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The delivery mode is recorded well in hospital records.2 We used OPCS-4 procedure codes, which are available for 98% of births in HES,50 to derive the mode of delivery and ICD-10 codes for the remaining deliveries. Our estimates showed that the delivery mode is also accurately recorded in primary care using Read codes (98% verified against hospital records). The recording, however, was incomplete (the delivery mode was known for 50% and 69% of children in THIN and CPRD data sets, respectively, with the higher proportion in CPRD due to the supplied data set being restricted to the records in the CPRD pregnancy register). For THIN and CPRD records not linked to HES, we used the Read codes to identify the mode of delivery, which increased the number of children in the sample.
The final stage involved matching national survey data on hospital prophylactic antibiotic administration policies (see National survey data for more details on the survey) to births. This involved identifying the NHS organisation code for each site about which the respondent was answering. This was carried out by cross-checking all of the hospital names with the NHS Coding and Classification Service records. In addition, each site had to be checked to see whether or not its site code had changed during the period of study; this happens when the trust responsible for the site changes. This also involved manual searches on a database of successor and predecessor organisations held by the NHS Coding and Classification Service. Not all deliveries were matched because not all sites replied to the questionnaire. There were some cases where individual units did not collect their site codes with sufficient specificity. This can happen when one trust manages a large number of smaller sites. There is a highly specific site code capable of attributing activity to an individual site; however, some organisations do not use the code appropriately, choosing to apply a more generic code with a trust prefix but no suffix (i.e. the part of the codes that identifies the site specifically). We linked only those questionnaire data where a valid and site-specific code was captured in HES and was the same as a site code attributed to a hospital that had responded to the survey.
In Washington State, 5 insurance carriers administer Medicaid insurance to enrollees. Each pharmacy in Washington State can hold a contract with none, some, or all 5 Medicaid insurance plans; Medicaid enrollees may choose any plan. We obtained the names, addresses, and contact information for pharmacies contracted with each Medicaid insurance plan from each health plan in September, October, and November 2017 through formal requests, direct download, or public record disclosure requests to the Washington Health Care Authority. Using business names, addresses, and telephone numbers, we manually matched data from Medicaid insurance plans to the list of actively licensed pharmacies from the Washington State Department of Health. Lists of insurance plans were sortable by county, city, or pharmacy name to facilitate matching. After matching, 2 study team members reviewed the entire list for accuracy. We then classified pharmacies by zip code. We created a dichotomous indicator for access to a Medicaid-contracted pharmacy (at least 1 pharmacy that was contracted with a Medicaid insurance plan in a zip code).
Geographic patterns of Medicaid-contracted pharmacies in Washington State, 2017, showing the number of pharmacies (top) and the number of pharmacies per 10,000 residents (bottom) in Washington State zip codes that contract with at least 1 Medicaid insurance plan. Inserts show the greater Seattle/Olympia area. 2ff7e9595c
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