Table 1. The prescribing indicators grouped by serious harm outcome.
| Indicator | Description of Indicator | Group at risk (Denominator) | Group exposed to hazardous prescribing (Numerator) |
|---|---|---|---|
| Hazardous prescribing indicators associated with GI bleeding | |||
| A | Prescription of an oral NSAID, without coprescription of an ulcer healing drug, to a patient aged ≥65 years | Patients aged ≥65 years without coprescription of an ulcer-healing drug (PPI or H2 antagonist) in the 3 months leading up to the audit date | Patients prescribed an oral NSAID in the 3 months leading up to the audit date |
| B | Prescription of an oral NSAID, without coprescription of an ulcer-healing drug, to a patient with a history of peptic ulceration | Patients aged ≥18 years with a Read code for peptic ulcer or upper GI bleed at least 3 months before audit date and not prescribed an ulcer-healing drug (PPI or H2 antagonist) within the 3 months leading up to the audit date | Patients prescribed an oral NSAID within the 3 months leading up to the audit date |
| C | Prescription of an antiplatelet drug, without coprescription of an ulcer-healing drug, to a patient with a history of peptic ulceration | Patients aged ≥18 years with a Read code for peptic ulcer or GI bleed at least 3 months before audit date and not prescribed an ulcer-healing drug (PPI or H2 antagonist) within the 3 months leading up to the audit date | Patients prescribed an antiplatelet drug (aspirin or clopidogrel or prasugrel or ticagrelor) within the 3 months leading up to the audit date |
| D | Prescription of warfarin or DOAC in combination with an oral NSAID | Patients aged ≥18 years prescribed warfarin or a DOAC (apixaban or dabigatran or rivaroxaban) within the 3 months leading up to the audit date | Patients prescribed an oral NSAID within the 3 months leading up to the audit date |
| E | Prescription of warfarin or DOAC and an antiplatelet drug in combination without coprescription of an ulcer-healing drug | Patients aged ≥18 years prescribed warfarin or DOAC without coprescription of an ulcer-healing drug (PPI or H2 antagonist) within the 3 months leading up to the audit date | Patients prescribed an antiplatelet drug (aspirin or clopidogrel or prasugrel or ticagrelor) within the 3 months leading up to the audit date and within 28 days of the warfarin/DOAC prescription |
| F | Prescription of aspirin in combination with another antiplatelet drug (without coprescription of an ulcer-healing drug) | Patients aged ≥18 years prescribed aspirin without coprescription of an ulcer-healing drug (PPI or H2 antagonist) within the 3 months leading up to the audit date | Patients prescribed another antiplatelet drug (clopidogrel or prasugrel or ticagrelor) within the 3 months leading up to the audit date and within 28 days of the aspirin prescription |
| Hazardous prescribing indicators associated with asthma | |||
| G | Prescription of a nonselective β-blocker to a patient with asthma | Patients aged ≥18 years with a Read code for asthma at least 3 months before audit date and no subsequent asthma resolved code during that time period | Patients prescribed a nonselective β-blocker within the 3 months leading up to the audit date |
| H | Prescription of a long-acting beta-2 agonist inhaler (excluding combination products with inhaled corticosteroid) to a patient with asthma who is not also prescribed an inhaled corticosteroid | Patients aged ≥18 years with a Read code for asthma at least 3 months before audit date (and no subsequent asthma resolved code during that time period) who have been prescribed a long-acting beta-2 agonist inhaler (excluding combination products with inhaled corticosteroid) within the last 3 months | Patients not prescribed an inhaled corticosteroid within the 3 months leading up to the audit date |
| Hazardous prescribing indicators associated with heart failure | |||
| I | Prescription of an oral NSAID to a patient with heart failure | Patients aged ≥18 years who have a diagnosis of heart failure at least 3 months before the audit date | Patients prescribed an oral NSAID within the 3 months leading up to the audit date |
| Hazardous prescribing indicators associated with cardiovascular events, including stroke | |||
| J | Prescription of antipsychotics for >6 weeks in a patient aged ≥65 years with dementia but not psychosis | Patients aged ≥65 years with a Read code for dementia at least 3 months before the audit date and no Read code for psychosis (or have a psychosis Read code and a subsequent psychosis resolved Read code) at least 3 months before the audit date | Patients prescribed antipsychotic drugs at least once within the 3 months leading up to the audit date |
| Hazardous prescribing indicators associated with acute kidney injury | |||
| K | Prescription of an oral NSAID to a patient with eGFR <45 mL/min | Patients aged ≥18 years with chronic renal failure: eGFR <45 mL/min at least 3 months before the audit date |
Patients prescribed an oral NSAID within the 3 months leading up to the audit date |
| Composite of all indicators (A-K) | Composite indicator (all 11 indicators) | Number of unique patients in any of the above “at risk” groups (denominators) | Number of patients exposed to a high-risk prescription (sum of the number of patients included in indicators A-K) |
| Composite of GI bleed indicators (A-F) | Composite of GI bleed indicator (all GI bleed indicators) | Number of unique patients in any of the above “at risk” groups (denominators associated with a GI bleed) | Number of patients exposed to a high-risk prescription (sum of the number of patients included in indicators A-F) |
DOAC, direct oral anticoagulant; eGFR, estimated glomerular filtration rate; GI, gastrointestinal; NSAID, nonsteroidal anti-inflammatory drug; PPI, proton pump inhibitor.