title: Are primary care factors associated with hospital episodes for adverse drug reactions? A national observational study.
abstract: OBJECTIVE
  Identification of primary care factors associated with hospital admissions for adverse drug reactions (ADRs).
  
  
  METHODS
  Cross-sectional analysis of 2010-2012 data from all National Health Service hospitals and 7664 of 8358 general practices in England.
  
  
  METHODS
  We identified all hospital episodes with an International Classification of Diseases (ICD) 10 code indicative of an ADR, in the 2010-2012 English Hospital Episode Statistics (HES) admissions database. These episodes were linked to contemporary data describing the associated general practice, including general practitioner (GP) and patient demographics, an estimate of overall patient population morbidity, measures of primary care supply, and Quality and Outcomes Framework (QOF) quality scores. Poisson regression models were used to examine associations between primary care factors and ADR-related episode rates.
  
  
  RESULTS
  212,813 ADR-related HES episodes were identified. Rates of episodes were relatively high among the very young, older and female subgroups. In fully adjusted models, the following primary care factors were associated with increased likelihood of episode: higher deprivation scores (population attributable fraction (PAF)=0.084, 95% CI 0.067 to 0.100) and relatively poor glycated haemoglobin (HbA1c) control among patients with diabetes (PAF=0.372; 0.218 to 0.496). The following were associated with reduced episode likelihood: lower GP supply (PAF=-0.016; -0.026 to -0.005), a lower proportion of GPs with UK qualifications (PAF=-0.035; -0.058 to -0.012), lower total QOF achievement rates (PAF=-0.021; -0.042 to 0.000) and relatively poor blood pressure control among patients with diabetes (PAF=-0.144; -0.280 to -0.022).
  
  
  CONCLUSIONS
  Various aspects of primary care are associated with ADR-related hospital episodes, including achievement of particular QOF indicators. Further investigation with individual level data would help develop understanding of the associations identified. Interventions in primary care could help reduce the ADR burden. ADRs are candidates for primary care sensitive conditions.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Ailsa J
authors.initials: AJ
authors.lastname: McKay
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Newson
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Soljak
authors.affiliation: School of Public Health, Imperial College London, London, UK.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK Department of LKCMedicine, Imperial College London-Nanyang Technological University, Singapore, Singapore.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.identifier: http://orcid.org/0000-0002-2357-9858
authors.initials: A
authors.lastname: Majeed
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012737:Sex Factors
keywords: EPIDEMIOLOGY; PRIMARY CARE; PUBLIC HEALTH