Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis

We evaluated the impact of the pharmacist-led Safety Medication dASHboard (SMASH) intervention on medication safety in primary care. SMASH comprised (1) training of clinical pharmacists to deliver the intervention; (2) a web-based dashboard providing actionable, patient-level feedback; and (3) pharm...

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Vydáno v:PLoS medicine Ročník 17; číslo 10; s. e1003286
Hlavní autoři: Peek, Niels, Gude, Wouter T., Keers, Richard N., Williams, Richard, Kontopantelis, Evangelos, Jeffries, Mark, Phipps, Denham L., Brown, Benjamin, Avery, Anthony J., Ashcroft, Darren M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Public Library of Science 13.10.2020
Public Library of Science (PLoS)
Témata:
Adult
Ambulatory care
Audits
Community Pharmacy Services - trends
Computerized physician order entry
Data warehouses
Drug Prescriptions
Electronic Health Records
Feedback
Female
General Practice - methods
Humans
Interrupted Time Series Analysis - methods
Intervention
Laboratories
Male
Medical errors
Medication errors
Medication Errors - prevention & control
Medicine and Health Sciences
Methods
Middle Aged
Patient safety
People and Places
Pharmaceutical care
Pharmacists
Physical Sciences
Prevention
Primary care
Primary health care
Primary Health Care - methods
Quality management
Risk Factors
Safety
Safety - statistics & numerical data
Time series
United Kingdom
United Kingdom
United Kingdom > UK
England
United States > US
ISSN:1549-1676, 1549-1277, 1549-1676
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Shrnutí:We evaluated the impact of the pharmacist-led Safety Medication dASHboard (SMASH) intervention on medication safety in primary care. SMASH comprised (1) training of clinical pharmacists to deliver the intervention; (2) a web-based dashboard providing actionable, patient-level feedback; and (3) pharmacists reviewing individual at-risk patients, and initiating remedial actions or advising general practitioners on doing so. It was implemented in 43 general practices covering a population of 235,595 people in Salford (Greater Manchester), UK. All practices started receiving the intervention between 18 April 2016 and 26 September 2017. We used an interrupted time series analysis of rates (prevalence) of potentially hazardous prescribing and inadequate blood-test monitoring, comparing observed rates post-intervention to extrapolations from a 24-month pre-intervention trend. The number of people registered to participating practices and having 1 or more risk factors for being exposed to hazardous prescribing or inadequate blood-test monitoring at the start of the intervention was 47,413 (males: 23,073 [48.7%]; mean age: 60 years [standard deviation: 21]). At baseline, 95% of practices had rates of potentially hazardous prescribing (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 < 0.001) at 24 weeks and by 40.7% (95% CI 29.1% to 54.2%, p < 0.001) at 12 months after introduction of SMASH. The rate of inadequate blood-test monitoring (composite of 2 indicators) reduced by 22.0% (95% CI 0.2% to 50.7%, p = 0.046) at 24 weeks; the change at 12 months (23.5%) was no longer significant (95% CI -4.5% to 61.6%, p = 0.127). After 12 months, 95% of practices had rates of potentially hazardous prescribing between 0.74% and 3.02%. Study limitations include the fact that practices were not randomised, and therefore unmeasured confounding may have influenced our findings. The SMASH intervention was associated with reduced rates of potentially hazardous prescribing and inadequate blood-test monitoring in general practices. This reduction was sustained over 12 months after the start of the intervention for prescribing but not for monitoring of medication. There was a marked reduction in the variation in rates of hazardous prescribing between practices.
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I have read the journal's policy and the authors of this manuscript have the following competing interests: RNK has received an honorarium for presenting on the topic of schizophrenia (epidemiology, aetiology, presentation and management) at the MORPh Consultancy Ltd Primary Care Pharmacists Training Network Mental Health Event, on 23rd October 2019, Liverpool UK.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1003286