Interventional Studies
| Lead Author (Year) | Setting | Number of Patients or Prescriptions | High-Risk Subpopulation | Definition of Medical Error | Intervention | Error Rate | Other Outcomes |
|---|---|---|---|---|---|---|---|
| Benson59 (2018) | Australian GP patients | 493 patients | Polypharmacy (5+ medications), diabetes, adherence concerns, asthma/chronic obstructive pulmonary disease, inadequate response to therapy, suspected adverse reaction, patient request, pain management, recent hospital discharge, and medication with a narrow therapeutic index | DRP—own definition | Feedback by pharmacist to GP | 1124 DRPs in 493 consultations, 685/984 (70%) recs accepted. 94% of patients had at least 1 DRP | Pharmacists made a total of 984 recommendations in relation to the 1140 DRPs identified, of which 685 (70%) were recorded as actioned by the GP Harms not measured |
| Clyne60 (2015) | Ireland PC | 196 patients | Ages 70+ | PIP—own definition | Intervention GP participants received a complex, multifaceted intervention Control practices received simple, patient-level PIP feedback | Baseline PIP: 1.31 drugs/patient intervention group, 1.39 in control group Completion PIP: 100% to 52% in the intervention group,100% to 77% in the control group (P = .02) 0.7 PIP per patient intervention, 1.18 control (P = .02) | Harms not measured |
| Clyne61 (2016) | Ireland PC | 196 patients—follow-up of primary study | Ages 70+ | PIP—own definition | Pharmacist feedback as above. | 51% patients with PIP in the intervention group, 76% in the control group (P = .01). The mean number of PIP drugs in the intervention group was 0.61, 1.03 in the control group (P = .01) | Harms not measured |
| Gibert62 (2018) | France PC | 172 patients | Ages 75+ who were taking at least 5 drugs | PIP—STOPP | GPs taught to use STOPP criteria on their own patients | GP's intervention decreased the number of PIMs according to STOPP criteria to 106 and was beneficial for 44.9% of the patients (n = 44). The mean MAI score of all medications and PIMs decreased by 14.3% (P < .001) and 39.1% (P < .001) respectively | Harms not measured |
| Howard63 (2014) | UK PC | 72 general practices 2038 patient records reviewed | Taking one of 8 classes of potentially hazardous medications | Potentially hazardous prescribing—own definition | Intervention practices received simple feedback plus a pharmacist-led information technology complex intervention (PINCER) lasting 12 weeks | Pharmacists recommended 2105 interventions in 74% (95% CI 73, 76; 1516/2038) of cases and 1685 actions were taken in 61% (95% CI 59, 63; 1246/2038) of cases;control group not reported | Harms not measured |
| Leendertse64 (2013) | Netherlands PC | 364 intervention and 310 control patients | Patients with a high risk on medication-related hospitalizations based on old age, use of 5 or more medicines, nonadherence and type of medication used | Medication-related hospital admissions, ADE, survival, quality of life (EQ5D/Visual Analog scale). | The intervention consisted of a patient interview and evaluation of a pharmaceutical care plan. The patient's own pharmacist and GP carried out the intervention. The control group received usual care and was cared for by a GP other than the intervention GP | 6 (1.6%) admissions in intervention group, 10 in control group (3.2%), p = NS | The secondary outcomes were not statistically significantly different either |
| Lenander65 (2014) | Sweden PC | 209 patients | Ages 65+ and 5+ medications | DRP—own definition | The pharmacist reviewed all medications (prescription, nonprescription, and herbal) regarding recommendations and renal impairment, giving advice to patients and GPs. Each patient met the pharmacist before seeing their GP.Control patients received their usual care | No significant difference was seen when comparing change in DRPs between the groups | Groups not balanced at beginning of trial. Harms not measured |
| Lopez-Picazo66 (2011) | Spain PC | 81,805 patients of 265 family physicians | No | Potentially serious drug interactions—own definition | Specially designed software analyzed EHR data and generated reports. Physicians and their patients randomized into 4 groups: control, report, sessions, and face-to-face personal interviews | Overall, a baseline mean of 6.7 interactions per 100 patients, which was reduced to 5.3 interactions after follow-up No difference between the control and report groups | Harms not measured |
| Peek67 (2020) | UK PC | 47,413 patients in 43 general practices | Have 1 or more risk factors for any of the 12 medication safety indicators at the start of the intervention | 12 medication safety indicators (10 relating to potentially hazardous prescribing and 2 to inadequate blood-test monitoring) developed for PINCER | SMASH comprised (1) training of clinical pharmacists to deliver the intervention; (2) a web-based dashboard providing actionable, patient-level feedb ack; and (3) pharmacists reviewing individual at-risk patients and initiating remedial actions or advising general practitionerson doing so | At baseline, 95% of practices had rates of potentially hazardousprescribing (composite of 10 indicators) between 0.88% and 6.19%. The prevalence of potentially hazardous prescribing reduced by 27.9% (95% CI 20.3% to 36.8%, P < .001) at 24 weeks and by 40.7% (95% CI 29.1% to 54.2%, P < .001) at 12 months | Harms not measured |
| Singh68 (2012) | New York PC | 1125 patients preintervention; 1050 patients postintervention | Ages 65+ | ADE—own definition | This was a cluster randomized trial in which 12 practices were each randomized to one of 3 states (4 practices each): (1) team resource management intervention; (2) team resource management intervention with PEA; (3) no intervention (comparison group). | In the “Intervention with PEA” group there was a statistically significant decrease in the overall rate of preventable ADEs after the intervention compared to before (7.4 per 100 patient-years vs 12.6, P = .018) and in the rate of moderate or severe (combined) preventable ADEs (1.6 vs 6.4, P = .035). | Examples of preventable errors include missed allergy, wrong dosage, errors of dispensing, administration errors, and failure to order or complete laboratory monitoring.Harms not measured.Groups were not balanced at baseline |
| Vanderman69 (2017) | Veterans Affairs PC in North Carolina | 1539 patients preinterv ention; 1490 patients postintervention | Ages 65+ | PIP—Beers | Computerized physician order entry in Epic EHR | PIP rate 12.6% preintervention, 12.0% post (p = NS) | Top 10 PIPs 9.0% to 8.3%, (P = .016) Harms not measured |
| Wessell70 (2008) | South Carolina PC | 124,802 patients | Ages 65+ | PIP—Beers | Quarterly performance reports, on-site visits, and annual meetings for 4 years | Always inappropriate 0.41% to 0.33%, rarely appropriate medication decreased from 1.48% to 1.30% | Harms not measured |
| Wessell71 (2013) | 20 PC sites in 14 US states | 49,047 patients | High-risk medication use based on 44 indicators | PIP—own definition | Local performance review, quarterly reports, and academic detailing | Improved 3/5 measures by 2.9% to 4.0%; 2/5 measures unchanged over 2 years | Harms not measured |
Abbreviations: ADE, adverse drug event; Beers, Beer's criteria; DRP, drug-related problem; EHR, electronic health record; GP, general practitioner; MAI, medication appropriateness index; PC, primary care; PEA, practice enhancement associate; PIM, potentially inappropriate medication; PIP, potentially inappropriate prescribing; STOPP, screening tool of old people's prescriptions.