OpenSAFELY and antibiotics
- Posted:
- Written by:
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- Francine Jury,
- Tjeerd Van Staa
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This article is part of a series: The Past, Present and Future of OpenSAFELY
- The past, present and future of OpenSAFELY: Introduction
- How OpenSAFELY works
- Co-pilots give newcomers a helping hand
- Standard tools for data preparation, and federated analytics
- Output checking helps to keep private data safe
- The legal basis: ethics, controls and building trust
- Earning and maintaining trust: PPIE and more
- How OpenSAFELY began
- Consequences of COVID-19 and the role of vaccination
- “No other platform comes close”
- The 'unreal' speed of OpenSAFELY
- Using OpenSAFELY to fight antimicrobial resistance
- OpenSAFELY and antibiotics
- Using OpenSAFELY to carry out a randomised trial
- The OpenSAFELY Collaborative
- Some reflections about funding
- What's next for OpenSAFELY?
Written by Francine Jury and Prof Tjeerd van Staa from the University of Manchester
The OpenSAFELY team at the University of Manchester (UoM) consisted mostly of early career researchers. Using OpenSAFELY gave us a new opportunity to analyse millions of anonymised patient records, but initially there was a steep learning curve. However, the support of the active OpenSAFELY user community, and ability to share programs and codes quickly, enabled the team to learn the necessary skills, and conduct a substantial and impactful amount of research.
Initially we used OpenSAFELY to analyse the impact of COVID-19 on the management of common infection and antibiotic prescribing in primary care. Our research highlighted the substantial challenges around antibiotic prescribing. Key findings included:
- A lack of risk-based prescribing of antibiotics (i.e., patients at low risk of infection-related complications were as likely to be prescribed an antibiotic as high-risk patients)
- A substantial number of patients receiving frequent antibiotics over time. Our research further highlighted increased concerns about the safety of this (patients with a history of frequent antibiotic prescribing with multiple types were at highest risk of developing severe COVID-19)
- Community-acquired sepsis is a significant problem, particularly in patient groups that suffer from health inequalities
There’s a need to strengthen clinical practice with better advice to clinicians, in order to improve targeting and risk-based prescribing of antibiotics.
The UoM eHealth research team used the OpenSAFELY analysis outputs to develop a number of tools with integrated algorithms. These include a series of dashboards that we built on top of local GP software systems in Manchester, that can identify:
- patients frequently prescribed antibiotics
- inappropriately prescribed antibiotics
- practice prescribing by patient risk profiles.
These dashboards are now being used across the north west of England, giving clinical teams an opportunity to audit prescribing for common infections, and identify areas for improvement interventions.
In addition, we’ve built the BRIT2 knowledge support system for clinicians, now being trialled across the north west. It integrates risk scores for infection-related complications that can support clinical decision-making in consultations with patients. The risk scores developed from OpenSAFELY analysis include risks of hospitalisation, antibiotic failure, increased resistance and risk of adverse events.
Being able to analyse millions of patient records through OpenSAFELY allowed the UoM Research team to present to clinicians risks based on hundreds of patients with the same risk profiles as their patient, making visualisation and presentation of information easy to understand and act upon. The UoM eHealth research team will continue to use OpenSAFELY to investigate future applications of these tools that can impact other significant health challenges.