Evaluating the validity of clinical codes to identify cataract and glaucoma in the UK Clinical Practice Research Datalink

Kang, Elizabeth M.; Pinheiro, Simone P.; Hammad, Tarek A.; Abou‐Ali, Adel

doi:10.1002/pds.3726

Cited by 18 publications

(16 citation statements)

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“…by requesting additional data from GPs for a subset of patients), results for the SA did not find differences between the algorithms with intermediate (2) and least sensitivity (3). Similar findings have been reported in other studies using CPRD data to identify different conditions, [100][101][102] which suggests that CPRD Read Codes can be used to identify a representative sample of patients with a particular condition in the UK. Our study was conducted and reported in accordance with recent guidelines for studies conducted using observational routinely collected health data (REporting of studies Conducted using Observational Routinely collected health Data, RECORD guidelines 103 ), which recognise the additional challenges of conducting research using routinely collected data obtained for administrative and clinical purposes rather than research.…”

Section: Systematic Review and Meta-analysissupporting

confidence: 87%

“…In addition, a proportion of patients did not have sufficient observation time in the cohort study for the algorithm to discriminate between BNP tested and BNP monitored. Ideally, we should have conducted a validation study (sending questionnaires to GPs for a sample of the cohort to verify the diagnosis and the timing of the diagnosis) 100 on the exposure algorithm but this was difficult given the lack of consensus about what BNP monitoring should constitute and the limited time frame of the project.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

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Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

Pufulete

Maishman

Dabner

et al. 2017

Health Technol Assess

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BackgroundHeart failure (HF) affects around 500,000 people in the UK. HF medications are frequently underprescribed and B-type natriuretic peptide (BNP)-guided therapy may help to optimise treatment.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of BNP-guided therapy compared with symptom-guided therapy in HF patients.DesignSystematic review, cohort study and cost-effectiveness model.SettingA literature review and usual care in the NHS.Participants(a) HF patients in randomised controlled trials (RCTs) of BNP-guided therapy; and (b) patients having usual care for HF in the NHS.InterventionsSystematic review: BNP-guided therapy or symptom-guided therapy in primary or secondary care.Cohort study: BNP monitored (≥ 6 months’ follow-upandthree or more BNP testsandtwo or more tests per year), BNP tested (≥ 1 tests but not BNP monitored) or never tested.Cost-effectiveness model: BNP-guided therapy in specialist clinics.Main outcome measuresMortality, hospital admission (all cause and HF related) and adverse events; and quality-adjusted life-years (QALYs) for the cost-effectiveness model.Data sourcesSystematic review: Individual participant or aggregate data from eligible RCTs.Cohort study: The Clinical Practice Research Datalink, Hospital Episode Statistics and National Heart Failure Audit (NHFA).Review methodsA systematic literature search (five databases, trial registries, grey literature and reference lists of publications) for published and unpublished RCTs.ResultsFive RCTs contributed individual participant data (IPD) and eight RCTs contributed aggregate data (1536 participants were randomised to BNP-guided therapy and 1538 participants were randomised to symptom-guided therapy). For all-cause mortality, the hazard ratio (HR) for BNP-guided therapy was 0.87 [95% confidence interval (CI) 0.73 to 1.04]. Patients who were aged < 75 years or who had heart failure with a reduced ejection fraction (HFrEF) received the most benefit [interactions (p = 0.03): < 75 years vs. ≥ 75 years: HR 0.70 (95% CI 0.53 to 0.92) vs. 1.07 (95% CI 0.84 to 1.37); HFrEF vs. heart failure with a preserved ejection fraction (HFpEF): HR 0.83 (95% CI 0.68 to 1.01) vs. 1.33 (95% CI 0.83 to 2.11)]. In the cohort study, incident HF patients (1 April 2005–31 March 2013) were never tested (n = 13,632), BNP tested (n = 3392) or BNP monitored (n = 71). Median survival was 5 years; all-cause mortality was 141.5 out of 1000 person-years (95% CI 138.5 to 144.6 person-years). All-cause mortality and hospital admission rate were highest in the BNP-monitored group, and median survival among 130,433 NHFA patients (1 January 2007–1 March 2013) was 2.2 years. The admission rate was 1.1 patients per year (interquartile range 0.5–3.5 patients). In the cost-effectiveness model, in patients aged < 75 years with HFrEF or HFpEF, BNP-guided therapy improves median survival (7.98 vs. 6.46 years) with a small QALY gain (5.68 vs. 5.02) but higher lifetime costs (£64,777 vs. £58,139). BNP-guided therapy is cost-effective at a threshold of £20,000 per QALY.LimitationsThe limitations of the trial were a lack of IPD for most RCTs and heterogeneous interventions; the inability to identify BNP monitoring confidently, to determine medication doses or to distinguish between HFrEF and HFpEF; the use of a simplified two-state Markov model; a focus on health service costs and a paucity of data on HFpEF patients aged < 75 years and HFrEF patients aged ≥ 75 years.ConclusionsThe efficacy of BNP-guided therapy in specialist HF clinics is uncertain. If efficacious, it would be cost-effective for patients aged < 75 years with HFrEF. The evidence reviewed may not apply in the UK because care is delivered differently.Future workIdentify an optimal BNP-monitoring strategy and how to optimise HF management in accordance with guidelines; update the IPD meta-analysis to include the Guiding Evidence Based Therapy Using Biomarker Intensified Treatment (GUIDE-IT) RCT; collect routine long-term outcome data for completed and ongoing RCTs.Trial registrationCurrent Controlled Trials ISRCTN37248047 and PROSPERO CRD42013005335.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 40. See the NIHR Journals Library website for further project information. The British Heart Foundation paid for Chris A Rogers’ and Maria Pufulete’s time contributing to the study. Syed Mohiuddin’s time is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust. Rachel Maishman contributed to the study when she was in receipt of a NIHR Methodology Research Fellowship.

