12For each patient we also extracted data on age; sex; postcode


Thirty one per cent of Scottish practices contributed data, covering a population representative of Scotland for age, sex, and deprivation, and including patients living in their own homes or in nursing homes.11We extracted data for all patients permanently registered on 31 March 2007 who were defined as being particularly vulnerable to one of the specified prescriptions because of age pandora earrings, pre existing disease (heart failure, dementia, chronic kidney disease, peptic ulcer), or pre existing co prescription (warfarin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker https://www.pandora4saleuk.com/, diuretic). We used the disease register business rules of the UK Quality and Outcomes Framework to define heart failure, chronic kidney disease, dementia, and psychosis, with a bespoke Read code set used to define peptic ulcer disease.12For each patient we also extracted data on age; sex; postcode assigned deprivation, using the Carstairs score (grouped into fifths)13; and number of oral drugs on active repeat prescription, with at least one prescription issued in the past 84 days. Variables defined at practice level were rurality or remoteness based on the Scottish Executive urban rural classification, list size (grouped into fourths), whether the practice held a new General Medical Services or section 17c or 2c contract (the Scottish equivalent of a Personal Medical Services contract where there is local variation from the national new General Medical Services template), postgraduate training status, dispensing status, whether the practice was single handed, and whether the practice achieved maximum points for three relevant drug measures in the Quality and Outcomes Framework: medicines 10, where practices are paid for meeting prescribing advisers and agreeing three improvement projects for the subsequent year, with evidence of delivery of the previous year’s agreed projects, and medicines 11 and 12 where practices are paid for carrying out drug reviews on more than 80% of patients taking repeat drugs, with extra payment for achieving this for patients taking four or more repeat drugs.12Given the limitations of existing indicator sets described above, we defined a new set of indicators of hazardous prescribing for drugs prescribed in situations identified as clearly high risk in national safety alerts3 4 14 and commonly implicated in serious harm, as measured by emergency hospital admission due to an adverse drug event.1 2 Indicators were required to be ones where the prescribing being measured was clearly stated to be contraindicated or to be avoided in routine practice, either in the British National Formulary,15 national clinical guidelines,16 prescribing advice,14 17 18 19 or safety alerts.3 It is important to recognise that most patients receiving such prescriptions will not be harmed and few of these prescriptions are absolutely contraindicated.

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