Abstract
BackgroundThe extent of medication-related harm in general practice is unknown.AimTo identify and describe all medication-related harm in electronic general practice records. The secondary aim was to investigate factors potentially associated with medication-related harm.Design and settingRetrospective cohort records review study in 44 randomly selected New Zealand general practices for the 3 years 2011–2013.MethodEight GPs reviewed 9076 randomly selected patient records. Medication-related harms were identified when the causal agent was prescribed in general practice. Harms were coded by type, preventability, and severity. The number and proportion of patients who experienced medication-related harm was calculated. Weighted logistic regression was used to identify factors associated with harm.ResultsIn total, 976 of 9076 patients (10.8%) experienced 1762 medication-related harms over 3 years. After weighting, the incidence rate of all medication-related harms was 73.9 harms per 1000 patient–years, and the incidence of preventable, or potentially preventable, medication-related harms was 15.6 per 1000 patient–years. Most harms were minor (n = 1385/1762, 78.6%), but around one in five harms were moderate or severe (n = 373/1762, 21.2%); three patients died. Eighteen study patients were hospitalised; after weighting this correlates to a hospitalisation rate of 1.1 per 1000 patient–years. Increased age, number of consultations, and number of medications were associated with increased risk of medication-related harm. Cardiovascular medications, antineoplastic and immunomodulatory agents, and anticoagulants caused most harm by frequency and severity.ConclusionMedication-related harm in general practice is common. This study adds to the evidence about the risk posed by medication in the real world. Findings can be used to inform decision making in general practice.
Highlights
The extent of medication-related harm in general practice is unknown
Event reporting, and compensation claims provide a limited perspective on medication-related harm in the real world, producing data not typically generalisable to general practice populations
This study examined medication-related harm in general practice using a subset of data from a nation-wide retrospective cohort review of general practice electronic health records that looked at all harms.[10,11]
Summary
The extent of medication-related harm in general practice is unknown. Reducing medication-related harm is a top priority for improving patient safety.[1,2] Primary healthcare settings remain relatively unexamined for patient harm.[3] It is possible patient harm in general practice has been underestimated.[4] Medicationrelated harm accounts for around 3% of all hospital admissions on average, with higher rates observed in older people.[5,6,7,8]. Event reporting, and compensation claims provide a limited perspective on medication-related harm in the real world, producing data not typically generalisable to general practice populations. Population-based records review research can identify harms experienced in the course of routine clinical care and identify patients at increased risk of harm to improve patient safety.[9]
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