Department of General Practice and Rural Health, Otago Medical School, Dunedin Campus, University of Otago, Dunedin, New Zealand.
Department of Family Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain (RCSI Bahrain), Adliya, Bahrain.
Br J Gen Pract. 2021 Jul 29;71(709):e626-e633. doi: 10.3399/BJGP.2020.1126. Print 2021 Aug.
The extent of medication-related harm in general practice is unknown.
To identify and describe all medication-related harm in electronic general practice records. The secondary aim was to investigate factors potentially associated with medication-related harm.
Retrospective cohort records review study in 44 randomly selected New Zealand general practices for the 3 years 2011-2013.
Eight GPs reviewed 9076 randomly selected patient records. Medication-related harms were identified when the causal agent was prescribed in general practice. Harms were coded by type, preventability, and severity. The number and proportion of patients who experienced medication-related harm was calculated. Weighted logistic regression was used to identify factors associated with harm.
In total, 976 of 9076 patients (10.8%) experienced 1762 medication-related harms over 3 years. After weighting, the incidence rate of all medication-related harms was 73.9 harms per 1000 patient-years, and the incidence of preventable, or potentially preventable, medication-related harms was 15.6 per 1000 patient-years. Most harms were minor ( = 1385/1762, 78.6%), but around one in five harms were moderate or severe ( = 373/1762, 21.2%); three patients died. Eighteen study patients were hospitalised; after weighting this correlates to a hospitalisation rate of 1.1 per 1000 patient-years. Increased age, number of consultations, and number of medications were associated with increased risk of medication-related harm. Cardiovascular medications, antineoplastic and immunomodulatory agents, and anticoagulants caused most harm by frequency and severity.
Medication-related harm in general practice is common. This study adds to the evidence about the risk posed by medication in the real world. Findings can be used to inform decision making in general practice.
目前尚不清楚普通实践中与药物相关的伤害程度。
确定并描述电子普通实践记录中的所有与药物相关的伤害。次要目的是调查与药物相关的伤害潜在相关的因素。
2011-2013 年，在 44 家随机选择的新西兰普通实践中进行回顾性队列记录研究。
8 名全科医生审查了 9076 名随机选择的患者记录。当在普通实践中开出处方时，会确定与药物相关的伤害。伤害按类型、可预防程度和严重程度进行编码。计算经历与药物相关的伤害的患者人数和比例。使用加权逻辑回归来确定与伤害相关的因素。
在 3 年期间，共有 9076 名患者中的 976 名（10.8%）经历了 1762 次与药物相关的伤害。经加权后，所有与药物相关的伤害发生率为每 1000 患者年 73.9 例，可预防或潜在可预防的与药物相关的伤害发生率为每 1000 患者年 15.6 例。大多数伤害是轻微的（=1385/1762，78.6%），但大约五分之一的伤害是中度或重度的（=373/1762，21.2%）；有 3 名患者死亡。18 名研究患者住院；经加权后，这相当于每 1000 患者年的住院率为 1.1 例。年龄增加、就诊次数增加和用药数量增加与与药物相关的伤害风险增加相关。心血管药物、抗肿瘤和免疫调节药物以及抗凝剂因频率和严重程度而导致最多的伤害。
普通实践中的与药物相关的伤害很常见。本研究增加了关于药物在现实世界中带来的风险的证据。研究结果可用于为普通实践中的决策提供信息。
