Lainer Miriam, Vögele Anna, Wensing Michel, Sönnichsen Andreas
a Paracelsus Medical University, Institute of General Practice, Family Medicine and Preventive Medicine , Salzburg , Austria.
Eur J Gen Pract. 2015 Sep;21 Suppl(sup1):14-8. doi: 10.3109/13814788.2015.1043124.
Drug treatment is an important clinical process in primary care that is associated with risk of error and adverse events.
To review currently available research evidence on the topic and to develop a framework, which can help to guide improvement of medication safety.
Systematic reviews were performed on adverse drug events (ADE), their preventability, and on available tools and methods to improve medication safety with a particular focus on information technology. Consensus methods were used to develop a framework to guide the improvement of medication safety based on the findings of our literature review.
The median prevalence rate of ADEs in primary care patients was 12.8%. Only a median of 16.5% of ADEs were preventable and thus could be classified as medication errors. Our review of information technology interventions found that only about half of the studies found a reduction of medication errors. In both reviews, the wide range between studies emphasizes the necessity of a validated medication error classification system. Another important aspect of medication safety appears to be a general lack of safety culture in primary care, which led us to the development of the Salzburg medication safety framework (SaMSaF), based on the MaPSaF tool to improve patient safety. The tool proved to be feasible and useful in a pilot study with several GP practices.
A number of tools and interventions to investigate and enhance medication safety have been identified. Further research is necessary to implement and evaluate current concepts.
药物治疗是基层医疗中的一个重要临床过程，与差错和不良事件风险相关。
回顾关于该主题的现有研究证据，并制定一个有助于指导提高用药安全性的框架。
对药物不良事件（ADE）、其可预防性以及用于提高用药安全性的现有工具和方法进行系统评价，特别关注信息技术。采用共识方法，根据我们文献综述的结果制定一个指导提高用药安全性的框架。
基层医疗患者中ADE的中位患病率为12.8%。只有中位16.5%的ADE是可预防的，因此可归类为用药差错。我们对信息技术干预措施的综述发现，只有约一半的研究发现用药差错有所减少。在这两项综述中，研究之间的广泛差异强调了一个经过验证的用药差错分类系统的必要性。用药安全的另一个重要方面似乎是基层医疗中普遍缺乏安全文化，这促使我们在MaPSaF工具的基础上开发了萨尔茨堡用药安全框架（SaMSaF），以提高患者安全。该工具在对多个全科医生诊所进行的试点研究中被证明是可行且有用的。
已确定了一些用于调查和提高用药安全性的工具和干预措施。有必要进行进一步研究以实施和评估当前的概念。
