"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
Business Services Organisation
Ophthalmic
Pharmaceutical
Family
Practitioner Unit
(FPS)
Medical
Information &
Registration Unit
Dental
Data Available
Dental Data:
Registration Data:
-Dentists & Associates
-Patient Level information
-Patient Registrations &
Treatments
-Registered population
-Dental Payments
-Immigration/Emigration
-Internal Movement
-GP Payments
Ophthalmic Data:
Pharmaceutical Data:
-Vouchers for Eye tests
& Glasses
-Prescription Cost
analysis
-Opticians, Ophthalmic
Surgeons &
-Drug information
-Ophthalmic Payments
-NEW Enhanced
Prescription Information
Enhanced Prescribing Data
Second 2-D
barcode pre-printed
on prescription
gives GP
information
2-D barcode captures all
information printed on the
prescription, including
prescribed drug data, plus
some data not visible on
the prescription
Unique individuals using/accessing Family
Practitioner Services in 2009-10
All
Medical
Pharmacy
Dental
Ophthalmic
FPS
This
Had an
column
233,515
represents
the
1,386,029
population
865,886
of
NI –
293,647
I
N
T
E
R
A
C
T
I
O
N
1.87m
1st Apr 2010
1,625,206
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
Lactobacilli
Streptococci
Clostridia
Coliform
Bacteriodes
Methicillin-resistant Staphylococcus aureus (MRSA)
Publicity on Inappropriate Antibiotic Prescribing
Prescribing Patterns
ANTIBIOTIC PRESCRIPTIONS & POPULATION
1,950,000
COUNT
1,900,000
1,850,000
1,800,000
1,750,000
NUMBER ANTIBIOTIC
PRESCRIPTIONS
1,700,000
POPULATION
1,650,000
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
YEAR
Prescribing Patterns
TOTAL ANTIVIRALS
1,600,000
1,400,000
TOTAL ANTIVIRALS
1,200,000
1,000,000
800,000
600,000
400,000
200,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
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
NILS data at NISRA
Prescribing data at HSC BSO
Personal
identifiers
EPD
Health &
Care
Number
Health &
Care
Number
One-way encryption
NILS
One-way encryption
Removed
EPD
xyzb
EPD
Matching
xyzb
xyzb
NILS
Removed
Researcher access
EPD
NILS
NILS
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
80
70
60
%
50
Males
40
Females
30
20
10
0
0 to 4
5 to 15
16 to 44
45 to 64
Age Group
65+
All
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 Status
Models 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 Value
Models 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 ***
Next Steps
Preliminary analysis only!
Next steps for analysis:
 more risk factors – variables to include family structure, selfreported 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
Acknowledgements

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.
HSC BSO
Family Practitioner Services
Website: www.hscbusiness.hscni.net/services/index.html
NILS Research Support Unit
Northern Ireland Statistics and Research Agency
McAuley House
Tel: 028 90 348138
Email: [email protected]
Website: nils-rsu.census.ac.uk
Frequencies Table
0
age
male
1 to 2
female
male
3 to 5
female
male
6+
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
168,250
151,643
39,888
59,642
6,852
14,689
1,571
3,692
446,227
Total