Changes in English medication safety indicators throughout the COVID-19 pandemic: a federated analysis of 57 million patients’ primary care records in situ using OpenSAFELY

Changes in English medication safety indicators throughout the COVID-19 pandemic: a federated analysis of 57 million patients’ primary care records in situ using OpenSAFELY

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How to cite: Changes in English medication safety indicators throughout the COVID-19 pandemic: a federated analysis of 57 million patients’ primary care records in situ using OpenSAFELY. Louis Fisher, Lisa E. M. Hopcroft, Sarah Rodgers, James Barrett, Kerry Oliver, Anthony J. Avery, Dai Evans, Helen Curtis, Richard Croker, Orla Macdonald, Jessica Morley, Amir Mehrkar, Seb Bacon, Simon Davy, Iain Dillingham, David Evans, George Hickman, Peter Inglesby, Caroline E. Morton, Becky Smith, Tom Ward, William Hulme, Amelia Green, Jon Massey, Alex J. Walker, Chris Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Shaun O’Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Ben Goldacre, Brian MacKenna. medRxiv 2022.05.05.22273234; doi: https://doi.org/10.1101/2022.05.05.22273234

Abstract

Background:

Primary care services have been substantially disrupted during the COVID-19 pandemic. PINCER is a nationally adopted programme of activities that aims to identify and correct hazardous prescribing in GP practices by measuring compliance with various patient safety metrics in each practice’s NHS electronic health record data, and providing structured feedback and support to clinicians to address any identified issues.

Methods:

We used all relevant codes from SNOMED-CT and the NHS Dictionary of Medicines and Devices to implement the PINCER measures in the primary care electronic health records of all patients in all practices using electronic health record software provided by TPP and EMIS (approximately 95% of the population of England) using the OpenSAFELY tools, with the permission of NHS England. We report trends and between-practice variation for compliance with all PINCER measures between September 2019 and September 2021 using decile charts.

Results:

The indicators were successfully implemented across GP data in OpenSAFELY. Hazardous prescribing remained largely unchanged during the COVID-19 pandemic, with only small reductions in achievement of the PINCER indicators. There were transient delays in blood test monitoring for some medications, particularly ACE inhibitors. All indicators exhibited substantial recovery by September 2021. We identified 1,813,058 patients at risk of at least one hazardous prescribing event.

Conclusions:

Good performance was maintained during the COVID-19 pandemic across a diverse range of widely evaluated measures of safe prescribing.