"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

Medical Dental Pharmaceutical Information & Registration Unit Ophthalmic Family Practitioner Unit (FPS) Business Services Organisation

Data Available Registration Data: -Patient Level information -Registered population -Immigration/Emigration -Internal Movement -GP Payments Pharmaceutical Data: -Prescription Cost analysis -Drug information -NEW Enhanced Prescription Information Dental Data: -Dentists & Associates -Patient Registrations & Treatments -Dental Payments Ophthalmic Data: -Vouchers for Eye tests & Glasses -Opticians, Ophthalmic Surgeons & -Ophthalmic Payments

Enhanced Prescribing Data 2-D barcode captures all information printed on the prescription, including prescribed drug data, plus some data not visible on the prescription Second 2-D barcode pre-printed on prescription gives GP information

Unique individuals using/accessing Family Practitioner Services in

Current Data Examples

Current Information Percentage People in receipt of drugs for treatment of bacterial infections

Body Invaders Virus Fungus ParasiteBacteria

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

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

Personal identifiers Health & Care Number Removed xyzb Prescribing data at HSC BSO NILS data at NISRA Health & Care Number NILS xyzb One-way encryption EPD NILS One-way encryption xyzb NILS EPD NILS EPD Researcher access Matching Removed

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

Prelim results: Multinomial Logistic Regression – Relative Risks Demographic Factors: Age & Sex Sex1 to 2 Items3 to 5 Items6+ Items Male1.00 Female1.69 ***2.36 ***2.48 *** Age1 to 2 Items3 to 5 Items6+ Items ***1.78 ***1.85 *** ***1.76 ***2.60 *** ***3.21 ***8.20 *** ***2.45 ***8.96 ***

Prelim results: Multinomial Logistic Regression – Relative Risks Demographic Factors: Community Background & Marital Status Models adjusted for Age & Sex Community Background1 to 2 Items3 to 5 Items6+ Items Catholic1.00 Protestant0.95 ***0.94 ***0.85 *** Other/None Marital (16+)1 to 2 Items3 to 5 Items6+ Items Single1.00 Married/Re-married1.21 ***1.27 ***1.31 *** Sep/Div/Widowed1.09 ***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 Items3 to 5 Items6+ Items Degree A’Levels1.10 ***1.16 ** (0.002)1.22 GCSEs1.21 ***1.30 ***1.49 *** No Qualifications1.39 ***1.95 ***2.66 *** Tenure & CV (excl. private renting) 1 to 2 Items3 to 5 Items6+ Items Own Occ 200K+1.00 Own Occ , ***1.22 ***1.23 ** (0.004) Own Occ , ***1.32 ***1.39 *** Own Occ , ***1.47 ***1.57 *** Own Occ less than ***1.60 ***1.92 *** Social Rented1.34 ***1.81 ***2.26 ***

Preliminary analysis only! Next steps for analysis:  more risk factors – variables to include family structure, self- reported 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 Next Steps

 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. Acknowledgements

HSC BSO Family Practitioner Services Website: NILS Research Support Unit Northern Ireland Statistics and Research Agency McAuley House Tel: Website: nils-rsu.census.ac.uk

01 to 23 to 56+ agemalefemalemalefemalemalefemalemalefemaleTotal 0 to 412,21410,8813,0133, ,304 3 to , to 4470,61460,52114,84725,1051,9665, , to 6435,64330,07910,38814,3832,2304, ,35199, ,47525,2933,8676,6371,1312, ,13360,592 Total168,250151,64339,88859,6426,85214,6891,5713,692446,227 Frequencies Table