Table 1.

Noninterventional Studies

Lead Author (Year)SettingNumber of Patients or PrescriptionsHigh-Risk Subpopulation?Definition of Medical ErrorError RateOther Outcomes
Abramson15 (2011)PC in NY2432 paper prescriptions at baseline and 2079 electronic at 1 yearNoPIP—IOM definition of prescribing errors16.0%
Abramson16 (2012)PC in NY1629 prescriptions at 3 months postimplementation, 1738 at 1 yearNoPIP—IOM definition of prescribing errors4.5%
Al-Busadi17(2020)Oman PC377 patientsAges 65+PIP—Beers, STOPP12.7%-17.2%
Almeida18 (2019)Brazilian PC227 patients≥ 60 years of agePIP—Beers53.7%-63.4%
Amos19 (2015)Italy PC865,354 patientsAges 65+PIP—own definition (Maio)28% had at least one PIP8%, 10%, and 14% of individuals were prescribed at least one medication that “should always be avoided,” is “rarely appropriate,” and has “some indications but [is] often misused,” respectively.
Aspinall20 (2002)Pennsylvania Veterans Affairs PC198 patient/provider pairsNo, but limited to a VA outpatient populationADE—provider or patient report26%83 ADEs reported in active surveillance versus 1 in passive reporting
Aubert21 (2016)Swiss university PC1002 patientsAges 50-80PIP—STOPP
PIP 6.7%, PPO 27.5%> 65 years, 5.6% PIP, 32.2% PPO
Avery22 (2013)England PC6048 prescriptions for 1777 patientsNoPIP—own definition4.9%
Awad23 (2019)Kuwait PC478 patients, 2645 prescriptionsAges 65+PIP—Beers, STOPP, FORTA, MAI44.3%-53.1%
Barry24 (2016)Northern Ireland PC6826 patientsMedicine for dementia dispensedPIP—STOPP64.4%
Ble25 (2015)UK PC13,900 patientsAges 65+PIP—Beers38.4% any, 17.4% long-term
Bregnhoj26 (2007)Danish GP patients212 patients, 1621 prescriptionsAge of 65+, taking 5 or medicationsPIP—MAI94.3%
Brekke27 (2008)Norwegian GP patients85,836 patientsAges 70+PIP—own definition18.4%
Bruin-Huisman28 (2017)Dutch GP patients4537 patients per yearAges 65+PIP—STOPP
34.7% PIP, 84.8% PPO
Cahir29 (2014)Irish PC931 patientsAges 70+PIP—STOPP42% PIPPatients with ≥ 2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21), have a significantly lower mean HRQoL utility (adjusted coefficient −0.09), and nearly a 2‐fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85).
Castillo-Paramo30 (2014)Spanish PC272 patientsAges 65+PIP—STOPP
Chen31 (2005)England PC37,940 patientsNoPIP—own definition0.19% drug-drug, 0.49% drug-diseaseTwo thirds of PIP medications on PC medication list were started by hospital doctors
Clark32 (2007)Scotland PC2513 ADR reports in year 2000 and 1455 ADR reports in 2001NoADE—own definitionThe “top 10” medications accounted for 1715 of 2817 (60.9%, 95% CI 59.1, 62.7) ADE reports but only 2.2 million out of a total of 128 million primary care prescriptions (1.7%).
Corona-Rojo33 (2009)Mexico public health centers1400 patientsAges 70+PIP—own definition53%
Dhabali34 (2011)Malaysia University PC17,288 patientsNoPIP—own definition5.3%
Dhabali35 (2012)Malaysia University PC23,733 patientsNoPIP—own definition0.87%
Diaz Hernandez36 (2018)US federally funded PC2218 patientsAges 65 + with at least one chronic condition who received pharmacy services with 2 or more medications and experienced a medication error or an ADEPotential ADE and ADE—own definition, several sourcesMedication errors 12.5/100, potential ADE 9.4/100, ADE 5.0/100
Doubova Dubova37 (2007)Mexico PC624 patientsAges 50+ with nonmalignant pain syndrome who received prescriptions of nonopioid analgesicsPIP—own definition80%
Fiss38 (2011)German PC744 patientsAges 50+ who regularly took one or more drugs, rural areas of Germany, GP home visitsPIP—Beers18%
Gnadinger39 (2017)Switzerland PC197 cases of medication incidents 180 physicians (GP and pediatricians) at 144 practicesNo“Medication incidents” self-described2.07 per GP per year = 46.5 per 100,000 contacts.
