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Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics

OBJECTIVE: To implement complex, PINCER (pharmacist led information technology intervention) prescribing indicators, on a national scale with general practice data to describe the impact of the covid-19 pandemic on safe prescribing. DESIGN: Population based, retrospective cohort study using federate...

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Autores principales: Fisher, Louis, Hopcroft, Lisa EM, Rodgers, Sarah, Barrett, James, Oliver, Kerry, Avery, Anthony J, Evans, Dai, Curtis, Helen, Croker, Richard, Macdonald, Orla, Morley, Jessica, Mehrkar, Amir, Bacon, Sebastian, Davy, Simon, Dillingham, Iain, Evans, David, Hickman, George, Inglesby, Peter, Morton, Caroline E, Smith, Becky, Ward, Tom, Hulme, William, Green, Amelia, Massey, Jon, Walker, Alex J, Bates, Christopher, Cockburn, Jonathan, Parry, John, Hester, Frank, Harper, Sam, O’Hanlon, Shaun, Eavis, Alex, Jarvis, Richard, Avramov, Dima, Griffiths, Paul, Fowles, Aaron, Parkes, Nasreen, Goldacre, Ben, MacKenna, Brian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10254692/
https://www.ncbi.nlm.nih.gov/pubmed/37303488
http://dx.doi.org/10.1136/bmjmed-2022-000392
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author Fisher, Louis
Hopcroft, Lisa EM
Rodgers, Sarah
Barrett, James
Oliver, Kerry
Avery, Anthony J
Evans, Dai
Curtis, Helen
Croker, Richard
Macdonald, Orla
Morley, Jessica
Mehrkar, Amir
Bacon, Sebastian
Davy, Simon
Dillingham, Iain
Evans, David
Hickman, George
Inglesby, Peter
Morton, Caroline E
Smith, Becky
Ward, Tom
Hulme, William
Green, Amelia
Massey, Jon
Walker, Alex J
Bates, Christopher
Cockburn, Jonathan
Parry, John
Hester, Frank
Harper, Sam
O’Hanlon, Shaun
Eavis, Alex
Jarvis, Richard
Avramov, Dima
Griffiths, Paul
Fowles, Aaron
Parkes, Nasreen
Goldacre, Ben
MacKenna, Brian
author_facet Fisher, Louis
Hopcroft, Lisa EM
Rodgers, Sarah
Barrett, James
Oliver, Kerry
Avery, Anthony J
Evans, Dai
Curtis, Helen
Croker, Richard
Macdonald, Orla
Morley, Jessica
Mehrkar, Amir
Bacon, Sebastian
Davy, Simon
Dillingham, Iain
Evans, David
Hickman, George
Inglesby, Peter
Morton, Caroline E
Smith, Becky
Ward, Tom
Hulme, William
Green, Amelia
Massey, Jon
Walker, Alex J
Bates, Christopher
Cockburn, Jonathan
Parry, John
Hester, Frank
Harper, Sam
O’Hanlon, Shaun
Eavis, Alex
Jarvis, Richard
Avramov, Dima
Griffiths, Paul
Fowles, Aaron
Parkes, Nasreen
Goldacre, Ben
MacKenna, Brian
author_sort Fisher, Louis
collection PubMed
description OBJECTIVE: To implement complex, PINCER (pharmacist led information technology intervention) prescribing indicators, on a national scale with general practice data to describe the impact of the covid-19 pandemic on safe prescribing. DESIGN: Population based, retrospective cohort study using federated analytics. SETTING: Electronic general practice health record data from 56.8 million NHS patients by use of the OpenSAFELY platform, with the approval of the National Health Service (NHS) England. PARTICIPANTS: NHS patients (aged 18-120 years) who were alive and registered at a general practice that used TPP or EMIS computer systems and were recorded as at risk of at least one potentially hazardous PINCER indicator. MAIN OUTCOME MEASURE: Between 1 September 2019 and 1 September 2021, monthly trends and between practice variation for compliance with 13 PINCER indicators, as calculated on the first of every month, were reported. Prescriptions that do not adhere to these indicators are potentially hazardous and can cause gastrointestinal bleeds; are cautioned against in specific conditions (specifically heart failure, asthma, and chronic renal failure); or require blood test monitoring. The percentage for each indicator is formed of a numerator of patients deemed to be at risk of a potentially hazardous prescribing event and the denominator is of patients for which assessment of the indicator is clinically meaningful. Higher indicator percentages represent potentially poorer performance on medication safety. RESULTS: The PINCER indicators were successfully implemented across general practice data for 56.8 million patient records from 6367 practices in OpenSAFELY. Hazardous prescribing remained largely unchanged during the covid-19 pandemic, with no evidence of increases in indicators of harm as captured by the PINCER indicators. The percentage of patients at risk of potentially hazardous prescribing, as defined by each PINCER indicator, at mean quarter 1 (Q1) 2020 (representing before the pandemic) ranged from 1.11% (age ≥65 years and non-steroidal anti-inflammatory drugs) to 36.20% (amiodarone and no thyroid function test), while Q1 2021 (representing after the pandemic) percentages ranged from 0.75% (age ≥65 years and non-steroidal anti-inflammatory drugs) to 39.23% (amiodarone and no thyroid function test). Transient delays occurred in blood test monitoring for some medications, particularly angiotensin-converting enzyme inhibitors (where blood monitoring worsened from a mean of 5.16% in Q1 2020 to 12.14% in Q1 2021, and began to recover in June 2021). All indicators substantially recovered by September 2021. We identified 1 813 058 patients (3.1%) at risk of at least one potentially hazardous prescribing event. CONCLUSION: NHS data from general practices can be analysed at national scale to generate insights into service delivery. Potentially hazardous prescribing was largely unaffected by the covid-19 pandemic in primary care health records in England.
