• Richard A Young, Kimberly G Fulda, Anna Espinoza, Ayse P Gurses, Zachary N Hendrix, Timothy Kenny, and Yan Xiao.
• From JPS Hospital Family Medicine Residency Program, Fort Worth, TX (RAY); Department of Family Medicine and Osteopathic Manipulative Medicine, North Texas Primary Care Practice-Based Research Network, University of North Texas Health Science Center, Fort Worth, TX (KGF, AE); Armstrong Institute Center for Health Care Human Factors, School of Medicine, Bloomberg School of Public Health, Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University (APG); University of Texas at Arlington, Arlington, TX (ZNH); Maine Medical Center, Portland, ME (TK); College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX (YX). ryoung01@jpshealth.org.
• J Am Board Fam Med. 2022 May 1; 35 (3): 610628610-628.

PurposeTo review the literature on medication safety in primary care in the electronic health record era.MethodsIncluded studies measured rates and outcomes of medication safety in patients whose prescriptions were written in primary care clinics with electronic prescribing. Four investigators independently reviewed titles and analyzed abstracts with dual-reviewer review for eligibility, characteristics, and risk of bias.ResultsOf 1464 articles identified, 56 met the inclusion criteria. Forty-three studies were noninterventional and 13 included an intervention. The majority of the studies (30) used their own definition of error. The most common outcomes were potentially inappropriate prescribing/medications (PIPs), adverse drug events (ADEs), and potential prescribing omissions (PPOs). Most of the studies only included high-risk subpopulations (39), usually older adults taking > 4 medications. The rate of PIPs varied widely (0.19% to 98.2%). The rate of ADEs was lower (0.47% to 14.7%). There was poor correlation of PIP and PPO with documented ADEs leading to physical harm.ConclusionsThis literature is limited by its inconsistent and highly variable outcomes. The majority of medication safety studies in primary care were in high-risk populations and measured potential harms rather than actual harms. Applying algorithms to primary care medication lists significantly overestimates rate of actual harms.© Copyright 2022 by the American Board of Family Medicine.

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