Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink

BackgroundWorkload in general practice has risen during the last decade, but the factors associated with this increase are unclear.AimTo examine factors associated with consultation rates in general practice.Design and settingA cross-sectional study examining a sample of 304 937 patients registered at 316 English practices between 2013 and 2014, drawn from the Clinical Practice Research Datalink.MethodAge, sex, ethnicity, smoking status, and deprivation measures were linked with practice-level data on staffing, rurality, training practice status, and Quality and Outcomes Framework performance. Multilevel analyses of patient consultation rates were conducted.ResultsConsultations were grouped into three types: all (GP or nurse), GP, and nurse. Non-smokers consulted less than current smokers (all: rate ratio [RR] = 0.88, 95% CI = 0.87 to 0.89; GP: RR = 0.88, 95% CI = 0.87 to 0.89; nurse: RR = 0.91, 95% CI = 0.90 to 0.92). Consultation rates were higher for those in the most deprived quintile compared with the least deprived quintile (all: RR = 1.18, 95% CI = 1.16 to 1.19; GP: RR = 1.17, 95% CI = 1.15 to 1.19; nurse: RR = 1.13, 95% CI = 1.11 to 1.15). For all three consultation types, consultation rates increased with age and female sex, and varied by ethnicity. Rates in practices with >8 and ≤19 full-time equivalent (FTE) GPs were higher compared with those with ≤2 FTE GPs (all: RR = 1.26, 95% CI = 1.06 to 1.49; GP: RR = 1.36, 95% CI = 1.19 to 1.56).ConclusionThe analyses show consistent trends in factors related to consultation rates in general practice across three types of consultation. These data can be used to inform the development of more sophisticated staffing models, and resource allocation formulae.

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Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study

British Journal of General Practice ◽

10.3399/bjgp18x700457 ◽

2018 ◽

Vol 69 (678) ◽

pp. e42-e51 ◽

Cited By ~ 7

Author(s):

Yan Li ◽

Anna Mölter ◽

Andrew White ◽

William Welfare ◽

Victoria Palin ◽

...

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Antibiotic Prescribing ◽

Sectional Study ◽

Prescribing Practices ◽

Cross Sectional ◽

General Practices ◽

The Uk

BackgroundHigh levels of antibiotic prescribing are a major concern as they drive antimicrobial resistance. It is currently unknown whether practices that prescribe higher levels of antibiotics also prescribe more medicines in general.AimTo evaluate the relationship between antibiotic and general prescribing levels in primary care.Design and settingCross-sectional study in 2014–2015 of 6517 general practices in England using NHS digital practice prescribing data (NHS-DPPD) for the main study, and of 587 general practices in the UK using the Clinical Practice Research Datalink for a replication study.MethodLinear regression to assess determinants of antibiotic prescribing.ResultsNHS-DPPD practices prescribed an average of 576.1 antibiotics per 1000 patients per year (329.9 at the 5th percentile and 808.7 at the 95th percentile). The levels of prescribing of antibiotics and other medicines were strongly correlated. Practices with high levels of prescribing of other medicines (a rate of 27 159.8 at the 95th percentile) prescribed 80% more antibiotics than low-prescribing practices (rate of 8815.9 at the 5th percentile). After adjustment, NHS-DPPD practices with high prescribing of other medicines gave 60% more antibiotic prescriptions than low-prescribing practices (corresponding to higher prescribing of 276.3 antibiotics per 1000 patients per year). Prescribing of non-opioid painkillers and benzodiazepines were also strong indicators of the level of antibiotic prescribing. General prescribing levels were a much stronger driver for antibiotic prescribing than other risk factors, such as deprivation.ConclusionThe propensity of GPs to prescribe medications generally is an important driver for antibiotic prescribing. Interventions that aim to optimise antibiotic prescribing will need to target general prescribing behaviours, in addition to specifically targeting antibiotics.

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Measuring the complexity of general practice consultations: development and validation of a complexity measure

British Journal of General Practice ◽

10.3399/bjgp.2020.0486 ◽

2020 ◽

pp. BJGP.2020.0486

Author(s):

Chris Salisbury ◽

Sarah Lay-Flurrie ◽

Clare Bankhead ◽

Alice Fuller ◽

Mairead Murphy ◽

...