Goren40 (2017)Turkish PC1206 patientsAges 65+PIP—own definition33%They detected 29 (0.9%) A, 380 (11.8%) B, 2494 (77.7%) C, 289 (9%) D, and 18 (0.6%) X risk rating category PIPs
Guthrie41 (2011)UK PC139,404 patients“Particularly vulnerable” defined by age, pre-existing disease, or pre-existing coprescription.PIP—STOPPPPO—START13.9%
Jayaweera42 (2020)US PC111,461 PCPs who specialized in family medicine, internal medicine, general practice, and geriatric medicineMedicare Part D patientsPIP—Beers4.9%PIP varied widely across PCPs with the bottom quartile at 1.2% and the top quartile at 10.1%
Kheir43 (2014)Qatar PC52 patients, 175 DRPs were identified with an average of 3.4 DRPs per patientNoDRP—own definition3.4 DRPs per patientThe most commonly reported DRPs were nonadherence to drug therapy (31%), need for education and counseling (23%),and ADRs (21%)
Khoja44 (2011)Saudi Arabia PC463 prescriptions from public clinics and 2836 from private clinicsNo“Prescription errors”—own definition18.7%Type B errors were detected in 8.0% versus 6.0% of drugs prescribed by public and private clinics, respectively, and type C errors were found in 2.2% versus 1.1% drugs prescribed by public and private clinics, respectively
Komagamine45 (2018)Japan hospital PC671 patients65+PIP—Beers54.8% in patients exempt from payment, 36.0% for others
Kovacevic46 (2017)Serbian PC388 prescriptions“Elderly” with polypharmacyDRP—own definition98.2% with at least one DRP
Kunac47 (2014)New Zealand PC376 voluntary reportsNoMedication errors—own definition14.7% of reports listed a patient harm
Miller49 (2006)Australian PC8215 patients Each GP was asked to record whether or not each of 30 patients had experienced an ADE in the preceding 6 monthsNoADE—own definition; frequency of hospitalization852 patients (10.4%) had experienced ADEA GP severity rating for the most recent ADE was provided for 551 patients. Over half (53.9%) were rated as having a “mild” event(s), with a third rated as “moderate.” A “severe” rating was given for 55 patients (10.0% of those with an ADE or 6.7 per 1000 patients sampled). Responses to the question on hospitalization were received for 223 patients in survey 2. Of these, 7.6% (95% CI, 3.6 to 11.6) had been hospitalized as a result of the most recent ADE (9.7 per 1000 patients in the total sample). Preventability was judged for 327 patients in survey 3. GPs classified the ADE as preventable for 23.2% (95% CI, 17.4 to 29.1), made up of 19.9% of “mild” events, 25% of “moderate” and 32% of “severe” events
Oliveira50 (2015)Brazilian family health units142 patientsAges 60+PIP—Beers, STOPP33.8%-51.8%
Perez51 (2018)Ireland PC38,229 patientsAges 65+PIP—STOPP45.3%-51.0%
Ryan52 (2009)Ireland PC500 patientsAges 65+ and at least 1 medicationPIP—Beers and IPET13%
Ryan53 (2009)Ireland PC1329 patientsAges 65+ and at least 1 medicationPIP—Beers, STOPP
177 (61.8%) of the potential PIPs identified were of “high severity”
Stocks54 (2015)UK PC949,552 patientsNoPIP—own definition5.26%
Trinkley55 (2017)Ohio University PC1160 patients A pharmacist performed a comprehensive EHR review and conducted a telephone interview with each of the respective participants at 7-21 days (first screen) and 30- 60 days (second screen) following a medication changeNoADE—own definitionOf the 701 participants and 1368 unique medication changes, 226 (32%) suspected ADEs were identified; 30% of the suspected ADEs were deemed to be “definite” or “probable” following causality assessment, 21% of the 68 ADEs were preventable, and 40% were ameliorableAll ADEs were considered significant; however, only 2 were serious or life-threatening
Wallace56 (2017)Ireland PC605 patients for ADE interview; 662 patients for EQ-5 Days-3L questionnaire; 806 patients for chart reviewAges 70+PIP—Beers, STOPP
ADE—own definition
HRQoL—Euro Quol-5 Dimensions (EQ-5 Days)-3L
26% Beers
74% ≥ 1 ADE
In multivariable analysis ≥2 Beers 2012 PIP was not associated with ADEs (adjusted incidence rate ratio 1.00 [95% CI 0.78, 1.29]), poorer HRQoL (adjusted coefficient −0.05 [95% CI −0.11, 0.003]), A&E visits (adjusted OR 1.54 [95% CI 0.88, 2.71]), or emergency admission (adjusted OR 0.72 [95% CI 0.41, 1.28]). At baseline, the prevalence of ≥ 1 PIP was 40% (n = 243), with 362 (60%) participants prescribed no PIP, 142 (24%) 1 PIP, and 101 (16%) ≥ 2 PIPs
Wauters57 (2016)Belgium PC503 patients in the Belfrail-Med cohortAges 80+PIP—STOPP
PIP 56%
PPO 67%
Increase risk of hospitalization (HR 1.26) and mortality (HR 1.39) for underuse but not overuse
Wucherer58 (2017)Germany PC446 patientsAges 70+ with positive screening for dementiaDRP—PIE-Doc®-System92.8%Problems related to administration and compliance were the most common group of DRPs (59.9% of registered DRPs; n = 645), followed by problems with drug interactions (16.7%; n = 180), problems with inappropriate drug choice (14.7%; n = 158), problems with the dosage (6.2%; n = 67), and problems with ADEs (2.5%; n = 27)
  • Abbreviations: A&E, accident & emergency; ADE, adverse drug event; ADR, adverse drug reaction; Beers, Beer's criteria; DRP, drug-related problem; EHR, electronic health record; FORTA, fit for the aged; GP, general practitioner; HRQoL, health-related quality of life; IOM, Institute of Medicine; MAI, medication appropriateness index; PC, primary care; PCP, primary care physician; PIP, potentially inappropriate prescribing; PPO, potential prescribing omission; START, screening tool to alert to right treatment; STOPP, screening tool of old people's prescriptions.