Background: Addressing the problem of preventable drug related morbidity (PDRM) in primary care is a challenge\r\nfor health care systems internationally. The increasing implementation of clinical information systems in the UK and\r\ninternationally provide new opportunities to systematically identify patients at risk of PDRM for targeted medication\r\nreview. The objectives of this study were (1) to develop a set of explicit medication assessment criteria to identify\r\npatients with sub-optimally effective or high-risk medication use from electronic medical records and (2) to identify\r\nmedication use topics that are perceived by UK primary care clinicians to be priorities for quality and safety\r\nimprovement initiatives.\r\nMethods: For objective (1), a 2-round consensus process based on the RAND/UCLA Appropriateness Method\r\n(RAM) was conducted, in which candidate criteria were identified from the literature and scored by a panel of 10\r\nexperts for ââ?¬Ë?appropriatenessââ?¬â?¢ and ââ?¬Ë?necessityââ?¬â?¢. A set of final criteria was generated from candidates accepted at each\r\nlevel. For objective (2), thematically related final criteria were clustered into ââ?¬Ë?topicsââ?¬â?¢, from which a panel of 26 UK\r\nprimary care clinicians identified priorities for quality improvement in a 2-round Delphi exercise.\r\nResults: (1) The RAM process yielded a final set of 176 medication assessment criteria organised under the\r\ndomains ââ?¬Ë?qualityââ?¬â?¢ and ââ?¬Ë?safetyââ?¬â?¢, each classified as targeting ââ?¬Ë?appropriate/necessary to doââ?¬â?¢ (quality) or ââ?¬Ë?inappropriate/\r\nnecessary to avoidââ?¬â?¢ (safety) medication use. Fifty-two final ââ?¬Ë?qualityââ?¬â?¢ assessment criteria target patients with unmet\r\nindications, sub-optimal selection or intensity of beneficial drug treatments. A total of 124 ââ?¬Ë?safetyââ?¬â?¢ assessment\r\ncriteria target patients with unmet needs for risk-mitigating agents, high-risk drug selection, excessive dose or\r\nduration, inconsistent monitoring or dosing instructions. (2) The UK Delphi panel identified 11 (23%) of 47 scored\r\ntopics as ââ?¬Ë?high priorityââ?¬â?¢ for quality improvement initiatives in primary care.\r\nConclusions: The developed criteria set complements existing medication assessment instruments in that it is not\r\nlimited to the elderly, can be implemented in electronic data sets and focuses on drug groups and conditions\r\nimplicated in common and/or severe PDRM in primary care. Identified priorities for quality and safety improvement\r\ncan guide the selection of targets for initiatives to address the PDRM problem in primary care.
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