RT Journal Article SR Electronic T1 Ambulatory Medication Safety in Primary Care: A Systematic Review JF The Journal of the American Board of Family Medicine JO J Am Board Fam Med FD American Board of Family Medicine SP 610 OP 628 DO 10.3122/jabfm.2022.03.210334 VO 35 IS 3 A1 Richard A. Young A1 Kimberly G. Fulda A1 Anna Espinoza A1 Ayse P. Gurses A1 Zachary N. Hendrix A1 Timothy Kenny A1 Yan Xiao YR 2022 UL http://www.jabfm.org/content/35/3/610.abstract AB 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. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.Results: Of 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (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.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 to primary care medication lists significantly overestimates rate of actual harms.