International Primary Care Classifications: the Effect of Fifteen Years of Evolution

Lamberts, H; Wood, Maurice; Hofmans-okkes, I. M.

doi:10.1093/fampra/9.3.330

Cited by 116 publications

(97 citation statements)

References 28 publications

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“…17 All four GP practices contribute data to the Integrated Primary Care Information (IPCI) database. This longitudinal GP electronic health record database contains the anonymised patient records of patients registered with GPs throughout the Netherlands, containing data on patient demographics, diagnoses using the International Classification for Primary Care (ICPC) 18 and journal entries, referrals, laboratory results, and hospitalisations. In addition, details of drug prescriptions using the Anatomical Therapeutic Chemical (ATC) code 19 and their dosage regimens are available.…”

Section: Resultsmentioning

confidence: 99%

High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study

Koffeman¹,

Valkhoff²,

Celik³

et al. 2014

Br J Gen Pract

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BackgroundThe use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with serious adverse drug events (ADEs). AimTo determine the prevalence of over-thecounter (OTC) NSAID use in the general population and in patients with a high risk of developing a serious NSAID-related ADE. Design and settingCross-sectional study in four general practices in the Netherlands. MethodTwo patient samples were selected: a random sample of adults (general population sample); and adult patients with a high risk of developing a serious ADE in case of NSAID use (highrisk sample). All included patients were sent a questionnaire regarding their use of OTC NSAIDs in the 4 weeks prior to participation. ResultsIn the general population sample, 118 of 456 (26%) invited patients completed the questionnaire. Of these, 35 (30%) had used an OTC NSAID. In the high-risk sample, 264 of 713 (37%) invited patients completed the questionnaire, and of these high-risk patients 33 (13%) had used an OTC NSAID. Over 20% of OTC NSAID users in the general population sample and over 30% in the high-risk sample had used the OTC NSAID for >7 days. OTC NSAIDs were used in a dosage exceeding the recommended daily maximum by 9% and 3% of OTC NSAID users in the general population and the high-risk sample respectively. ConclusionOTC NSAIDs are used by almost one-third of the general population. In the high-risk patients selected, one in eight patients used an OTC NSAID. Continued efforts by health authorities and healthcare professionals to inform patients of the risks of these drugs are warranted. Keywordsanti-inflammatory agents, non-steroidal; general practice; over-the-counter drugs; primary care. 20-21 Study populationWithin the participating practices, two samples of patients were selected, using the medical records contained in the IPCI database. The first was a random sample of all adult patients aged ≥18 years (general population sample). In the second sample adult patients were specifically selected who, according to Dutch clinical prescription guidelines, 7,10-12 had at least one risk factor leading to a high risk of developing a serious NSAID-related ADE (high-risk sample). It was aimed to select at least the following number of patients from each of the following risk groups:• 150 patients with a history of peptic ulcer or ulcer complication;• 200 patients aged >70 years;• 300 patients with two or more of the following minor risk factors: use of anticoagulant, use of aspirin, use of corticosteroid, use of selective serotonin reuptake inhibitor, age 60-70 years, history of severe rheumatoid arthritis, diabetes mellitus or heart failure;• 50 patients with a history of myocardial infarction;• 50 patients with a history of stroke;• 100 patients with a history of heart failure; or• 50 patients with a glomerular filtration rate (GFR) <30mL/min.As these risk factors often overlap, patients could be selected more than once, thereby contributing to the numbers in each risk group. The diagnoses of diseases and conditions mentioned were ide...

