Table 2.

Interventional Studies

Lead Author (Year)SettingNumber of Patients or PrescriptionsHigh-Risk SubpopulationDefinition of Medical ErrorInterventionError RateOther Outcomes
Benson59 (2018)Australian GP patients493 patientsPolypharmacy (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 indexDRP—own definitionFeedback by pharmacist to GP1124 DRPs in 493 consultations, 685/984 (70%) recs accepted. 94% of patients had at least 1 DRPPharmacists 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 PC196 patientsAges 70+PIP—own definitionIntervention 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 PC196 patients—follow-up of primary studyAges 70+PIP—own definitionPharmacist 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 PC172 patientsAges 75+ who were taking at least 5 drugsPIP—STOPPGPs taught to use STOPP criteria on their own patientsGP'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) respectivelyHarms not measured
Howard63 (2014)UK PC72 general practices 2038 patient records reviewedTaking one of 8 classes of potentially hazardous medicationsPotentially hazardous prescribing—own definitionIntervention practices received simple feedback plus a pharmacist-led information technology complex intervention (PINCER) lasting 12 weeksPharmacists 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 reportedHarms not measured
Leendertse64 (2013)Netherlands PC364 intervention and 310 control patientsPatients with a high risk on medication-related hospitalizations based on old age, use of 5 or more medicines, nonadherence and type of medication usedMedication-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 = NSThe secondary outcomes were not statistically significantly different either
Lenander65 (2014)Sweden PC209 patientsAges 65+ and 5+ medicationsDRP—own definitionThe 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 careNo significant difference was seen when comparing change in DRPs between the groupsGroups not balanced at beginning of trial.
Harms not measured
Lopez-Picazo66 (2011)Spain PC81,805 patients of 265 family physiciansNoPotentially serious drug interactions—own definitionSpecially designed software analyzed EHR data and generated reports. Physicians and their patients randomized into 4 groups: control, report, sessions, and face-to-face personal interviewsOverall, 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 PC47,413 patients in 43 general practicesHave 1 or more risk factors for any of the 12 medication safety indicators at the start of the intervention12 medication safety indicators (10 relating to potentially hazardous prescribing and 2 to inadequate blood-test monitoring) developed for PINCERSMASH 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 soAt 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 monthsHarms not measured
Singh68 (2012)New York PC1125 patients preintervention; 1050 patients postinterventionAges 65+ADE—own definitionThis 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 Carolina1539 patients preinterv ention; 1490 patients postinterventionAges 65+PIP—BeersComputerized physician order entry in Epic EHRPIP 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 PC124,802 patientsAges 65+PIP—BeersQuarterly performance reports, on-site visits, and annual meetings for 4 yearsAlways 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 states49,047 patientsHigh-risk medication use based on 44 indicatorsPIP—own definitionLocal performance review, quarterly reports, and academic detailingImproved 3/5 measures by 2.9% to 4.0%; 2/5 measures unchanged over 2 yearsHarms 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.