The review includes 91 publications from research and development projects concerning patient safety related to medication use in primary care.In addition, the summary provides an overview of the most important professional guidelines, government regulations and legislation for drug treatment in Norwegian municipalities.

Challenges to face

The prevalence of drug related problems is high in the elderly population, and particularly significant among nursing home residents and patients receiving home health care services. Drugs considered as particularly dangerous to elderly, are in widespread use. The incidence of drug-related problems seem to be related to the user’s age, gender, economics, presence of depression, use of anxiolytics, cognitive decline and risk of falling. It is believed that differences in physician staffing also might be one reasonable explanation to drug-related problems. There are major challenges in regard to documentation, information exchange and interactions related to drug treatment. Discrepancies between medication lists across different settings and healthcare actors are common. Patients themselves state that they lack knowledge about drug use and adverse reactions. When errors and discrepancies are discovered, healthcare actors fail to document and report it. This makes it difficult to learn from the mistakes made.

Effects and experiences of interventions

Experience from quality collaboratives through The Norwegian Patient Safety Programme indicates that participation has provided nursing homes and home care services increased knowledge, awareness and tools that can contribute to safety in drug use. However, whether quality collaboratives causes permanent improvements of practice is not known. Systematic interdisciplinary drug reviews with reconciliation of drug lists makes it easier to detect drug-related problems and helps to reduce inappropriate treatment. Pharmacist’s expertise and contributions in interdisciplinary collaboration is previous focused in several studies, while we know less about the doctor and the nurse’s role and responsibilities in the teamwork. We also lack knowledge about the clinical effect of implementing drug reviews and drug reconciliations. Weaknesses in previous studies’ designs makes it hard to draw evidence-based conclusions. The introduction of multi-dose drug dispensing has reduced the discrepancies between medication lists, and given more consistent drugs from the pharmacies. Meanwhile, we find that multi-dose users may be at higher risk of receiving inappropriate drugs, with the exception of serious drug interactions. Health care professionals’ overview of the patients’ medication has in some cases been reported to be greater, in other cases more difficult. The impression is that both nurses and doctors feel more secure that the patient get the right medicine. However, it is uncertain whether multi-dose dispensing itself ensures the quality of the drug therapy and more appropriate use of medicines.

Need for more knowledge

  • studies measuring clinical efficacy (e.g. adverse reactions, quality of life, hospitalizations and mortality) of quality improvement measures, such as drug reviews and drug reconciliations
  • longitudinal studies that can identify whether quality collaboratives for correct drug use provides actual and permanent practice improvements
  • studies that explore teamwork (both within and between different professions) related to drug treatment • studies describing patients’ experiences of interactions and collaboration with health care professionals related to drug use
  • studies describing how home care patients understand and comply with their drug therapy
  • studies looking at differences among patients at different levels of health care settings, in terms of prevalence and type of drug-related problems