One in four has adverse drug reaction
Published 4/16/2003 5:05 PM
BOSTON, April 16 (UPI) -- One in four patients walks out of a doctor's office with a drug prescription that could injure them, Harvard University researchers reported Wednesday.
Researchers, led by Dr. Tejal Gandhi, director of patient safety at Brigham and Women's Hospital and an instructor at Harvard Medical School, surveyed 661 patients from four Boston area primary care practices and found 162 of them suffered one or more medication-related injuries.
There were 182 adverse events in all, the researchers report in the April 17 issue of the New England Journal of Medicine, including 24 serious but non-fatal events. Gandhi estimates 27 out of every 100 patients experience an adverse drug event.
Most drug prescriptions are given to patients visiting doctors' offices, not to hospitalized patients, Gandhi explained, so outpatient drug-related medical errors are potentially a much bigger problem than in-hospital errors.
"Our data indicate that the rate of outpatient adverse drug events may be about four times as high as that reported in hospital studies," Gandhi told United Press International.
Moreover, although medication errors usually can be identified quickly in hospitals, where patients are monitored constantly, "it can take much longer to identify the problem in the community," she said.
The researchers classified the events according to their severity and preventability. In addition to the 24 serious events, 157 events were significant.
"About 10 percent of these events were preventable and another third were ameliorable", meaning the symptoms could have been reduced in duration or severity if the system worked properly, Gandhi said.
Of the 51 adverse drug events categorized as ameliorable, over 60 percent could be attributed to the physician's failure to respond to a patient's medication-related symptoms.
"More than a third of the time patients failed to inform the physician of symptoms, but in several cases the physician did not act when informed of the symptoms," she said, noting, "we don't enough data to determine why the physician didn't act. For example, it may be that the physician decided that the adverse effect was outweighed by the benefit of the drug."
Some events were caused by poor drug selection. For example, an allergic rash that resulted when a patient was prescribed an antibiotic, despite a documented allergy.
"Our data resulted in some clear strategies that can be employed to help reduce the rate of outpatient adverse drug events," said Gandhi. "These would include better education about commonly prescribed medications, increased monitoring for side effects, and using computerized checks for drug dosages and allergies."
Dr. Carol Ley, chair of the National Patient Safety Foundation and medical director for 3-M in St. Paul, Minn., said the Harvard study confirms something her group had suspected: medical errors are more prevalent in the out-patient setting. While calling for more studies to confirm the Harvard report, Ley said there are three ways to cut down on these errors.
"First, every patient should have a primary care physician and that one physician should be a repository for all medical information?including all prescription information," Ley told UPI. "That is the first line of defense."
The next step is the pharmacist, especially pharmacists who use computerized prescription tracking systems that automatically flag prescriptions that may cause drug-drug interactions or that may be contraindicated because of allergies, she said.
In the final analysis, however, Ley said patients are their own best defenders.
"Twice a year every patient should brown-bag it to the doctor's office. By that I mean pile all their pills in a brown bag, take them to the doctor and go over every one to make sure that the prescription is necessary and is being taken in the proper way," she advised.
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