OBJECTIVE: Outpatient drug complications have not been well studied. We sought to assess the incidence and characteristics of outpatient drug complications, identify their clinical and nonclinical correlates, and evaluate their impact on patient satisfaction. DESIGN:Retrospective chart reviews and patient surveys. SETTING: Eleven Boston-area ambulatory clinics. PATIENTS:We randomly selected 2,248 outpatients, 20 to 75 years old. MEASUREMENTS AND MAIN RESULTS:Among 2,248 patients reporting prescription drug use, 394 (18%) reported a drug complication. In contrast, chart review revealed an adverse drug event in only 64 patients (3%). In univariate analyses, significant correlates of patient-reported drug complications were number of medical problems, number of medications, renal disease, failure to explain side effects before treatment, lower medication compliance, and primary language other than English or Spanish. In multivariate analysis, independent correlates were number of medical problems (odds ratio T herapeutic drugs are a core component of the practice of medicine; 75% of office visits to primary care providers involve the initiation or continuation of drug therapy. 1 Adverse drug events (ADEs), defined as injuries due to drugs, occur commonly in the hospital setting. In the ADE Prevention Study, ADEs occurred at a rate of 6.5 per 100 admissions, and 28% of these events were preventable. 2 Many other studies have also been done to characterize inpatient ADEs. [3][4][5][6] Data suggest that ADEs among outpatients are an important problem as well. A recent meta-analysis suggested that in 1994 more than 1 million outpatients in the United States experienced an ADE that required admission to the hospital, and that 4.7% of admissions were caused by drugs. 7 The study also suggested that there were 106,000 fatal ADEs in the United States in 1994, which would place them between the fourth and sixth leading causes of death, although these projections may be high. 8 A recent study of U.S. death certificates showed that the number of people who reportedly died from medication errors increased by 2. 5-fold from 1983 to 1993, 9 suggesting that the problem may be worsening. However, compared with the inpatient setting, there is relatively little information about ADEs in the ambulatory setting. Estimates of the proportion of outpatients experiencing an ADE per year have ranged from 5% to 35%. 10,11 Several reasons exist for the relative lack of information about ADEs in the ambulatory setting. In contrast to inpatients, outpatients are responsible for both obtaining and administering their medications. Therefore, the process is much less controlled. Also, physicians have less regular contact with outpatients and are less likely to hear about their problems. Chart review also has limitations related to high costs and inadequate documentation. 12 Therefore, previous studies of outpatients have relied heavily on patient report, which has inherent limitations. Dependence on patients' recall during interviews or on re-[

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PURPOSE: Psychiatric disorders and abnormal personality traits are commonly identified in patients complaining of fatigue, most of whom can be diagnosed to have depressive (D), anxiety (A), somatoform (S) or eating (E) disorders. This study was designed to determine the relationship between the prevalence of severe fatigue and the presence of personality pathology in individuals with these psychiatric disorders. METHODS: We analyzed 1197 referrals to an academic psychosomatic medicine outpatient unit. All patients underwent highly structured standardized psychometric and clinical assessments which allowed the categorical classification into D, A, S, and E groups. Within each group, the self-scored severity of fatigue experienced during the week preceding the evaluation was compared for patients with and without personality disorders (P). RESULTS: The one-week prevalence of severe fatigue was 38% in D (N ϭ 324) and 45% in D ϩ P (N ϭ 139), p ϭ NS; 29% in A (N ϭ 216) and 29% in A ϩ P (N ϭ 79), p ϭ NS; 33% in E (N ϭ 99) and 32% in E ϩ P (N ϭ 53), p ϭ NS; and 20% in S (N ϭ 209) and 34% in S ϩ P (N ϭ 78), p Ͻ .01. The difference in fatigue severity was ϩ 5% for D ϩ P vs D (p ϭ NS), ϩ 1% for A ϩ P vs A (p ϭ NS), Ϫ 2% for E ϩ P vs E (p ϭ NS) and 32% for S ϩ P vs S (p Ͻ .01). The greater severity of fatigue had a significant contribution to the difference in the 14-item index of somatic distress only for S vs S ϩ P (p ϭ .03) CONCLUSION: Severe fatigue may be a marker of personality pathology in patients with unexplained somatic complaints who do not suffer from depressive, anxiety or eating disorders. SOMATIC DISTRESS OF THE MENTALLY ILL AND ITS RELATIONSHIP TO PERSONALITY DISORDERS.N Schmitz, N Hartkamp, W Tress, M Franz, P Manu, Department of Psychosomatics and Psychoterapy, Heinrich-Heine-University, Duesseldorf, Germany; Department of Medicine and Department of Psychiatry, Long Island Jewish Medical Center, Glen Oaks, NY PURPOSE: Personality disorders are often invoked by clinicians as a contributing factor to the severity of physical complaints of psychiatric patiens, but the scientific support for this asociation is scant. This study was designed to determine the relationship between somatic distress and the presence of personality pathology in individuals with well-defined psychiatric disorders. METHODS: We analyzed 1437 consective referrals to an academic psychosomatic outpatient unit. Standardized psychometric and clinical evaluations were used to diagnose personality (P), depressive (D), anxiety (A), and somatoform (S) disorders. The assessment of somatic distress was based on the self-rating of the severity of 14 somatic experiences (SE) during the week preceding the evaluation. RESULTS: Compared with D (N ϭ 324), A (N ϭ 216) and S (N ϭ 209), patients with P (N ϭ 392) indicated the lowest severity of somatic distress (p ϭ .001). Patients with the comorbid associations D ϩ P (N ϭ 139) and A ϩ P (N ϭ 79) had experienced milder somatic distress than those with D or A alone (p ϭ .007). In contrast, patients with S...

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