Noninterventional Studies
| Lead Author (Year) | Setting | Number of Patients or Prescriptions | High-Risk Subpopulation? | Definition of Medical Error | Error Rate | Other Outcomes |
|---|---|---|---|---|---|---|
| Abramson15 (2011) | PC in NY | 2432 paper prescriptions at baseline and 2079 electronic at 1 year | No | PIP—IOM definition of prescribing errors | 16.0% | |
| Abramson16 (2012) | PC in NY | 1629 prescriptions at 3 months postimplementation, 1738 at 1 year | No | PIP—IOM definition of prescribing errors | 4.5% | |
| Al-Busadi17(2020) | Oman PC | 377 patients | Ages 65+ | PIP—Beers, STOPP | 12.7%-17.2% | |
| Almeida18 (2019) | Brazilian PC | 227 patients | ≥ 60 years of age | PIP—Beers | 53.7%-63.4% | |
| Amos19 (2015) | Italy PC | 865,354 patients | Ages 65+ | PIP—own definition (Maio) | 28% had at least one PIP | 8%, 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 PC | 198 patient/provider pairs | No, but limited to a VA outpatient population | ADE—provider or patient report | 26% | 83 ADEs reported in active surveillance versus 1 in passive reporting |
| Aubert21 (2016) | Swiss university PC | 1002 patients | Ages 50-80 | PIP—STOPP PPO—START | PIP 6.7%, PPO 27.5% | > 65 years, 5.6% PIP, 32.2% PPO |
| Avery22 (2013) | England PC | 6048 prescriptions for 1777 patients | No | PIP—own definition | 4.9% | |
| Awad23 (2019) | Kuwait PC | 478 patients, 2645 prescriptions | Ages 65+ | PIP—Beers, STOPP, FORTA, MAI | 44.3%-53.1% | |
| Barry24 (2016) | Northern Ireland PC | 6826 patients | Medicine for dementia dispensed | PIP—STOPP | 64.4% | |
| Ble25 (2015) | UK PC | 13,900 patients | Ages 65+ | PIP—Beers | 38.4% any, 17.4% long-term | |
| Bregnhoj26 (2007) | Danish GP patients | 212 patients, 1621 prescriptions | Age of 65+, taking 5 or medications | PIP—MAI | 94.3% | |
| Brekke27 (2008) | Norwegian GP patients | 85,836 patients | Ages 70+ | PIP—own definition | 18.4% | |
| Bruin-Huisman28 (2017) | Dutch GP patients | 4537 patients per year | Ages 65+ | PIP—STOPP PPO—START | 34.7% PIP, 84.8% PPO | |
| Cahir29 (2014) | Irish PC | 931 patients | Ages 70+ | PIP—STOPP | 42% PIP | Patients 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 PC | 272 patients | Ages 65+ | PIP—STOPP PPO—START | 37.5%-50.7% | |
| Chen31 (2005) | England PC | 37,940 patients | No | PIP—own definition | 0.19% drug-drug, 0.49% drug-disease | Two thirds of PIP medications on PC medication list were started by hospital doctors |
| Clark32 (2007) | Scotland PC | 2513 ADR reports in year 2000 and 1455 ADR reports in 2001 | No | ADE—own definition | The “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 centers | 1400 patients | Ages 70+ | PIP—own definition | 53% | |
| Dhabali34 (2011) | Malaysia University PC | 17,288 patients | No | PIP—own definition | 5.3% | |
| Dhabali35 (2012) | Malaysia University PC | 23,733 patients | No | PIP—own definition | 0.87% | |
| Diaz Hernandez36 (2018) | US federally funded PC | 2218 patients | Ages 65 + with at least one chronic condition who received pharmacy services with 2 or more medications and experienced a medication error or an ADE | Potential ADE and ADE—own definition, several sources | Medication errors 12.5/100, potential ADE 9.4/100, ADE 5.0/100 | |
| Doubova Dubova37 (2007) | Mexico PC | 624 patients | Ages 50+ with nonmalignant pain syndrome who received prescriptions of nonopioid analgesics | PIP—own definition | 80% | |
| Fiss38 (2011) | German PC | 744 patients | Ages 50+ who regularly took one or more drugs, rural areas of Germany, GP home visits | PIP—Beers | 18% | |
