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COVID-19 – high risk shielded patient list identification methodology

Medicines data

Background

The PCPM dataset includes a defined sub-set of NHS prescriptions dispensed data, with the exception of prescriptions which are dispensed in prisons, hospitals and private prescriptions.

It does not include items not dispensed and disallowed.

The data only included items prescribed via FP10 forms (includes electronic prescribing) and dispensed by NHS dispensing contractors. FP10 forms are the green forms patients receive. Therefore, it did not include:  

  • hospital prescribing
  • medicines supplied over the counter

Patient NHS numbers cannot be captured from every prescription and in general are available for around 96% of prescription forms (as of December 2019). However, this proportion can differ for individual drugs and prescribing organisations.

The data set provided all record level data below the British National Formulary classification (BNF code) levels requested from NHS BSA.

The data is partially limited as there is no indication data i.e. reason for prescribing. Some medicines have more than one indication for use.

Rule 1: Transplant

Identification of patients who had received a transplant and had medicines listed under BNF 8.2 (Drugs affecting the immune response) dispensed between November 2019 and December 2019 (inclusive).

It was not possible to identify the actual medicine (chemical substance) prescribed and dispensed, however, analysis of the data using ePACT found that 94,464 of the 94,559 records (or 99.9%) of BNF 8.2 codes were for the following immunosuppressant medicines:

BNF BNF code
Azathioprine 0802010G0
Mycophenolate Mofetil 0802010M0
Mycophenolic Sod 0802010N0
Ciclosporin 0802020G0
Sirolimus 0802020U0
Tacrolimus 0802020T0

For details of medicines prescribed and dispensed for BNF 8.2 please see Annex F.

Rule 3: Respiratory

Respiratory (patients with severe asthma or severe Chronic Obstructive Pulmonary Disease (COPD)) (applies to adult rule set)

Identification of patients with severe asthma was defined as taking regular or continuous courses of prednisolone, alongside ICD-10 coding. 

The usual medicines prescribed for patients with asthma are classified under BNF sections 3.1, 3.2 and 3.3. Many of the medicines within these BNF sections are also prescribed for patients with Chronic Obstructive Pulmonary Disease (COPD). Since PCPM data does not include indication for prescribing, it is not possible to differentiate all prescribing within BNF 3.1 and 3.2 between asthma and COPD.
 

Asthma

Patients likely to have severe asthma were identified, using medicines data, by the following methodology:

a. Patients with asthma were identified as being prescribed Long acting beta2-agonist (LABA) as either a LABA or in combination with an inhaled corticosteroid (LABA/ICS) OR prescriptions for a leukotriene receptor antagonist (e.g. monteluekast).

 

Sub paragaph BNF code
Leukotriene Receptor Antagonists 030302

A list of LABA and LABA/ICS medicines (presentations) used in the analysis is detailed in annex D. Formulations indicated only for COPD were excluded (Indacterol; Olodaterol).

AND

b. From the above list of patients, those who had been dispensed 4 or more prescriptions for prednisolone between July 2019 and December 2019 were identified and considered to have severe asthma. 

 

Chemical substance BNF code
Prednisolone 0603020T0

Due to time constraints more detailed analysis of the quantities of prednisolone per prescription (such as number of tablets) was not possible.

Whilst PCPM data does not include medicines prescribed and supplied by secondary care there can be a reasonable assumption that the majority of the management of asthma and COPD is undertaken in primary care via FP10 prescriptions.

In order to identify regular or continuous prescribing of prednisolone (defined as 4 or more prescriptions), analysis of the full 6 months data was necessary. Patients who commenced regular or continuous prednisolone recently (for example, October onwards) may not be included.

Because of the method of identifying patients with asthma, the data will include patients who have COPD and have also received 4 or more prescriptions for prednisolone. However, removing the patients identified in COPD analysis will have reduced the number (see below).    

COPD

Patients who were likely to have severe COPD were identified, using medicines data, by:

 

a.  prescriptions for a Long Acting Beta Agonist (LABA) and a Long Acting Muscarinic Agonist (LAMA) and an inhaled corticosteroid (ICS) in either November and/or December 2019.

 

NB: prescribed as either 3 separate medicines, combinations of single and dual / combination medicines or as triple therapy.
A list of medicines used in the analysis is detailed in Annex E.

OR

b.Patients who have had a prescription for Roflumilast most recently in November 2019 and/or December 2019. 

 

Chemical substance BNF code
Roflumilast 0303030B0

For more details on the methodology see the Gold COPD resource

Last edited: 6 October 2020 4:18 pm