Use of prescribing indicators as a means of identifying variation in the prevalence of valproate prescribing between health communities: a cross-sectional study

Evans, Andrew, Hinchliffe, Anne, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631 and Carson-Stevens, Andrew ORCID: https://orcid.org/0000-0002-7580-7699 2020. Use of prescribing indicators as a means of identifying variation in the prevalence of valproate prescribing between health communities: a cross-sectional study. Integrated Healthcare Journal 2 (1) , e000022. 10.1136/ihj-2019-000022

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Abstract

Objective To determine the appropriateness of valproate prescribing indicators in England and Wales as a means of identifying variation in the prevalence of valproate use among women and girls of childbearing potential between health communities. Methods and analysis Cross-sectional study using an ecological design using routinely published, publicly available valproate prescribing data for the period January to March 2019 and 2018 mid-year population estimates. Results In England and Wales, 87.7 people in every 1000 people prescribed valproate were women or girls aged 14–45 years (range 60.4–133.2). The prevalence of valproate use among all women and girls of childbearing age was 1.49 cases per 1000 women and girls aged 14–45 years (range 0.47–3.13). Considerable variation in prevalence was observed depending on which of two measures was used. The relative risk of exposure between health communities increased from 2.2 to 6.6 depending on the measure used, leading to the identification of different health communities being a priority for action. Wide variation was observed in the prevalence of valproate use among individuals other than women and girls aged 14–45 years (mean prevalence 3.89 cases per 1000 population, range 2.42–7.78). The prevalence of valproate use in all Clinical Commissioning Groups and Local Health Boards was lower in the at-risk population than in the rest of the population (p=0.046) with a strong positive correlation observed between the prevalence of valproate use in these two groups (p<0.001). Conclusion Current indicators may lead to a failure to systematically review women and girls of childbearing age prescribed valproate. Urgent consideration should be given to changing the indicators used in England and Wales.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license
Publisher:	BMJ Publishing Group
ISSN:	2399-5351
Date of First Compliant Deposit:	12 February 2021
Date of Acceptance:	17 September 2020
Last Modified:	06 May 2023 05:14
URI:	https://orca.cardiff.ac.uk/id/eprint/138518

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