title: Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study.
abstract: BACKGROUND
  Adrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified.
  
  
  OBJECTIVE
  To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012.
  
  
  METHODS
  Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database.
  
  
  METHODS
  Children and young people aged between 0-17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12).
  
  
  RESULTS
  A total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%.
  
  
  CONCLUSIONS
  The number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed.
authors.affiliation: Queen Elizabeth Hospital, Birmingham, and research fellow in health economics, University of Birmingham, Birmingham.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Diwakar
authors.affiliation: Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham.
authors.forename: Carole
authors.initials: C
authors.lastname: Cummins
authors.affiliation: Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham; and research fellow in research & development, Medical Innovation Research and Development Unit, Heart of England NHS Foundation Trust, Birmingham.
authors.forename: Ronan
authors.initials: R
authors.lastname: Ryan
authors.affiliation: Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham.
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham.
authors.forename: Tracy
authors.initials: T
authors.lastname: Roberts
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage*; D000707:Anaphylaxis / Q000188:drug therapy*; D002648:Child; D004837:Epinephrine / Q000008:administration & dosage*; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007273:Injections, Intramuscular; D010818:Practice Patterns, Physicians'; D055656:Prescriptions; D012189:Retrospective Studies; D012646:Self Administration
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine
keywords: adrenaline; allergy; anaphylaxis; database; general practice; prescriptions; primary health care