Keyword(s):

General Practice ◽

Delphi Study ◽

Cross Sectional Study ◽

Complexity Measure ◽

Research Management ◽

Clinical Practice Research Datalink ◽

Delphi Panel ◽

Sectional Study ◽

Cross Sectional ◽

The Cross

Background: The complexity of general practice consultations may be increasing and vary in different settings. Testing these hypotheses requires a measure of complexity. Aim: To develop a valid measure of general practice consultation complexity applicable to routine medical records. Design: Delphi study to select potential indicators of complexity followed by cross-sectional study to develop and validate a complexity measure. Setting: English general practices. Method: An online Delphi study over two rounds involved 32 general practitioners to identify potential indicators of consultation complexity. The cross-sectional study used an age-sex stratified random sample of 173,130 patients and 725,616 general practice face-to-face consultations from 2013/14 in the Clinical Practice Research Datalink. We explored independent relationships between each indicator and consultation duration using mixed effects regression models, and revalidated findings using data from 2017/18. We assessed the proportion of complex consultations in different age-sex groups. Results: After two rounds, the Delphi panel endorsed 34 of 45 possible complexity indicators. In the cross-sectional study, after excluding factors because of low prevalence or confounding, 17 indicators were retained. Defining complexity as the presence of any of these factors, 308,370 consultations (42.5%) were complex. Mean duration of complex consultations was 10.49 minutes, compared to 9.64 minutes for non-complex consultations. The proportion of complex consultations was similar in men and women but increased with age. Conclusion: Our consultation complexity measure has face and construct validity. It may be useful for research, management and policy, informing decisions about the range of resources needed in different practices.

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Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

BMJ Open ◽

10.1136/bmjopen-2020-039625 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039625

Author(s):

Jason I Chiang ◽

John Furler ◽

Frances Mair ◽

Bhautesh D Jani ◽

Barbara I Nicholl ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Linear Regression Models ◽

Sectional Study ◽

Cross Sectional ◽

Long Term Conditions ◽

Australian General Practice

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

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Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

BMJ ◽

10.1136/bmj.j84 ◽

2017 ◽

pp. j84 ◽

Cited By ~ 108

Author(s):

Isaac Barker ◽

Adam Steventon ◽

Sarah R Deeny

Keyword(s):

General Practice ◽

Ambulatory Care ◽

Continuity Of Care ◽

Hospital Admissions ◽

Cross Sectional Study ◽

Ambulatory Care Sensitive Conditions ◽

Sectional Study ◽

Cross Sectional ◽

Level Data ◽

Ambulatory Care Sensitive

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A cross-sectional study reporting concussion exposure, assessment and management in Western Australian general practice

BMC Family Practice ◽

10.1186/s12875-021-01384-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Elizabeth Thomas ◽

HuiJun Chih ◽

Belinda Gabbe ◽

Melinda Fitzgerald ◽

Gill Cowen

Keyword(s):

General Practice ◽

Cross Sectional Study ◽

Limited Information ◽

Sectional Study ◽

Cross Sectional ◽

Usual Practice ◽

Exact Test ◽

Concussion Management ◽

Practice Knowledge ◽

Western Australian

Abstract Background General Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment. Information relating to how concussion is actually being assessed and managed in General Practice is scarce. This study aimed to identify characteristics of current Western Australian (WA) GP exposure to patients with concussion, factors associated with GPs’ knowledge of concussion, confidence of GPs in diagnosing and managing patients with concussion, typical referral practices and familiarity of GPs with guidelines. Methods In this cross-sectional study, GPs in WA were recruited via the RACGP WA newsletter and shareGP and the consented GPs completed an electronic survey. Associations were performed using Chi-squared tests or Fisher’s Exact test. Results Sixty-six GPs in WA responded to the survey (response rate = 1.7%). Demographics, usual practice, knowledge, confidence, identification of prolonged recovery as well as guideline and resource awareness of GPs who practised in regional and metropolitan areas were comparable (p > 0.05). Characteristics of GPs were similar between those who identified all symptoms of concussion and distractors correctly and those who did not (p > 0.05). However, 84% of the respondents who had never heard of concussion guidelines were less likely to answer all symptoms and distractors correctly (p = 0.039). Whilst 78% of the GPs who were confident in their diagnoses had heard of guidelines (p = 0.029), confidence in managing concussion was not significantly associated with GPs exposure to guidelines. It should be noted that none of the respondents correctly identified signs of concussion and excluded the distractors. Conclusions Knowledge surrounding concussion guidelines, diagnosis and management varied across GPs in WA. Promotion of available concussion guidelines may assist GPs who lack confidence in making a diagnosis. The lack of association between GPs exposure to guidelines and confidence managing concussion highlights that concussion management may be an area where GPs could benefit from additional education and support.

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