Preventable drug-related morbidity in primary care part 2 - impact of preventable drug-related morbidity

Abstract

Objective: To review the literature on strategies to reduce the risk of preventable drug-related morbidities in primary care. Methods: We searched nine electronic databases, bibliographies of papers, two authoritative internet sites and used personal contacts to identify literature on strategies to improve the safety and the quality of medicines usage in primary care. Results: The combined search strategy yielded 96 potentially relevant references. Those which met our inclusion criteria were divided into reviews and original articles; if available the former were used in the present work. References were further grouped into four not mutually exclusive categories, according to the stage of the medication-use process they were directed at: prescribing, dispensing, administration/compliance and monitoring stages. Five main strategies emerged to improve the safety and quality of the medication-use process in primary care: educational strategies for practitioners, educational strategies for patients, behavioural strategies for patients, computerisation and revision of professional roles. These strategies may be applicable to more than one stage of the medication-use process and comprise a large number of possible interventions, such as academic detailing and workshops, the use of memorandums and information technology to support medicine-taking, computerising patient data, employing informatics to support practitioners decision-making and automated signalling of risk events. Conclusion: Reducing preventable drug-related morbidities in primary care is likely to require the adoption of multiple strategies at different stages of the medication-use process, targeting simultaneously not only people, but also procedures, and the organisation. The implementation of interventions should ideally be guided by evidence on their value. Educational efforts directed to health care professionals and behavioural strategies to enhance patient compliance have been extensively studied, while the use of informatics and the inclusion of pharmacists in therapeutic management need further research to evaluate their benefit.