Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

Abstract

BackgroundThere is an urgent need to improve patient safety in the area of medication treatment among the elderly. The aim of this study was to explore which improvement needs and strengths, relating to medication safety, arise from a multi-professional intervention in primary care and further to describe and follow up on the agreements for change that were established within the intervention.MethodsThe SÄKLÄK project was a multi-professional intervention in primary care consisting of self-assessment, peer-review, feedback and written agreements for change. Data were obtained from five primary care units randomised to the intervention group. Reviewer feedback reports and agreements for change were analysed using content analysis.ResultsStrengths that were identified included a committed leadership, work methods to enhance medication safety and access to consultants. Methods for securing an accurate medication list, knowledge and methods of working of the prescriber and patient’s ability to contribute to medication safety were areas that gave rise to three predesigned categories for improvement needs on a local level. Another category became apparent during the analysis; namely learning from mistakes and from results. In all categories, apparent shortcomings were identified. These included inaccurate medication lists, lack of medication reconciliation, lack of time for follow-up of elderly patients, need for further education in geriatrics and pharmacotherapy and lack of information on indication and maximum dosage. An increased number of medication reviews were among the most common agreements for change seen.ConclusionsThis study identified substantial shortcomings, like poorly updated medication lists, which affected medication safety in the participating Swedish primary care units. Similar shortcomings are most likely present in other primary care units in the country. Working together multi-professionally, including performing medication reviews, could be one way of improving medication safety. On the other hand, the individual physician must possess enough pharmaceutical knowledge and the working conditions must allow time for follow-up of prescriptions. Strengths of the primary care unit, such as successful methods of working, must be taken advantage of. The culture in primary care may affect the ability to successfully implement routines that improve patient safety and reduce risk of medication errors.

Drugs, distrust and dialogue –a focus group study with Swedish GPs on discharge summary use in primary care

“…Relevant information was sought via different sources, such as by gaining access to the hospital medical electronic records not normally accessible to the GPs, clearly suggesting failure of the information transfer. Indeed, common medical records is often viewed as a way to improve communication [ 4 , 31 ], but must be kept accurate to be of value [ 4 , 37 ]. A common medical record and medication list was also a general wish for the future in our study, which however does not eliminate the responsibility to work for well-functioning care transitions in the meantime.…”

Elderly at risk in care transitions When discharge summaries are poorly transferred and used –a descriptive study

“…Similar to our results, a recent study from the Netherlands showed one third of in-hospital prescription changes was not or incorrectly documented in the primary care medical record [ 33 ], which is in line with a previous study on post-discharge medication-related information [ 34 ]. According to previous Swedish and American studies, discrepancies between the patients’ intended medication regimen and the medication list in primary care are common [ 35 – 37 ], even with a common medical record [ 35 , 36 ], and the need for great improvement regarding updated medication lists was noted [ 38 ]. An accurate medication list is essential to assess the patient’s symptoms as well as the risks and effects of treatment [ 28 ].…”

“…A common medication list for hospital and primary care was also proposed in the survey free text comments. Even though a common list could increase medication safety, this may fail due to unsatisfactory maintenance and frequent errors [ 35 , 38 ]. In addition, hoping for a future common list does not eliminate the responsibility to keep current medication lists accurate.…”

“…Hence, opinions of a single GP may be represented rather than those of all colleagues. As previously noted, GPs are often individualists that work in their own way, without the management leading the medical work [ 38 ]. It is possible the non-respondents would report updating medication lists and making patient chart entries to a lower extent.…”

An intervention model with self‐assessment and subsequent multi‐professional review might be effective and feasible to improve drug safety in primary healthcare. A survey‐based evaluation of SÄKLÄK2

“…This project was multi‐professional and involved six professional health care organizations with the aim to determine whether an intervention could improve drug safety in elderly patients . The outcome of the project showed promising results . A second project, SÄKLÄK2, was initiated in 2016 in order to further assess the effect of the intervention model and to evaluate the possibility to introduce this model more widely across Sweden.…”