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  • Because many of the resources have diagnostic and prevention data as well as prescribing we can also look at which factors were associated with changingThese variables were significant (odds ratio 95% CI)Continued to improve
  • Not just numbers – duration50% 15 years and overSome coming ang going of patients but possible to follow medication use for example over 10 years of diabetes.
  • We’ve moved on
  • A very recent publication Another issue over time number of events validated
  • More specifically
  • clearly studies of: a cause of death or acute and potentially fatal conditions will miss events unless a cause is confirmed for all fatalities. Links to death certificates
  • The accumulated experience has resulted in guidance
  • In addition to published experience the data resources themselves have improved
  • Again with a UK slant
  • Calculated from number of tests and number of patients.
  • Pan european equivalent has been to share protocols rather than to merge data as differences in coding systems. But a common software to run initial queries. Encepp (european network for centres of pharmacepidemiology and pharmacovigulance) are looking at the issue as one of there objectives
  • Not just to increase numbers, also to provide more information on individuals
  • Not just to increase numbers, also to provide more information on individuals
  • Another option look for specialist datasets
  • Another option look for specialist datasets
  • A word of caution

Transcript

  • 1.  
    Availability and use of prescribing databases:
    trends and issues
    gillian_hall@gchall.demon.co.uk
  • 2. Background
    Data resources such as
    THIN
    GPRD
    Q Research
    … in the UK
  • 3.
  • 4. Factors associated with a change
  • 5. Patient years (THIN)
    CEGEDIM 2010
  • 6. Practice duration (THIN)
  • 7. 45
    40
    35
    30
    25
    per 100,000 years
    20
    15
    10
    5
    0
    1992-94
    1995-97
    1998-2001
    2002-2005
    Post-herpetic neuralgia
    Trigeminal neuralgia
    Phantom limb pain
    Painful diabetic neuropathy
    Neuropathic pain incidence
  • 8. Most common initial treatments
    (% those treated); 2002-5
  • 9. Other improvements
    Published experience
    Increased use of electronic data at source
    Merging datasets
  • 10. Validation
    GPRD validations
    357 validations
    183 diagnoses
    median cases confirmed 89%
    range 24–100%
    Herrett, E et al, British Journal of Clinical Pharmacology 2010
  • 11. Validation
    Deaths in 1 year (THIN)
    99.6% of 1,399 deaths had died
    In medical & admin. files as well as designated field
    0.3% of deaths <1 year dated 366-485 days
    Hall GC, Pharmacoepidemiol Drug Saf 2009
  • 12. Validation
    63% had an electronic COD
    47% from coded entries
    17% from free text
  • 13. Validation
    7 suicides were identified
    1 was coded as suicide
    2 had a cause of death indicative of suicide
    4 had no cause of death or indication of suicide
  • 14. Exposure- prescription duration (days)
  • 15. Guidance
    Guidelines
    • ISPOR – database methods
    • 16. STROBE - reporting observational studies
    • 17. ISPE - use of databases
  • Advances in data recording
    Both in-house – greater use of systems
    Electronic links to external data
  • 18. Advances in data recording
    QoF (Quality and outcomes framework) 2004
    Financial encouragement of preventive medicine in chronic disease
    Electronic links
    appointments and feedback
    laboratory
  • 19. Recording of diabetic data
  • 20. Haemoglobin results (% pts)
  • 21. Advances in data recording
    Resultant issues
    Difficult to interpret trends
    Can’t always simply re-run programmes
    Continue to learn about a resource
  • 22. Mean HbA1c (%) at insulin start (UK)
    THIN 2002-2007
  • 23. HbA1c at change in diabetic treatment
    Eliasson et al. Diabetes & Metabolism 2007;33:269-76
  • 24. Merging databases
    What about very rare conditions?
    End stage renal disease
    Pancreatitis
    Phantom limb pain
  • 25. Merging databases
    HMO Research Network (US)
    13 health systems
    13 research groups
    13 million active people
    Platt, R 2001 Pharmacoepidemiol Drug Saf
  • 26. Merging databases
    Merge of UK general practice databases with other sources
    Socioeconomic data
    Death
    Hospital Episode Statistics
  • 27. Merging databases
    Issues
    Confidentiality issues
    Results in limited size
    Cost
  • 28. Data Resources
    Example: PMS - end stage renal disease:
  • 29. Data Resources
    Example: PMS - end stage renal disease:
    Specialist database – US renal database
  • 30. Data Resources
    PainDB
    Hadn’t been validated …
    55% patients, all visits recorded
    88% entries matched
    9% on Pain DB, not written notes
  • 31. OC - VTE Study
    Jick and Farmer both on GPRD
    Jick (5yr controls) GSD 2.1 (1.0-4.4)
    Farmer
    (YOB) GSD 1.3 (0.8-2.1)
    (5yr controls) GSD 1.5 (0.9-2.3)
  • 32. Prescribing patterns
  • 33. Conclusion
    Resources keep improving
    New resources available
    We need to develop in parallel