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Section: Systematic Review and Meta-analysissupporting

confidence: 87%

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

Pufulete

Maishman

Dabner

et al. 2017

Health Technol Assess

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“…Data source and population for pharmacoepidemiological studies Data were extracted from the UK Clinical Practice Research Datalink (CPRD) which contains electronic medical record (EMR) data from >5 million UK people (further details of the data source are contained in online supplement 1) [10][11][12]. People with medically treated asthma and ocular hypertension were identified by Read Codes and prescriptions for asthma and ocular hypertension medicines.…”

Section: Methodsmentioning

confidence: 99%

Respiratory effect of beta‐blocker eye drops in asthma: population‐based study and meta‐analysis of clinical trials

Moralès

Dreischulte

Lipworth

et al. 2016

Brit J Clinical Pharma

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AIMSTo measure the prevalence of beta-blocker eye drop prescribing and respiratory effect of ocular beta-blocker administration in people with asthma. METHODSWe measured the prevalence of ocular beta-blocker prescribing in people with asthma and ocular hypertension, and performed a nested case-control study (NCCS) measuring risk of moderate exacerbations (rescue steroids in primary care) and severe exacerbations (asthma hospitalization) using linked data from the UK Clinical Practice Research Datalink. We then performed a systematic review and meta-analysis of clinical trials evaluating changes in lung function following ocular beta-blocker administration in people with asthma. RESULTSFrom 2000 to 2012, the prevalence of non-selective and selective beta-blocker eye drop prescribing in people with asthma and ocular hypertension fell from 23.0% to 13.4% and from 10.5% to 0.9% respectively. In the NCCS, the relative incidence (IRR) of moderate exacerbations increased significantly with acute non-selective beta-blocker eye drop exposure (IRR 4.83, 95% CI 1.56-14.94) but not with chronic exposure. In the meta-analysis, acute non-selective beta-blocker eye drop exposure caused significant mean falls in FEV1 of À10.9% (95% CI À14.9 to À6.9), and falls in FEV1 of ≥20% affecting one in three. Corresponding values for selective beta-blockers in people sensitive to ocular non-selective beta-blockers was À6.3% (95% CI À11.7 to À0.8), and a nonsignificant increase in falls in FEV1 of ≥20%. CONCLUSIONNon-selective beta-blocker eye drops significantly affect lung function and increase asthma morbidity but are still frequently prescribed to people with asthma and ocular hypertension despite safer agents being available. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Beta-blocker eye drops may be absorbed into the systemic circulation but the prevalence of beta-blocker eye drop prescribing and impact on lung function and exacerbations in people with asthma has been poorly quantified. WHAT THIS STUDY ADDS• Acute non-selective beta-blocker eye drop exposure significantly affects lung function and increases asthma morbidity but are still frequently prescribed to people with asthma and ocular hypertension despite safer agents being available.

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“…3 Thus, to determine the accuracy of AS diagnostic codes, we administered a questionnaire to the GPs caring for patients with one or more AS diagnoses (Read code N100.00, “Ankylosing spondylitis”) in THIN. 67 This method was selected for AS diagnosis validation because of the potential for diagnoses to be miscoded in GP records, such as in the event that a tentative diagnosis was recorded using a code that failed to capture the diagnostic uncertainty.…”

Section: Methodsmentioning

confidence: 99%

Validity of ankylosing spondylitis diagnoses in The Health Improvement Network

Dubreuil

Peloquin

Zhang

et al. 2016

Pharmacoepidemiol Drug Saf

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Background/Purpose Because ankylosing spondylitis (AS) is uncommon, large medical record databases offer important opportunities for pharmacoepidemiologic research. However, the validity of AS diagnoses recorded by a general practitioner (GP) is unknown. We assessed the validity of algorithms for identifying AS in The Health Improvement Network (THIN). Methods THIN is a database of GP records for over 10 million persons in the UK. In 2014, we administered a questionnaire to GPs of 100 adults for whom an AS diagnosis had been recorded. As high positive predictive value (PPV) is critically important in AS research, we sought to determine the PPV of an AS diagnostic code relative to the GP's clinical impression as the gold standard. Other AS algorithms included: more than one AS diagnostic code, prescription of a nonsteroidal anti‐inflammatory drug (NSAID), disease modifying anti‐rheumatic drug (DMARD) or biologic. Results In 61 of 85 returned questionnaires, the GP's clinical impression confirmed AS yielding an overall PPV of 72%. PPV was 89% for two AS codes >7 days apart, and was 86% for an AS code plus a DMARD/biologic. Sensitivity was reduced with algorithms requiring two AS codes (64%) and a DMARD/biologic prescription (30%). Algorithms requiring prescription of an NSAID, or the absence of OA or RA had lower PPV (71–75%) and higher sensitivity (95–98%). Conclusion An AS identification algorithm of two AS diagnoses separated by >7 days provided the highest PPV. This algorithm should be used for pharmacoepidemiologic studies in THIN. Copyright © 2016 John Wiley & Sons, Ltd.

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Evaluating the validity of clinical codes to identify cataract and glaucoma in the UK Clinical Practice Research Datalink

Abstract: High PPV suggests that the algorithms based on the clinical Read codes are sufficient to identify the cataract and glaucoma cases in CPRD. However, these codes alone may not be able to accurately identify the timing of the diagnosis of these eye disorders. Ltd.

Cited by 18 publications

References 16 publications

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

Respiratory effect of beta‐blocker eye drops in asthma: population‐based study and meta‐analysis of clinical trials

Validity of ankylosing spondylitis diagnoses in The Health Improvement Network

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