Croker, Orla Macdonald, Jessica Morley, Amir Mehrkar, Seb Bacon, Simon Davy, Iain Dillingham, David Evans, George Hickman, Peter Inglesby, Caroline E. Morton, Becky Smith, Tom Ward, William Hulme, Amelia Green, Jon Massey, Alex J. Walker, Chris Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Shaun O’Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Ben Goldacre, Brian MacKenna
Contact
Get in touch and tell us how you use this report or new features you'd like to see: team@opensafely.org
First published
21 Sep 2021
Last released
22 May 2023
Links

Pharmacist-led information technology intervention (PINCER) is an effective way to reduce errors in prescription and medication monitoring which are responsible for a large proportion of adverse drug events. This is achieved through the monitoring of 13 PINCER indicators.

The purpose of this notebook is to describe practice level changes in adherence to each of the PINCER indicators throughout the COVID-19 pandemic. For each indicator, the number of unique patients experiencing hazardous prescribing described by a given indicator at any point during the study period is provided. The total number of hazardous prescribing events for each indicator is also shown. Practice level monthly rates of hazardous prescribing are calculated, ranked and used to calculate deciles of activity for each indicator, which are represented as decile charts.

Summary

Q1 mean percentage 2020 Q1 mean percentage 2021 Numerator Denominator % Ratio of hazardous prescribing events to unique patients experiencing an event Number of practices with at least one hazardous prescribing event % practices with at least one hazardous prescribing event
Indicators associated with gastrointestinal bleeding - - 551,844 10,881,675 5.07 - 6335 nan
Age >= 65 & NSAID 1.11 0.75 334,487 9,207,007 3.63 4.54 6304 99.03
PU & NSAID 1.32 1.07 32,089 678,218 4.73 3.83 5801 91.44
PU & antiplatelet 4.24 3.85 41,414 678,218 6.11 10.9 5943 93.38
Warfarin/DOAC & NSAID 1.39 1.18 84,101 1,915,117 4.39 4.57 6193 97.42
Warfarin/DOAC & antiplatelet 2.26 1.67 52,575 1,249,865 4.21 5.86 6068 95.32
Aspirin & other antiplatelet 1.67 1.2 36,927 1,470,315 2.51 7.15 5777 90.53
Indicators associated blood test monitoring - - 1,102,209 3,358,954 32.81 - 6329 nan
ACEI or loop diuretic, no blood tests 5.16 12.14 850,587 3,095,595 27.48 5.89 6303 99.00
Methotrexate and no FBC 18.64 22.73 164,502 238,042 69.11 5.05 6278 98.61
Methotrexate and no LFT 19.62 23.27 166,484 238,042 69.94 5.14 6278 98.61
Lithium and no level recording 31.47 38.44 40,664 45,456 89.46 6.93 5912 93.23
Amiodarone and no TFT 36.2 39.23 46,268 59,925 77.21 6.22 5993 94.19
Indicators associated with cautioned medication in other conditions (including heart failure, asthma and acute kidney injury) - - 228,587 7,594,687 3.01 - 6321 nan
Asthma & beta-blocker 1.27 1.29 185,289 6,646,586 2.79 10.24 6307 99.08
HF & NSAID 1.71 1.43 31,034 735,781 4.22 6.09 5622 88.45
CRF & NSAID 1.27 1.12 14,558 476,925 3.05 4.7 2217 87.08

Gastrointestinal (GI) Bleed Indicators

Age 65+, on oral NSAID without gastroprotection (GI_P3A)

Prescription of an oral NSAID in the previous 3 months to patients aged 65 or above who have not been co-prescribed an ulcer healing drug in the previous 3 months.

H/O peptic ulcer, on oral NSAID without gastroprotection (GI_P3B)

Prescription of an oral NSAID in the previous 3 months to patients with a history of peptic ulceration/gastric bleed who have not been co-prescribed an ulcer healing drug in the previous 3 months.

H/O peptic ulcer, on antiplatelet without gastroprotection (GI_P3C)

Prescription of an aniplatelet drug in the previous 3 months in patients with a history of peptic ulceration/gastric bleed who have not been co-prescribed an ulcer healing drug in the previous 3 months.

On OAC and oral NSAID (GI_P3D)

Prescription of warfarin or a DOAC in the previous 3 months and a prescription of an oral NSAID in the previous 3 months.

On OAC and antiplatelet without gastroprotection (GI_P3E)

Prescription of warfarin or a DOAC in combination with an antiplatelet drug in the previous 3 months without co-prescription of an ulcer-healing drug.

Note: "In combination" is defined as a co-prescription within 28 days of each other.

On aspirin and antiplatelet without gastroprotection (GI_P3F)

Prescription of aspirin in combination with another antiplatelet drug in the previous 3 months without co-prescription of an ulcer-healing drug.

Note: "In combination" is defined as a co-prescription within 28 days of each other.

Monitoring Indicators

Age 75+, on ACEI or loop, no renal function/electrolytes test (MO_P13)

Absence of a computer-recorded check of renal function or electrolytes in the previous 15 months in patients aged 75 or over who have been prescripted an ACEi of loop diuretic in the previous 6 months.

Methotrexate audit (MO_P15)

On methotrexate without recorded full blood count

Absence of a recorded full blood count in the previous 3 months in patients who have been receiving a methotrexate prescription for at least 3 months.

On methotrexate without recorded liver function test

Absence of a recorded liver function test in the previous 3 months in patients who have been receiving a methotrexate prescription for at least 3 months.

On lithium without recent lithium test (MO_P17)

Absence of a recorded check of lithium concentration in the previous 3 months in patients who have been receiving a lithium prescription for at least 3 months.

On amiodarone without recent thyroid function test (MO_P18)

Absence of a recorded thyroid function test in the previous 6 months in patients who have been receiving a lithium prescription for at least 6 months.

Other Indicators

Asthma and non-selective BB (AS_P3G)

Prescription of a non-selective beta-blocker in the previous 3 months in patients with a history of asthma.

Note: History of asthma is defined as patients with a recorded code for asthma without a more recent asthma resolved code.

Heart failure and oral NSAID (HF_P3I)

Prescription of an oral NSAID in the previous 3 months in patients with heart failure.

eGFR <45 and oral NSAID (KI_P3K)

NOTE: The results below are for TPP practices only.

Prescription of an oral NSAID in the previous 3 months to patients with an eGFR < 45.