"Use of antibiotics - groundbreaking analysis from the new electronic
prescription system."
Kim Moylan HSC-BSO & Fiona Johnston NILS-RSU
Seminar Outline
Introduction to the HSC BSO: Data Available
Enhanced Prescribing Data: Antibiotics
Introduction to the NILS: Data Available
Distinct Linkage Project using the NILS &BSO
Preliminary Results
Next Steps
Medical
Dental
Pharmaceutical
Information & Registration
Unit
Ophthalmic
Family Practitioner Unit
(FPS)
Business Services Organisation
Data AvailableRegistration Data:
-Patient Level information
-Registered population
-Immigration/Emigration
-Internal Movement
-GP Payments
Pharmaceutical Data:
-Prescription Cost analysis
-Drug information
-NEW Enhanced Prescription Information
Dental Data:
-Dentists & Associates
-Patient Registrations & Treatments
-Dental Payments
Ophthalmic Data:
-Vouchers for Eye tests & Glasses
-Opticians, Ophthalmic Surgeons &
-Ophthalmic Payments
Enhanced Prescribing Data
2-D barcode captures all information printed on the
prescription, including prescribed drug data, plus some data not visible on
the prescription
Second 2-D barcode pre-printed on prescription gives GP information
Unique individuals using/accessing Family Practitioner Services in 2009-10
All Medical Pharmacy Dental Ophthalmic FPS
ThisHad an
column 233,515 I
represents NT
the E 1,386,029 R
population A 865,886 C
of TI
NI – 293,647 ON
1.87m 1,625,206
1st Apr 2010 No recorded interaction 248,231
Current Data Examples
Current Information
Percentage People in receipt of drugs for treatment of bacterial infections
Body Invaders
Virus
Fungus
Parasite Bacteria
Antibiotics
Clostridium difficile (C Diff)
THE 'NORMAL' GUT BACTERIA LactobacilliStreptococci
ClostridiaColiform
Bacteriodes
Methicillin-resistant Staphylococcus aureus (MRSA)
Publicity on Inappropriate Antibiotic Prescribing
Prescribing Patterns
ANTIBIOTIC PRESCRIPTIONS & POPULATION
1,650,000
1,700,000
1,750,000
1,800,000
1,850,000
1,900,000
1,950,000
2000200120022003200420052006200720082009
YEAR
CO
UN
T
NUMBER ANTIBIOTICPRESCRIPTIONS
POPULATION
Prescribing Patterns
TOTAL ANTIVIRALS
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
TOTAL ANTIVIRALS
Northern Ireland Longitudinal Study
Distinct Linkage Projects (DLPs)
Potential to link to health and social services data for specially defined one-off studies; so far successfully linked to:• Breast Screening• Dental Activity• Prescribing
Legal and ethical scrutiny and privacy protection protocols
Database Linkage & Encryption Methodology
Personal identifiers
Health & Care Number
Removed
xyzb
Prescribing data at HSC BSO NILS data at NISRA
Health & Care Number
NILS
xyzb
One-way encryption
EPD
EPD NILS
One-way encryption
xyzbNILS
EPD
NILS EPD
Researcher access
Matching
Removed
NILS-EPD Distinct Linkage Project
Study Aims Identify current antibiotic prescribing patterns by demographic & area
characteristics. Inform health policy & health research on management of antibiotics
prescribing.
Study Design NILS members linked to antibiotic prescription data held on EPD, based on the
12 months ending May 2010
Relationship between antibiotic prescriptions (incl. number of prescription items received) and:
(1) individual demographic & socio-economic characteristics(2) area attributes(3) indicator for high (70% and over) and low coverage rates for scanned prescriptions
Descriptive analysis to look at patterns of prescription & regression analysis to test the relative importance of variables on usage.
