"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: nils-rsu@qub.ac.uk

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