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Section: Resultsmentioning

confidence: 99%

High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study

Koffeman¹,

Valkhoff²,

Celik³

et al. 2014

Br J Gen Pract

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“…GP records contain diagnoses from GPs and specialists according to accepted guidelines and recorded according to the International Classification of Primary Care system. 16 The following risk factors were included in this study: ischemic heart disease, cerebrovascular accident or transient ischemic attack, hypertension, diabetes mellitus, dyslipidemia, and heart failure.…”

Section: Definitionsmentioning

confidence: 99%

Atrial Fibrillation Is an Independent Risk Factor for Ventricular Fibrillation

Bardai

Blom

Hoeijen

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— Atrial fibrillation (AF) is associated with sudden cardiac death. We aimed to study whether AF is associated with ventricular fibrillation (VF), the most common cause of sudden cardiac death and whether this association is independent of confounders, ie, concomitant disease, use of antiarrhythmic or QT-prolonging drugs, and acute myocardial infarction. Methods and Results— We performed a community-based case-control study. Cases were patients with out-of-hospital cardiac arrest because of ECG-documented VF. Controls were age-/sex-matched non-VF subjects from the community. VF risk in AF patients was studied by means of (conditional) logistic regression, adjusting for all available confounders. We studied 1397 VF cases and 3474 controls. AF occurred in 215 cases (15.4%) and 90 controls (2.6%). AF was associated with a 3-fold increased risk of VF (adjusted odds ratio, 3.1 [2.1–4.5]). VF risk in AF cases was increased to the same extent across all age/sex groups and in AF cases who had no comorbidity (adjusted odds ratio 3.0 [1.6–5.5]) or used no confounding drugs (antiarrhythmics, 2.4 [1.4–4.3]; QT-prolonging drugs, 3.1 [1.8–5.4]). VF risk was similarly increased in AF cases with acute myocardial infarction–related VF (adjusted odds ratio 2.6 [1.4–4.8]), and those with non-acute myocardial infarction–related VF (adjusted odds ratio 4.3 [1.9–10.1]). Conclusions— AF is independently associated with a 3-fold increased risk of VF. Comorbidity, use of antiarrhythmic or QT-prolonging drugs, or acute myocardial infarction does not fully account for this increased risk.

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“…The IPCI database contains anonymised patient identification information (age, sex, patient identification number and GP registration information), narratives, symptoms, signs, GP and specialist diagnoses, prescriptions, physical findings, laboratory values and summaries of specialist letters. The International Classification of Primary Care (ICPC) is the coding system for patient complaints and diagnoses but they can also be entered as free text [21]. Therefore, the medical records do not only capture GP diagnoses and symptoms, but also the results and summaries of specialist care.…”

Section: Settingmentioning

confidence: 99%

Use of tiotropium Respimat Soft Mist InhalerversusHandiHaler and mortality in patients with COPD

et al. 2013

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Tiotropium, a long-acting anticholinergic, is delivered via HandiHaler or via Respimat. Randomised controlled trials suggest that use of tiotropium Respimat increases the risk of dying. We compared the risk of mortality between tiotropium Respimat versus HandiHaler.Within the Integrated Primary Care Information database, we defined a source population of patients, aged o40 years, with o1 year of follow-up. Based on prescription data, we defined episodes of tiotropium use (Respimat or HandiHaler). The risk of mortality, within these episodes, was calculated using a Cox proportional hazard regression analysis.From the source population, 11 287 patients provided 24 522 episodes of tiotropium use. 496 patients died while being exposed to HandiHaler or Respimat. Use of Respimat was associated with almost 30% increased risk of dying (adjusted HR 1.27, 95% CI 1.03-1.57) with the highest risk for cardiovascular/ cerebrovascular death (adjusted HR 1.56, 95% CI 1.08-2.25). The risk was higher in patients with coexisting cardiovascular disease (adjusted HR 1.36, 95% CI 1.07-1.73) than in patients without (adjusted HR 1.02, 95% CI 0.61-1.71).Use of tiotropium Respimat was associated with an almost 30% increase of mortality compared with HandiHaler and the association was the strongest for cardiovascular/cerebrovascular death. It is unclear whether this association is causal or due to residual confounding by chronic obstructive pulmonary disease severity. @ERSpublications Tiotropium Respimat was associated with a 30% increase in mortality compared with HandiHaler in COPD

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International Primary Care Classifications: the Effect of Fifteen Years of Evolution

Cited by 116 publications

References 28 publications

High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study

High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study

Atrial Fibrillation Is an Independent Risk Factor for Ventricular Fibrillation

Use of tiotropium Respimat Soft Mist InhalerversusHandiHaler and mortality in patients with COPD

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