SMASH evaluation dataset

ABSTRACT Background. We evaluated the impact of a pharmacist-led Safety Medication dASHboard (SMASH) intervention on medication safety in primary care. Methods and findings. SMASH comprised: (1) training of clinical pharmacists to deliver the intervention; (2) a web-based dashboard providing actionable, patient-level feedback; and (3) pharmacists reviewing individual at-risk patients, and initiating remedial actions or advising general practitioners on doing so. It was implemented in 43 general practices covering a population of 235,595 people in Salford (Greater Manchester), UK. All practices started receiving the intervention between 18 April 2016 and 26 September 2017. We used an interrupted time series analysis of rates of potentially hazardous prescribing and inadequate blood-test monitoring, comparing observed rates post-intervention to extrapolations from a 24-month pre-intervention trend. The number of people registered to participating practices and having one or more risk factors for being exposed to hazardous prescribing or inadequate blood-test monitoring at the start of the intervention was 47,413 (males: 23,073 [48.7%]; mean age: 60 [standard deviation: 21]). At baseline, 95% of practices had rates of potentially hazardous prescribing (composite of 10 indicators) between 0.88% and 6.19%. The prevalence of potentially hazardous prescribing reduced by 27.9% (95% confidence interval [CI], 20.3% to 36.8%, p&lt;0.001) at 24 weeks and by 40.7% (95% CI, 29.1% to 54.2%, p&lt;0.001) at twelve months after introduction of SMASH. The rate of inadequate blood-test monitoring (composite of 2 indicators) reduced by 22.0% (95% CI, 0.2% to 50.7%, p=0.046) at 24 weeks; the change at 12 months (23.5%) was no longer significant (95% CI, -4.5% to 61.6%, p=0.127). After 12 months, 95% of practices had rates of potentially hazardous prescribing between 0.74% and 3.02%. Study limitations include the fact that practices were not randomized, and therefore unmeasured confounders may have influenced our findings. Conclusions. The SMASH intervention was associated with reduced rates of potentially hazardous prescribing and inadequate blood-test monitoring in general practices. This reduction was sustained over 12 months after start of the intervention for prescribing but not for monitoring of medication. There was a marked reduction in the variation in rates of high-risk prescribing between practices.摘要：研究背景。本研究评估了药师主导的安全药物监控仪表盘（Safety Medication dASHboard, SMASH）干预措施对基层医疗用药安全的影响。研究方法与结果：SMASH干预包含三部分内容：（1）对临床药师开展干预实施相关培训；（2）搭建基于网页的仪表盘，提供可操作的患者个体水平反馈信息；（3）由药师对个体高危患者进行评估，启动补救措施或为全科医生提供相关指导。该干预在英国大曼彻斯特都会区索尔福德市的43家全科诊所实施，覆盖人口共计235595人。所有诊所均于2016年4月18日至2017年9月26日期间启动该干预。本研究采用间断时间序列分析法，对潜在危险处方与血液检测监测不规范的发生率展开分析，将干预后观测到的发生率与基于24个月干预前趋势的外推值进行对比。干预启动时，在参与研究的诊所注册且存在至少一项暴露于危险处方或血液检测监测不规范风险因素的患者共47413例，其中男性23073例（占比48.7%），平均年龄60岁（标准差为21）。基线状态下，95%的诊所的潜在危险处方（由10项指标复合而成）发生率介于0.88%至6.19%之间。在SMASH干预实施后24周，潜在危险处方发生率降低了27.9%（95%置信区间[CI]：20.3%~36.8%，p<0.001）；干预后12个月时，该发生率降低了40.7%（95%CI：29.1%~54.2%，p<0.001）。血液检测监测不规范（由2项指标复合而成）的发生率在干预后24周降低了22.0%（95%CI：0.2%~50.7%，p=0.046）；干预后12个月时的变化幅度为23.5%，但该结果不再具有统计学显著性（95%CI：-4.5%~61.6%，p=0.127）。干预实施12个月后，95%的诊所的潜在危险处方发生率介于0.74%至3.02%之间。本研究存在如下局限性：诊所未进行随机分组，因此未测量的混杂因素可能对研究结果造成影响。结论：SMASH干预可降低全科诊所中的潜在危险处方发生率与血液检测监测不规范率。对于处方安全而言，该改善效果在干预启动后12个月内持续存在，但用药监测的改善效果未得到维持。不同诊所间的高危处方发生率差异也出现了显著缩小。