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spelling pubmed-102546922023-06-10 Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics Fisher, Louis Hopcroft, Lisa EM Rodgers, Sarah Barrett, James Oliver, Kerry Avery, Anthony J Evans, Dai Curtis, Helen Croker, Richard Macdonald, Orla Morley, Jessica Mehrkar, Amir Bacon, Sebastian Davy, Simon Dillingham, Iain Evans, David Hickman, George Inglesby, Peter Morton, Caroline E Smith, Becky Ward, Tom Hulme, William Green, Amelia Massey, Jon Walker, Alex J Bates, Christopher Cockburn, Jonathan Parry, John Hester, Frank Harper, Sam O’Hanlon, Shaun Eavis, Alex Jarvis, Richard Avramov, Dima Griffiths, Paul Fowles, Aaron Parkes, Nasreen Goldacre, Ben MacKenna, Brian BMJ Med Original Research OBJECTIVE: To implement complex, PINCER (pharmacist led information technology intervention) prescribing indicators, on a national scale with general practice data to describe the impact of the covid-19 pandemic on safe prescribing. DESIGN: Population based, retrospective cohort study using federated analytics. SETTING: Electronic general practice health record data from 56.8 million NHS patients by use of the OpenSAFELY platform, with the approval of the National Health Service (NHS) England. PARTICIPANTS: NHS patients (aged 18-120 years) who were alive and registered at a general practice that used TPP or EMIS computer systems and were recorded as at risk of at least one potentially hazardous PINCER indicator. MAIN OUTCOME MEASURE: Between 1 September 2019 and 1 September 2021, monthly trends and between practice variation for compliance with 13 PINCER indicators, as calculated on the first of every month, were reported. Prescriptions that do not adhere to these indicators are potentially hazardous and can cause gastrointestinal bleeds; are cautioned against in specific conditions (specifically heart failure, asthma, and chronic renal failure); or require blood test monitoring. The percentage for each indicator is formed of a numerator of patients deemed to be at risk of a potentially hazardous prescribing event and the denominator is of patients for which assessment of the indicator is clinically meaningful. Higher indicator percentages represent potentially poorer performance on medication safety. RESULTS: The PINCER indicators were successfully implemented across general practice data for 56.8 million patient records from 6367 practices in OpenSAFELY. Hazardous prescribing remained largely unchanged during the covid-19 pandemic, with no evidence of increases in indicators of harm as captured by the PINCER indicators. The percentage of patients at risk of potentially hazardous prescribing, as defined by each PINCER indicator, at mean quarter 1 (Q1) 2020 (representing before the pandemic) ranged from 1.11% (age ≥65 years and non-steroidal anti-inflammatory drugs) to 36.20% (amiodarone and no thyroid function test), while Q1 2021 (representing after the pandemic) percentages ranged from 0.75% (age ≥65 years and non-steroidal anti-inflammatory drugs) to 39.23% (amiodarone and no thyroid function test). Transient delays occurred in blood test monitoring for some medications, particularly angiotensin-converting enzyme inhibitors (where blood monitoring worsened from a mean of 5.16% in Q1 2020 to 12.14% in Q1 2021, and began to recover in June 2021). All indicators substantially recovered by September 2021. We identified 1 813 058 patients (3.1%) at risk of at least one potentially hazardous prescribing event. CONCLUSION: NHS data from general practices can be analysed at national scale to generate insights into service delivery. Potentially hazardous prescribing was largely unaffected by the covid-19 pandemic in primary care health records in England. BMJ Publishing Group 2023-05-11 /pmc/articles/PMC10254692/ /pubmed/37303488 http://dx.doi.org/10.1136/bmjmed-2022-000392 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Fisher, Louis
Hopcroft, Lisa EM
Rodgers, Sarah
Barrett, James
Oliver, Kerry
Avery, Anthony J
Evans, Dai
Curtis, Helen
Croker, Richard
Macdonald, Orla
Morley, Jessica
Mehrkar, Amir
Bacon, Sebastian
Davy, Simon
Dillingham, Iain
Evans, David
Hickman, George
Inglesby, Peter
Morton, Caroline E
Smith, Becky
Ward, Tom
Hulme, William
Green, Amelia
Massey, Jon
Walker, Alex J
Bates, Christopher
Cockburn, Jonathan
Parry, John
Hester, Frank
Harper, Sam
O’Hanlon, Shaun
Eavis, Alex
Jarvis, Richard
Avramov, Dima
Griffiths, Paul
Fowles, Aaron
Parkes, Nasreen
Goldacre, Ben
MacKenna, Brian
Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics
title Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics
title_full Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics
title_fullStr Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics
title_full_unstemmed Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics
title_short Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics
title_sort changes in medication safety indicators in england throughout the covid-19 pandemic using opensafely: population based, retrospective cohort study of 57 million patients using federated analytics
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10254692/
https://www.ncbi.nlm.nih.gov/pubmed/37303488
http://dx.doi.org/10.1136/bmjmed-2022-000392
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