Stocks S Jill, Kontopantelis Evangelos, Akbarov Artur, Rodgers Sarah, Avery Anthony J, Ashcroft Darren M
NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK.
BMJ. 2015 Nov 3;351:h5501. doi: 10.1136/bmj.h5501.
What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?
A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin.
49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices-for example, INR results in patients receiving warfarin.
The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention.
FUNDING, COMPETING INTERESTS, DATA SHARING: National Institute for Health Research through the Greater Manchester Primary Care Patient Safety Translational Research Centre (grant No GMPSTRC-2012-1). Data from CPRD cannot be shared because of licensing restrictions.
在英国的全科医疗中，不同类型的潜在危险处方的流行情况如何，各医疗机构之间有何差异？
一项横断面研究纳入了截至2013年4月1日向临床实践研究数据链（CPRD）提供数据的526家全科医疗机构中，所有因诊断和处方组合而存在处方或监测错误潜在风险的成年患者。主要结局指标为抗凝剂、抗血小板药物、非甾体抗炎药、β受体阻滞剂、格列酮类药物、二甲双胍、地高辛、抗精神病药物、复方激素避孕药、雌激素的潜在危险处方的流行情况，以及对于重复开具血管紧张素转换酶抑制剂和袢利尿剂、胺碘酮、甲氨蝶呤、锂盐或华法林的患者，血液检测监测频率低于推荐频率的情况。
在949552名有风险的患者中，49927名触发了至少一项处方指标（5.26%，95%置信区间5.21%至5.30%），在182721名患者中，21501名触发了至少一项监测指标（11.8%，11.6%至11.9%）。不同类型的潜在危险处方的流行率从几乎为零到10.2%不等，监测不足的流行率从10.4%到41.9%不等。老年患者和开具多种重复用药的患者触发处方指标的风险显著更高，而重复处方较少的年轻患者触发监测指标的风险显著更高。某些指标在各医疗机构之间存在很大差异。尽管处方安全指标描述了可能增加患者伤害风险且通常应避免的处方模式，但在某些临床合理的情况下总会有例外。此外，对于某些医疗机构，CPRD可能未获取某些信息，例如接受华法林治疗患者的国际标准化比值（INR）结果。
某些指标的高流行率强调了现有的处方风险以及在初级保健中对其进行适当考量的必要性，特别是对于老年患者和服用多种药物的患者。各医疗机构之间的巨大差异表明通过有针对性的机构层面干预有改善的潜力。
资金、竞争利益、数据共享：由英国国家卫生研究院通过大曼彻斯特初级保健患者安全转化研究中心提供资金（资助编号GMPSTRC - 2012 - 1）。由于许可限制，无法共享来自CPRD的数据。