| Gnadinger39 (2017) | Switzerland PC | 197 cases of medication incidents 180 physicians (GP and pediatricians) at 144 practices | No | “Medication incidents” self-described | 2.07 per GP per year = 46.5 per 100,000 contacts. | |
| Goren40 (2017) | Turkish PC | 1206 patients | Ages 65+ | PIP—own definition | 33% | 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 PC | 139,404 patients | “Particularly vulnerable” defined by age, pre-existing disease, or pre-existing coprescription. | PIP—STOPPPPO—START | 13.9% | |
| Jayaweera42 (2020) | US PC | 111,461 PCPs who specialized in family medicine, internal medicine, general practice, and geriatric medicine | Medicare Part D patients | PIP—Beers | 4.9% | PIP varied widely across PCPs with the bottom quartile at 1.2% and the top quartile at 10.1% |
| Kheir43 (2014) | Qatar PC | 52 patients, 175 DRPs were identified with an average of 3.4 DRPs per patient | No | DRP—own definition | 3.4 DRPs per patient | The most commonly reported DRPs were nonadherence to drug therapy (31%), need for education and counseling (23%),and ADRs (21%) |
| Khoja44 (2011) | Saudi Arabia PC | 463 prescriptions from public clinics and 2836 from private clinics | No | “Prescription errors”—own definition | 18.7% | 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 PC | 671 patients | 65+ | PIP—Beers | 54.8% in patients exempt from payment, 36.0% for others | |
| Kovacevic46 (2017) | Serbian PC | 388 prescriptions | “Elderly” with polypharmacy | DRP—own definition | 98.2% with at least one DRP | |
| Kunac47 (2014) | New Zealand PC | 376 voluntary reports | No | Medication errors—own definition | 14.7% of reports listed a patient harm | |
| Miller49 (2006) | Australian PC | 8215 patients Each GP was asked to record whether or not each of 30 patients had experienced an ADE in the preceding 6 months | No | ADE—own definition; frequency of hospitalization | 852 patients (10.4%) had experienced ADE | A 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 units | 142 patients | Ages 60+ | PIP—Beers, STOPP | 33.8%-51.8% | |
| Perez51 (2018) | Ireland PC | 38,229 patients | Ages 65+ | PIP—STOPP | 45.3%-51.0% | |
| Ryan52 (2009) | Ireland PC | 500 patients | Ages 65+ and at least 1 medication | PIP—Beers and IPET | 13% | |
| Ryan53 (2009) | Ireland PC | 1329 patients | Ages 65+ and at least 1 medication | PIP—Beers, STOPP PPO—START | 18.3%-21.4% 22.7% | 177 (61.8%) of the potential PIPs identified were of “high severity” |
| Stocks54 (2015) | UK PC | 949,552 patients | No | PIP—own definition | 5.26% | |
| Trinkley55 (2017) | Ohio University PC | 1160 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 change | No | ADE—own definition | Of 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 ameliorable | All ADEs were considered significant; however, only 2 were serious or life-threatening |
| Wallace56 (2017) | Ireland PC | 605 patients for ADE interview; 662 patients for EQ-5 Days-3L questionnaire; 806 patients for chart review | Ages 70+ | PIP—Beers, STOPP ADE—own definition HRQoL—Euro Quol-5 Dimensions (EQ-5 Days)-3L | 40% STOPP 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 PC | 503 patients in the Belfrail-Med cohort | Ages 80+ | PIP—STOPP PPO—START | PIP 56% PPO 67% | Increase risk of hospitalization (HR 1.26) and mortality (HR 1.39) for underuse but not overuse |
| Wucherer58 (2017) | Germany PC | 446 patients | Ages 70+ with positive screening for dementia | DRP—PIE-Doc®-System | 92.8% | 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.