Medication Safety in Primary Care Practice - Translating Research into Practice

Medication errors in primary care practice cause morbidity; therefore, work is needed to specify relevant measures and conduct interventions to reduce these errors. This project conducted a six month consensus development process to select a set of medication safety measures, followed by a two-year multi-method quality improvement (QI) intervention in 20 independent practices designed to improve practice performance on these measures. The QI intervention included electronic health record (EHR) generated audit and feedback; annual practice-site visits for performance review, academic detailing, EHR clinical decision support training and QI assistance; and annual project network meetings for sharing of "best practice" approaches.

The main objectives of this study were to:

1. Develop a set of medication safety measures relevant for primary care.
2. Incorporate these measures in quarterly performance reports sent to participating practices.
3. Assess the impact of a validated quality improvement model on participating practice performance on these measures over a 24 month period.

The project team successfully achieved these three objectives. The consensus development process produced medication safety measures in five categories: avoiding potentially inappropriate therapy, avoiding potentially inappropriate dosages, avoiding potential drug-drug interactions, avoiding potential drug-disease interactions, and monitoring or prevention of adverse drug events. Strategies adopted to improve medication safety included developing procedures to assure the accurate patient medication lists, greater use of EHR decision support, adopting medication refill protocols, and using performance reports to identify patients with potential prescribing errors. During the intervention, practice performance improved significantly on avoidance of potentially inappropriate therapy, drug-disease interactions, and appropriate monitoring. Practice-level avoidance of potential drug-drug interactions and potentially inappropriate dosages were high at baseline, and did not change significantly over time.