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.
- 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
- 20 Jun 2022
- Links
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
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.
This analysis is run across all patients in England registered at a General Practice using either TPP or EMIS as their EHR vendor. This covers 95% of the English population.
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 | - |
| 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 | - |
| 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 | - |
| 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.