Ambulatory Medication Safety in Primary Care: A Systematic Review

Autor: Richard A. Young, Kimberly G. Fulda, Anna Espinoza, Ayse P. Gurses, Zachary N. Hendrix, Timothy Kenny, Yan Xiao
Rok vydání: 2022
Předmět:
Zdroj: J Am Board Fam Med
ISSN: 1558-7118
1557-2625
DOI: 10.3122/jabfm.2022.03.210334
Popis: PURPOSE: To review the literature on medication safety in primary care in the electronic health record era. METHODS: Included studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Searches were in Medline, EMBASE, and SCOPUS from January 1999 to December 2020. 4 investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias. RESULTS: Of 1,464 articles identified, 56 met the inclusion criteria. 43 studies were non-interventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. Others used Beers list (14), Screening Tool of Older Persons’ Prescriptions (STOPP) (13), and others. The most common outcomes were potentially inappropriate prescribing/medications (PIP) (45), adverse drug events (ADEs) (11), and potential prescribing omissions (PPO) (5). Most of the studies only included high-risk sub-populations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm. No studies adjusted results for patient shared decision making, nor measured other patient-oriented harms such as unnecessary hassle and expense, or decreased trust between physician and patient. CONCLUSIONS: This literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms such as Beers and STOPP lists to primary care medication lists significantly overestimates the rate of actual harms.
Databáze: OpenAIRE
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