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 forty-three 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%) at 24 weeks and by 40.7% (95% CI, 29.1% to 54.2%) 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%) at 24 weeks and by 23.5% (95% CI, -4.5% to 61.6%) at 12 months. After 12 months, 95% of practices had rates of potentially hazardous prescribing between 0.74% and 3.02%. We did not randomise practices but enrolled them in a naturalistic fashion. All our measurements were based on routinely kept electronic health records.
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.

The dataset contains prevalence rates for 13 medication safety indicators and various composites thereof (column measures), collected across 43 general practices (column practice_id) and 39 periods of 4 weeks (3 years in total; column week). Prevalence rates are described by numerator (column num), denominator (column denom), and percentage (column perc). For further details, see manuscript.