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

  1. Louis Fisher
  2. Lisa E. M. Hopcroft
  3. Sarah Rodgers
  4. James Barrett
  5. Kerry Oliver
  6. Anthony J. Avery
  7. Dai Evans
  8. Helen Curtis
  9. Richard Croker
  10. Orla Macdonald
  11. Jessica Morley
  12. Amir Mehrkar
  13. Seb Bacon
  14. Simon Davy
  15. Iain Dillingham
  16. David Evans
  17. George Hickman
  18. Peter Inglesby
  19. Caroline E. Morton
  20. Becky Smith
  21. Tom Ward
  22. William Hulme
  23. Amelia Green
  24. Jon Massey
  25. Alex J. Walker
  26. Chris Bates
  27. Jonathan Cockburn
  28. John Parry
  29. Frank Hester
  30. Sam Harper
  31. Shaun O’Hanlon
  32. Alex Eavis
  33. Richard Jarvis
  34. Dima Avramov
  35. Paul Griffiths
  36. Aaron Fowles
  37. Nasreen Parkes
  38. Ben Goldacre
  39. Brian MacKenna
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Abstract

Objective

To describe the impact of the COVID-19 pandemic on safe prescribing, using the PINCER prescribing indicators; to implement complex prescribing indicators at national scale using GP data.

Design

Population based cohort study, with the approval of NHS England using the OpenSAFELY platform.

Setting

Electronic health record data from 56.8 million NHS patients’ general practice records.

Participants

All NHS patients registered at a GP practice using TPP or EMIS computer systems and recorded as at risk of at least one potentially hazardous PINCER indicator between September 2019 and September 2021.

Main outcome measure

Monthly trends and between-practice variation for compliance with 13 PINCER measures between September 2019 and September 2021.

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.

Conclusion

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

Summary box

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WHAT IS ALREADY KNOWN ON THIS TOPIC

  • Primary care services were substantially disrupted by the COVID-19 pandemic.

  • Disruption to safe prescribing during the pandemic has not previously been evaluated.

  • PINCER is a nationally adopted programme of activities that aims to identify and correct hazardous prescribing in GP practices, by conducting manual audit on subgroups of practices.

WHAT THIS STUDY ADDS

  • For the first time, we were able to successfully generate data on PINCER indicators for almost the whole population of England, in a single analysis.

  • Our study is the most comprehensive assessment of medication safety during the COVID-19 pandemic in England, covering 95% of the population using well-validated measures.

  • Good performance was maintained across many PINCER indicators throughout the pandemic.

  • Delays in delivering some medication-related blood test monitoring were evident though considerable recovery was made by the end of the study period.

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