Dataset Information

High-risk prescribing in an Irish primary care population: trends and variation.

ABSTRACT:

Aims

The aims of the present study were to examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and the variation in HRP between general practitioners (GPs) and in the dispensing of high-risk prescriptions between pharmacies.

Methods

A repeated cross-sectional national pharmacy claims database study was conducted. Prescribing indicators were based on those developed in formal consensus studies and applicable to pharmacy claims data. Multilevel logistic regression was used to examine factors associated with HRP and dispensing.

Results

There were significant reductions in the rates of most indicators over time (P < 0.001). A total of 66?022 of 300?906 patients at risk in 2011 [21.9%, 95% confidence interval (CI) 21.8, 22.1%], and 42?109 of 278?469 in 2015 (15.1%, 95% CI 15.0, 15.3%), received ?1 high-risk prescription (P < 0.001). In 2015, indicators with the highest rates of HRP were prescription of a nonsteroidal anti-inflammatory drug (NSAID) without gastroprotection in those ?75 years (37.2% of those on NSAIDs), coprescription of warfarin and an antiplatelet agent or high-risk antibiotic (19.5% and 16.2% of those on warfarin, respectively) and prescription of digoxin ?250 ?g day^-1 in those ?65 years (14.0% of those on digoxin). Any HRP increased significantly with age and number of chronic medications (P < 0.001). a) After controlling for patient variables, the variation in the rate of HRP between GPs was significant (P < 0.05); and b) after controlling for patient variables and the prescribing GP, the variation in the rate of dispensing of high-risk prescriptions between pharmacies was significant (P < 0.05).

Conclusions

HRP in Ireland has declined over time, although some indicators persist. The variation between GPs and pharmacies suggests the potential for improvement in safe medicines use in community care, particularly in vulnerable older populations.

SUBMITTER: Byrne CJ

PROVIDER: S-EPMC5698567 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Publications

High-risk prescribing in an Irish primary care population: trends and variation.

Byrne Catherine J CJ Cahir Caitriona C Curran Carmel C Bennett Kathleen K

British journal of clinical pharmacology 20170816 12

<h4>Aims</h4>The aims of the present study were to examine the prevalence of high-risk prescribing (HRP) in community-dwelling adults in Ireland from 2011-2015 using consensus-validated indicators, factors associated with HRP, and the variation in HRP between general practitioners (GPs) and in the dispensing of high-risk prescriptions between pharmacies.<h4>Methods</h4>A repeated cross-sectional national pharmacy claims database study was conducted. Prescribing indicators were based on those dev ...[more]

PMID: 28701029

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Project description:OBJECTIVE:Urinary tract infections (UTIs) are an important reason to consult a general practitioner (GP). Here, we describe antimicrobial drug prescribing patterns for UTIs by GPs in relation to the Dutch primary care guidelines. METHODS:We conducted a population-based cohort study in the Dutch Integrated Primary Care Information (IPCI)database, which encompasses approximately 2.5 million patients. All patients aged ≥12 years with at least 1 year of follow-up from 1996 to 2014 were extracted from the database. The number of prescriptions and choice of drug type were investigated over time and in different age categories. The choice of antimicrobial drug classes for UTIs and the duration of nitrofurantoin use in women were compared with the Dutch primary care guidelines of 1989, 1999, 2005 and 2013. RESULTS:The source population comprised 1 755 085 patients who received 2 019 335 antimicrobial drug prescriptions; 401 655 (35.1%) prescriptions were for UTIs (45.2% in women and 12.6% in men). The proportion of prescriptions for UTIs within all prescriptions with an indication code increased from 5.2% in 1996 to 14% in 2014 in men and from 28% in 1996 to 50% in 2014 in women. In men, UTIs were most frequently treated with fluoroquinolones during the entire study period, whereas fluoroquinolones were only advised as first choice in the latest guideline of 2013. In women, UTIs were increasingly (p<0.05) treated with nitrofuran derivatives with a statistically significant difference after implementation of the guideline of 2005. Compliance to the advised duration of nitrofurantoin prescriptions in women has increased since the guideline of 2005. CONCLUSIONS:Antimicrobial drug prescribing for UTIs seemed to have increased over time. Prescribing in line with the UTI guidelines increased with regard to choice and duration of antimicrobial drugs. We showed that databases like IPCI, in which prescription and indication are monitored, can be valuable antibiotic stewardship tools.

Dataset Information

High-risk prescribing in an Irish primary care population: trends and variation.

Aims

Methods

Results

Conclusions

Publications

High-risk prescribing in an Irish primary care population: trends and variation.

Similar Datasets

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