Medication prescribing errors pertaining to cardiovascular/antidiabetic medications: A prescription audit in primary care

摘要

This study was carried out to identify the medication prescribing errors (MPEs) pertaining to cardiovascular/antidiabetic medications in prescriptions issued to hypertensive and diabetic hypertensive patients. A retrospective, nationwide audit of prescriptions (n=2773) issued by primary care physicians (n=194) of 20 health centres in Bahrain was carried out. Approximately one-quarter of prescriptions ordered by two-thirds of primary care physicians had errors. No significant differences with respect to overall errors were evident in prescriptions ordered by the family physicians and general practitioners. The most common error (in 8.0% of prescriptions) was prescribing β-blockers or diuretics (thiazide) or their combinations to patients on lipid-lowering drugs. Prescribing multiple antihypertensives, often with a similar mechanism, accounted for 2.2% errors: approximately half of these (1.45%) were two angiotensin-converting enzyme inhibitors (ACEIs) co-prescribed and/or ACEIs plus angiotensin-II receptor blockers. In 0.7% of prescriptions, β-blockers were ordered to patients on salbutamol treatment. High-dose metformin (3g/day) was prescribed to approximately 4% diabetic hypertensives; of these, many were elderly patients. Prescribing high-dose glibenclamide (median dose 15mg) to the elderly accounted for 3.6% of the overall errors. Polypharmacy, such as aspirin along with an immediate-release dipyridamole, was prescribed occasionally (0.25%), particularly by the general practitioners (P=0.0139). MPEs are common in primary care, in Bahrain. Some of these prescribing errors have the potential to harm patients. Effective measures to detect and prevent such errors are needed to improve the quality of health care. Standard treatment guidelines and educational interventions are important strategies to achieve these goals.