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Primary Care Medication Safety Surveillance with Integrated Primary and Secondary Care Electronic Health Records: A Cross-Sectional Study

Akbarov, Artur; Kontopantelis, Evangelos; Sperrin, Matthew; Stocks, Susan J.; Williams, Richard; Rodgers, Sarah; Avery, Anthony; Buchan, Iain; Ashcroft, Darren M.


Artur Akbarov

Evangelos Kontopantelis

Matthew Sperrin

Susan J. Stocks

Richard Williams

Sarah Rodgers

Iain Buchan

Darren M. Ashcroft


Introduction: The extent of preventable medication-related hospital admissions and medication-related issues in primary care is significant enough to justify developing decision support systems for medication safety surveillance. The prerequisite for such systems is defining a relevant set of medication safety-related indicators and understanding the influence of both patient and general practice characteristics on medication prescribing and monitoring.

Objective: The aim of the study was to investigate the feasibility of linked primary and secondary care electronic health record data for surveillance of medication safety, examining not only prescribing but also monitoring, and associations with patient- and general practice-level characteristics.

Methods: A cross-sectional study was conducted using linked records of patients served by one hospital and over 50 general practices in Salford, UK. Statistical analysis consisted of mixed-effects logistic models, relating prescribing safety indicators to potential determinants.

Results: The overall prevalence (proportion of patients with at least one medication safety hazard) was 5.45 % for prescribing indicators and 7.65 % for monitoring indicators. Older patients and those on multiple medications were at higher risk of prescribing hazards, but at lower risk of missed monitoring. The odds of missed monitoring among all patients were 25 % less for males, 50 % less for patients in practices that provide general practitioner training, and threefold higher in practices serving the most deprived compared with the least deprived areas. Practices with more prescribing hazards did not tend to show more monitoring issues.

Conclusions:Systematic collection, collation, and analysis of linked primary and secondary care records produce plausible and useful information about medication safety for a health system. Medication safety surveillance systems should pay close attention to patient age and polypharmacy with respect to both prescribing and monitoring failures; treat prescribing and monitoring as different statistical processes, rather than a combined measure of prescribing safety; and audit the socio-economic equity of missed monitoring.


Akbarov, A., Kontopantelis, E., Sperrin, M., Stocks, S. J., Williams, R., Rodgers, S., …Ashcroft, D. M. (2015). Primary Care Medication Safety Surveillance with Integrated Primary and Secondary Care Electronic Health Records: A Cross-Sectional Study. Drug Safety, 38(7), 671-682.

Journal Article Type Article
Acceptance Date Jun 1, 2015
Online Publication Date Jun 23, 2015
Publication Date 2015-07
Deposit Date Mar 20, 2017
Publicly Available Date Mar 20, 2017
Journal Drug Safety
Print ISSN 0114-5916
Electronic ISSN 1179-1942
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 38
Issue 7
Pages 671-682
Keywords Toxicology; Pharmacology (medical); Pharmacology
Public URL
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Akbarov Drug Saf 2015.pdf (1.2 Mb)

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