Evaluating the safety of mental health-related prescribing in UK primary care : a cross-sectional study using the Clinical Practice Research Datalink (CPRD)
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: Most patients with mental illness are managed in primary care, yet there is a lack of data exploring potential prescribing safety issues in this setting for this population.
OBJECTIVES: Examine the prevalence of, between-practice variation in, and patient and practice-level risk factors for, 18 mental health-related potentially hazardous prescribing indicators and four inadequate medication monitoring indicators in UK primary care.
METHOD: Cross-sectional analyses of routinely collected electronic health records from 361 practices contributing to Clinical Practice Research Datalink GOLD database. The proportion of patients 'at risk' (based on an existing diagnosis, medication, age and/or sex) triggering each indicator and composite indicator was calculated. To examine between-practice variation, intraclass correlation coefficient (ICC) and median OR (MOR) were estimated using two-level logistic regression models. The relationship between patient and practice characteristics and risk of triggering composites including 16 of the 18 prescribing indicators and four monitoring indicators were assessed using multilevel logistic regression.
RESULTS: 9.4% of patients 'at risk' (151 469 of 1 611 129) triggered at least one potentially hazardous prescribing indicator; between practices this ranged from 3.2% to 24.1% (ICC 0.03, MOR 1.22). For inadequate monitoring, 90.2% of patients 'at risk' (38 671 of 42 879) triggered at least one indicator; between practices this ranged from 33.3% to 100% (ICC 0.26, MOR 2.86). Patients aged 35-44, females and those receiving more than 10 repeat prescriptions were at greatest risk of triggering a prescribing indicator. Patients aged less than 25, females and those with one or no repeat prescription were at greatest risk of triggering a monitoring indicator.
CONCLUSION: Potentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators. These findings support health providers to identify improvement targets and inform development of improvement efforts to reduce medication-related harm.
| Errataetall: |
CommentIn: BMJ Qual Saf. 2022 May;31(5):337-339. - PMID 34556544 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
BMJ quality & safety - 31(2022), 5 vom: 28. Mai, Seite 364-378 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Khawagi, Wael Y [VerfasserIn] |
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| Links: |
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Journal Article |
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| Anmerkungen: |
Date Completed 21.04.2022 Date Revised 16.07.2022 published: Print-Electronic CommentIn: BMJ Qual Saf. 2022 May;31(5):337-339. - PMID 34556544 Citation Status MEDLINE |
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| doi: |
10.1136/bmjqs-2021-013427 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM329768441 |
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| 245 | 1 | 0 | |a Evaluating the safety of mental health-related prescribing in UK primary care |b a cross-sectional study using the Clinical Practice Research Datalink (CPRD) |
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| 500 | |a Date Revised 16.07.2022 | ||
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| 500 | |a CommentIn: BMJ Qual Saf. 2022 May;31(5):337-339. - PMID 34556544 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: Most patients with mental illness are managed in primary care, yet there is a lack of data exploring potential prescribing safety issues in this setting for this population | ||
| 520 | |a OBJECTIVES: Examine the prevalence of, between-practice variation in, and patient and practice-level risk factors for, 18 mental health-related potentially hazardous prescribing indicators and four inadequate medication monitoring indicators in UK primary care | ||
| 520 | |a METHOD: Cross-sectional analyses of routinely collected electronic health records from 361 practices contributing to Clinical Practice Research Datalink GOLD database. The proportion of patients 'at risk' (based on an existing diagnosis, medication, age and/or sex) triggering each indicator and composite indicator was calculated. To examine between-practice variation, intraclass correlation coefficient (ICC) and median OR (MOR) were estimated using two-level logistic regression models. The relationship between patient and practice characteristics and risk of triggering composites including 16 of the 18 prescribing indicators and four monitoring indicators were assessed using multilevel logistic regression | ||
| 520 | |a RESULTS: 9.4% of patients 'at risk' (151 469 of 1 611 129) triggered at least one potentially hazardous prescribing indicator; between practices this ranged from 3.2% to 24.1% (ICC 0.03, MOR 1.22). For inadequate monitoring, 90.2% of patients 'at risk' (38 671 of 42 879) triggered at least one indicator; between practices this ranged from 33.3% to 100% (ICC 0.26, MOR 2.86). Patients aged 35-44, females and those receiving more than 10 repeat prescriptions were at greatest risk of triggering a prescribing indicator. Patients aged less than 25, females and those with one or no repeat prescription were at greatest risk of triggering a monitoring indicator | ||
| 520 | |a CONCLUSION: Potentially hazardous prescribing and inadequate medication monitoring commonly affect patients with mental illness in primary care, with marked between-practice variation for some indicators. These findings support health providers to identify improvement targets and inform development of improvement efforts to reduce medication-related harm | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a measurement/epidemiology | |
| 650 | 4 | |a medical error | |
| 650 | 4 | |a medication safety | |
| 650 | 4 | |a mental health | |
| 650 | 4 | |a primary care | |
| 650 | 4 | |a quality measurement | |
| 700 | 1 | |a Steinke, Douglas |e verfasserin |4 aut | |
| 700 | 1 | |a Carr, Matthew J |e verfasserin |4 aut | |
| 700 | 1 | |a Wright, Alison K |e verfasserin |4 aut | |
| 700 | 1 | |a Ashcroft, Darren M |e verfasserin |4 aut | |
| 700 | 1 | |a Avery, Anthony |e verfasserin |4 aut | |
| 700 | 1 | |a Keers, Richard Neil |e verfasserin |4 aut | |
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