Medication-related harm in New Zealand general practice: a retrospective records review

Abstract

Background: The extent of medication-related harm in general practice is unknown. Aim: To identify and describe all medication-related harm in electronic general practice records. Design and Setting: Retrospective cohort records review study in 44 randomly selected New Zealand general practices for the three years 2011-2013. Methods: Eight general practitioners 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. Results 976/9076 study patients (10.8%) experienced 1,762 medication-related harms over three 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 (1390/1762, 78.9%), but one in five harms were moderate or severe (373/1762, 21.1%); three patients died. Eighteen study patients were hospitalised; after weighting this correlates to a hospitalisation rate of 1.1 per 1000 patient-years. Increasing 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. Conclusion Medication-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.

Risk of medicine-related harms in primary care

“…This retrospective review aimed to identify and describe the incidence of medication-related harms in New Zealand general practices between 2011 and 2013 1. The study used a subset of data from a nationwide retrospective cohort review of general practice electronic health records that was looking at all harms.…”

“…From 2011 to 2013, 7308 (18%) of the included patients received 175 657 prescriptions for 846 different medications 1. There were 1762 medication-related harms in 976/9076 (11%) patient records, involving 255 different medications.…”

“…Cardiovascular medicines (eg, statins and antihypertensives) caused harms in 517/5965 (9%) patients prescribed these medicines with 11/517 classed as severe 1. Anticancer and immunomodulatory agents were taken by a small proportion of patients and had the highest rate of harm (12/131; 16%) but caused no severe harms.…”

“…A retrospective records review found that medication-related harm in general practice in New Zealand was common, but many were minor and unpreventable 1…”

Safer Prescribing and Care for the Elderly (SPACE): a cluster randomised controlled trial in general practice

“…Adverse drug events (ADEs) in primary care are common causing distress and burdening health systems. [2][3][4][5][6][7] About one-fifth of ADEs in primary care may be preventable through safer prescribing. 2 Cardiovascular medications (including anti-platelet medicines) and non-steroidal antiinflammatory drugs (NSAIDs) account for up to a third of serious ADEs in older age-groups, including upper gastrointestinal bleeding, kidney injury and exacerbation of heart failure, so are an important target for improvement.…”