How safe is primary care? A systematic review

IMPORTANCE

Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care.

OBJECTIVE

We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.

EVIDENCE REVIEW

We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised.

FINDINGS

Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2-3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patient's well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm.

CONCLUSIONS AND RELEVANCE

Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.

SYSTEMATIC REVIEW REGISTRATION

This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304).

Documentation of Student Pharmacists' Interventions from Medication Histories in a Primary Care Setting

Background:

Medication safety is a major concern in primary care. Documented interventions by clinical pharmacists have shown positive clinical outcomes. In addition, it has been shown that student pharmacists have positive outcomes when participating in their advanced pharmacy practice experiences (APPEs). Most of this documentation has taken place in hospital settings. No data are available regarding interventions performed when APPE students record medication histories prior to a primary care provider (PCP) appointment.

Objective:

To describe the number and types of interventions made by APPE students in recording medication histories and to describe PCP acceptance rates.

Methods:

This prospective study documented the interventions from medication histories by 2 APPE students. With faculty supervision, the students recorded medication histories and vital signs prior to patient appointments with their PCPs. This was done approximately 1.5 days/week. Recommendations to the PCP were made verbally prior to the patient examination. Type of recommendation made, patient demographics, and PCP acceptance were documented. Descriptive statistics were employed.

Results:

Over 6 weeks, 109 interventions were documented. The mean ± SD patient age was 61.8 ± 14.94 years. The most common interventions documented were laboratory monitoring (22.0%), drug information (17.4%), and patient education (14.7%). Of the applicable interventions, 69% (49/71) were accepted by the PCP.

Conclusions:

APPE students in this clinic provided a variety of recommendations following completion of medication histories. A majority of the interventions were accepted. Such data demonstrate the benefit of including APPE students in patient care.