Evaluating the safety of mental health-related prescribing in UK primary care: a cross-sectional study using the Clinical Practice Research Datalink (CPRD)

被引：3

作者：

Khawagi, Wael Y. ^{[1
,2
]}

Steinke, Douglas ^{[1
,3
]}

Carr, Matthew J. ^{[1
,4
]}

Wright, Alison K. ^{[1
,3
]}

Ashcroft, Darren M. ^{[1
,4
]}

Avery, Anthony ^{[4
,5
]}

Keers, Richard Neil ^{[1
,6
]}

机构：

[1] Univ Manchester, Fac Biol Med & Hlth, Ctr Pharmacoepidemiol & Drug Safety, Sch Hlth Sci,Div Pharm & Optometry, Manchester, Lancs, England

[2] Taif Univ, Coll Pharm, Dept Clin Pharm, At Taif, Saudi Arabia

[3] Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England

[4] Univ Manchester, Fac Biol Med & Hlth, NIHR Greater Manchester Patient Safety Translat R, Manchester, Lancs, England

[5] Univ Nottingham, Fac Med & Hlth Sci, Sch Med, Div Primary Care, Nottingham, England

[6] Greater Manchester Mental Hlth NHS Fdn Trust, Pharm Dept, Manchester, Lancs, England

来源：

BMJ QUALITY & SAFETY | 2022年 / 31卷 / 05期

关键词：

mental health; medication safety; medical error; measurement; epidemiology; primary care; quality measurement; ADVERSE DRUG EVENTS; MEDICATION ERRORS; QUALITY; TRENDS; TRIAL; INTERVENTION; COSTS; RISK;

D O I：

10.1136/bmjqs-2021-013427

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

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.

引用

页码：364 / 378

页数：15

共 72 条

[1] Primary Care Medication Safety Surveillance with Integrated Primary and Secondary Care Electronic Health Records: A Cross-Sectional Study [J].