Professional, structural and organisational interventions in primary care for reducing medication errors

Primary care is a unique healthcare environment, distinct from other aspects of the health system, with its own scope of challenges and risks. Primary care systems are structured in a manner where care is coordinated and communicated via a number of health professionals, services and family members, which presents multiple opportunities for error (Australian Commission on Safety and Quality in Healthcare, 2009). Medication management becomes particularly challenging in the primary care setting: patients come into contact with the system at different times and places, may use more than one doctor, clinic or pharmacy and generally administer their own medications (Olaniyan et al, 2015). Medication discrepancies and errors are a global problem, affecting low-, middle- and highincome countries, with errors occurring commonly at care transition in all economic environments (World Health Organization, 2016).

Preventable and non-preventable adverse events related to medication use in primary care significantly contribute to unplanned hospital admissions and mortality (Khalil et al, 2017). Tudor Car et al (2015) identified three top-ranked problems that lead to medication errors: unreconciled medication lists at handover, inadequate patient education on how to manage medications and poor discharge summaries. Stewart and Lynch (2014) showed that medication reconciliation and patient education are effective interventions to reduce medication discrepancies and errors, although they note that it was challenging to implement an effective organisation-wide medication review program.