title: Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study.
abstract: Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care.
  
  
  
  We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014.
  
  
  
  The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score.
  
  
  
  Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK. l.tudor.car@imperial.ac.uk.
authors.forename: Lorainne
authors.initials: L
authors.lastname: Tudor Car
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papachristou
authors.affiliation: UCD Conway Institute, gHealth Research Group, The University College Dublin School of Medicine, Dublin, Ireland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gallagher
authors.affiliation: Faculty of Health & Social Care, Health & Social Care Programme, The Open University, Milton Keynes, UK.
authors.forename: Rajvinder
authors.initials: R
authors.lastname: Samra
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Kerri
authors.initials: K
authors.lastname: Wazny
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Mona
authors.initials: M
authors.lastname: El-Khatib
authors.affiliation: Imperial College Health Partners, London, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bull
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.affiliation: Department of Global Health and Population & Department of Health Policy and Management, Harvard, Boston, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Igor
authors.initials: I
authors.lastname: Rudan
authors.affiliation: Health Services and Outcomes Research Programme, LKCMedicine, Nanyang Technological University, Singapore, Singapore.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Bell
authors.affiliation: Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust/UCL School of Pharmacy, London, UK.
authors.forename: Bryony Dean
authors.initials: BD
authors.lastname: Franklin
mesh_terms: D003142:Communication; D011307:Drug Prescriptions / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008131:London; D059065:Medication Reconciliation; D063886:Patient Discharge Summaries / Q000592:standards*; D010353:Patient Education as Topic; D062209:Patient Handoff; D061214:Patient Safety; D019338:Polypharmacy; D011320:Primary Health Care / Q000379:methods*
keywords: Clinicians; Crowd-sourcing; Medication error; Patient safety; Primary care; Priority-setting