Prelim results: Descriptive Analysis – Population Distribution
Prescriptions by Sex & Age
0
10
20
30
40
50
60
70
80
0 to 4 5 to 15 16 to 44 45 to 64 65+ All
Age Group
%
Males
Females
Prelim results: Multinomial Logistic Regression – Relative Risks Demographic Factors: Age & Sex
Sex 1 to 2 Items 3 to 5 Items 6+ Items
Male 1.00 1.00 1.00
Female 1.69 *** 2.36 *** 2.48 ***
Age 1 to 2 Items 3 to 5 Items 6+ Items
0-4 1.00 1.00 1.00
5-15 1.18 *** 1.78 *** 1.85 ***
16-44 1.09 *** 1.76 *** 2.60 ***
45-64 1.36 *** 3.21 *** 8.20 ***
65+ 0.81 *** 2.45 *** 8.96 ***
Prelim results: Multinomial Logistic Regression – Relative Risks
Demographic Factors: Community Background & Marital StatusModels adjusted for Age & Sex
Community Background 1 to 2 Items 3 to 5 Items 6+ Items
Catholic 1.00 1.00 1.00
Protestant 0.95 *** 0.94 *** 0.85 ***
Other/None - - -
Marital (16+) 1 to 2 Items 3 to 5 Items 6+ Items
Single 1.00 1.00 1.00
Married/Re-married 1.21 *** 1.27 *** 1.31 ***
Sep/Div/Widowed 1.09 *** 1.29 *** 1.46 ***
Prelim results: Multinomial Logistic Regression – Relative Risks
Socio-Economic Factors: Education & Tenure/Capital ValueModels adjusted for Age & Sex
Education (25+) 1 to 2 Items 3 to 5 Items 6+ Items
Degree+ 1.00 1.00 1.00
2+ A’Levels 1.10 *** 1.16 ** (0.002) 1.22
GCSEs 1.21 *** 1.30 *** 1.49 ***
No Qualifications 1.39 *** 1.95 *** 2.66 ***
Tenure & CV (excl. private renting)
1 to 2 Items 3 to 5 Items 6+ Items
Own Occ 200K+ 1.00 1.00 1.00
Own Occ 150 - 199,999+ 1.11 *** 1.22 *** 1.23 ** (0.004)
Own Occ 100 - 149,999+ 1.19 *** 1.32 *** 1.39 ***
Own Occ 75 - 99,999+ 1.30 *** 1.47 *** 1.57 ***
Own Occ less than 75 1.33 *** 1.60 *** 1.92 ***
Social Rented 1.34 *** 1.81 *** 2.26 ***
Preliminary analysis only!
Next steps for analysis: more risk factors – variables to include family structure, self-
reported health, socio-economic status (NSSEC and employment activity)
comparison of high and low scan rates further analysis on impact of sex and older age groups area based analysis – settlement band, deprivation, sub-region establish optimal regression models establish optimal frequencies for antibiotic item groupings
Desk research: over-prescribing & antimicrobial resistance lit. review
Dissemination activities
Next Steps
The help provided by the staff of the Northern Ireland Longitudinal Study and the Northern Ireland Mortality Study (NILS and NIMS) and the NILS Research Support Unit is acknowledged.
The NILS and NIMS are funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and NISRA. The NILS-RSU is funded by the ESRC and Northern Ireland Government.
The authors alone are responsible for the interpretation of the data.
Acknowledgements
HSC BSO
Family Practitioner Services
Website: www.hscbusiness.hscni.net/services/index.html
NILS Research Support Unit
Northern Ireland Statistics and Research Agency
McAuley HouseTel: 028 90 348138
Email: [email protected]
Website: nils-rsu.census.ac.uk
0 1 to 2 3 to 5 6+
age male female male female male female male female Total
0 to 4 12,214 10,881 3,013 3,387 306 419 28 56 30,304
3 to 5 30304 24869 7773 10130 1219 1841 157 211 76,504
16 to 44 70,614 60,521 14,847 25,105 1,966 5,413 321 941 179,728
45 to 64 35,643 30,079 10,388 14,383 2,230 4,411 614 1,351 99,099
65+ 19,475 25,293 3,867 6,637 1,131 2,605 451 1,133 60,592
Total 168,250 151,643 39,888 59,642 6,852 14,689 1,571 3,692 446,227
Frequencies Table