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Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records
Helen P Booth, Arlene M Gallagher, David Mullett, Lucy Carty, Shivani Padmanabhan, Puja R Myles, Stephen J Welburn, Matthew Hoghton, Imran Rafi and Janet Valentine
British Journal of General Practice 2019; 69 (686): e605-e611. DOI: https://doi.org/10.3399/bjgp19X704597
Helen P Booth
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
PhDRoles: Senior researcher
Arlene M Gallagher
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
BSc, MScRoles: Senior researcher
David Mullett
Royal College of General Practitioners, London.
MA (Oxon)Roles: Champion for quality improvement and patient safety
Lucy Carty
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
PhDRoles: Science writer
Shivani Padmanabhan
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
MScRoles: Technical research analyst
Puja R Myles
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
BDS, PhD, MPH, FFPH, PGCHERoles: Head of observational research
Stephen J Welburn
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
PhDRoles: Technical applications manager
Matthew Hoghton
Royal College of General Practitioners, London.
FRCP, MRCGPRoles: Co-medical director
Imran Rafi
Royal College of General Practitioners, London.
BSc, MSc, MSt, PhD, FRCP, FRCGP, DFMSRoles: Co-medical director
Janet Valentine
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, London.
BSc(Hons), PhDRoles: Director
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- Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health recordsSam Kosari, Louise S. Deeks, John Goss and Mark NauntonPublished on: 09 August 2019
- Published on: (9 August 2019)Page navigation anchor for Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health recordsQuality improvement of prescribing safety: a pilot study in primary care using UK electronic health records
- Sam Kosari, Pharmacist lecturer, University of Canberra
- Other Contributors:
- Louise S. Deeks, Pharmacist researcher, University of Canberra
- John Goss, Health economist, University of Canberra
- Mark Naunton, Professor of Pharmac, University of Canberra
We read with interest the pilot study which investigated using electronic health records for quality improvement of prescribing safety.1 We agree that pharmacistsin general practice could have an important role in actioning reports from electronic health records. We look forward to the impact evaluation which will assess alterations in prescribing because of this initiative.Show MoreIn addition to identifying potentially unsafe prescribing,...We read with interest the pilot study which investigated using electronic health records for quality improvement of prescribing safety.1 We agree that pharmacistsin general practice could have an important role in actioning reports from electronic health records. We look forward to the impact evaluation which will assess alterations in prescribing because of this initiative.In addition to identifying potentially unsafe prescribing,interrogation of electronic health records can also be used to identify patients whoare not prescribed appropriate medication for their condition, therefore are at risk of harm through untreated disease. We have previously reported about the activities of general practice pharmacists in Canberra, Australia,2 one of whom conducted an audit using electronic health records to identify patients diagnosed with atrial fibrillation (AF) in a single general practice during 2016. Three patientswere subsequently prescribed an oral anticoagulant to reduce the risk of thromboembolic stroke. The potential cost-benefits of this AF interventionwere estimated in Australian dollars using values from a meta-analysis by Hart et al.3 in which warfarin therapy (vs placebo) reduced stroke by 62% (48% - 72%) and all-cause mortality by 26% (4% - 43%); so, ifthese three patients had been treated with warfarin, this would have saved these patients 1.38 years of life and prevented 0.56 strokes over 5 years. The total value of the intervention (including the life year saved and health system cost savings minus the cost involved in prescribing and monitoring warfarin) resulted from pharmacist activities,was estimated to be $157,360 ($28,620 - $244,310) over 5 years4-7 adjusted to2016 value when the intervention occurred) .Sincethis cost estimation was conducted , direct acting oral anticoagulants (DOACs) have emerged as the effective and safe alternative to warfarinfor prevention of thromboembolic stroke.8 If the DOAC apixabanbeen used in the estimation as this is a cost-effective DOAC with evidence to prevent more strokes than warfarin in patients with AF9 then this value would have been higher.Our findings, support the regular interrogation of general practice electronic health records, not only to improve patient safety but to contribute to the sustainability of health provision.References1. Booth HP, Gallagher AM, Mullett D, et al. Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records. Br J GenPract 1 July 2019;bjgp19X704597 . DOI: https://doi.org/10.3399/bjgp19X704597.2. Deeks LS, Naunton M, Tay GH, et al. What can pharmacists doin general practice? Activities of pharmacists within general practice: A pilot. Aust J GenPract 2018; 47(8): 545-549.doi : 10.31128/AJGP-03-18-4520.3. Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic Therapy to Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis. Ann Intern Med 1999; 131:492-501.4. Department of the Prime Minister and Cabinet (Office of Best Practice Regulation 2014). Best Practice Regulation Guidance Note, 'Value of Statistical Life', [cited 15th July 2019]; Available from www. dpmc . gov. au /sites/default/files/publications/Value_of_Statistical_Life_guidance_note .pdf.5. Department of Health and Ageing (Australian Government) 2012 Review of Anticoagulant Therapies in Atrial Fibrillation [cited 5thAugust, 2019 ]; Available from www. pbs . gov. au /reviews/atrial-fibrillation-files/issues-and-options-paper.pdf.6. Price Waterhouse Coopers 2010. The Economic Costs of Atrial Fibrillation in Australia. [cited 5th August 2019]; Available from www. hps .com. au /wp -content/uploads/2016/10/Economic-costs-of-atrial-fibrillation-in-Australia.pdf.7. Calculated by the author from Australian Institute of Health and Welfare 2014. Health-care expenditure on cardiovascular diseases 2008–09. Cat. no. CVD 65. Canberra: AIHW and Australian Institute of Health and Welfare 2014. Cardiovascular disease, diabetes and chronic kidney disease - Australian facts: Prevalence and incidence. Cardiovascular, diabetes and chronic kidney disease series no. 2. Cat. no. CDK 2. Canberra: AIHW. Australian Institute of Health and Welfare.8. Ademi Z,Pasupathi K, Liew D. Cost-effectiveness of apixaban compared to warfarin in the management of atrial fibrillation in Australia. Eur JPrev Cardiol 2015; 22(3):344-53.doi : 10.1177/2047487313514019.9. López-López JA, Sterne JAC, Thom HHZ,et al Oral anticoagulantsfor prevention of stroke in atrial fibrillation:systematic review, network meta-analysis, and cost effectiveness analysis. BMJ. 2017; 28: 359: j5058.doi : 10.1136/bmj . j5058.Competing Interests: None declared.
In this issue
British Journal of General Practice
Vol. 69, Issue 686
September 2019
Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records
Helen P Booth, Arlene M Gallagher, David Mullett, Lucy Carty, Shivani Padmanabhan, Puja R Myles, Stephen J Welburn, Matthew Hoghton, Imran Rafi, Janet Valentine
British Journal of General Practice 2019; 69 (686): e605-e611. DOI: 10.3399/bjgp19X704597
Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records
Helen P Booth, Arlene M Gallagher, David Mullett, Lucy Carty, Shivani Padmanabhan, Puja R Myles, Stephen J Welburn, Matthew Hoghton, Imran Rafi, Janet Valentine
British Journal of General Practice 2019; 69 (686): e605-e611. DOI: 10.3399/bjgp19X704597
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