Reducing Adverse Drug Events

Abstract

Gains in life expectancy in the United States are being eroded at least in part due to the use and misuse of prescribed medications. 1 Earlier this year, the US Centers for Disease Control and Prevention reported that life expectancy for some groups in the United States continues to stagnate. Among middle-aged white women, life expectancy decreased, in large part due to medication overdose, opioid use, and liver disease. 2 In this issue of JAMA, the report by Shehab and colleagues 3 suggests that the burden and patterns of adverse health outcomes due to prescribed medications are broader than previously thought. The authors examined data from visits to 58 emergency departments (EDs) included in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project and identified 42 585 cases of adverse drug events (ADEs) in 2013-2014. The authors estimated that there were 4 ED visits per 1000 individuals for ADEs annually in the United States, and that 27.3% of ED visits for ADEs resulted in hospitalization. Persons aged 65 years or older accounted for an estimated 34.5% of ED visits for ADEs and experienced the highest hospitalization rates (43.6%).Among adults, the majority of ED visits for ADEs was attributed to anticoagulants, antibiotics, medications for diabetes, and opioids. Among children, antibiotics and neuropsychiatric agents were among the most common causes of ED visits for ADEs. Even though this study specifically excluded ED visits for drug withdrawal, therapeutic failure, occupational exposure, intentional overdose, and recreational drug use, Shehab et al 3 still found an estimated 1.3 million ED visits for ADEs, nearly a 10% increase from 2005-2006. The study was designed to identify ED visits related to ADEs; coders were trained to transcribe rather than interpret clinical notes. The ADEs summarized in this study appear to only be a fraction of the total ADEs in the United States.Emergency departments within Veterans Health Administration (VHA) medical centers and other integrated health care systems, such as Kaiser Permanente, were not eligible for inclusion in the NEISS-CADES survey and were therefore not included in the study by Shehab et al. 3 The types of excluded institutions are noteworthy because EDs from integrated health systems such as VHA medical centers may provide unique opportunities to address ADEs. More than 2.3 million ED visits occurred across EDs within VHA medical centers in 2013, 4 many of which were for patients older than 65 years, who were prescribed multiple medications, or both. The VHA medical centers and other integrated health care systems that share clinical data across inpatient and 2092

A dataset quantifying polypharmacy in the United States

“…Similarly high prevalence is reported in other countries (e.g., the United Kingdom 4 , Sweden 5 , China 6 , Brazil 7 , and India 8 . The prevalence of polypharmacy is driven by high rates of comorbidities (in the United States in 2012, 26% of all adults, and 61% of adults over 65 years of age had two or more chronic conditions 9 ), and exacerbated by clinical practices enabling overprescription and insufficient monitoring 10 , 11 . Drug-related morbidity has become a substantial healthcare burden: in the United States, adverse drug reactions are prevalent (causing 4 hospitalizations per 1000 people each year 10 ), serious (among top 10 common causes of death 12 ), and expensive (with associated annual costs estimated at US$30billion 13 to US$180billion 14 ).…”

Community-acquired and hospital-acquired medication harm among older inpatients and impact of a state-wide medication management intervention

“…This is an increase from their 2004–2005 estimate of 2.4 per 1000 individuals 4. In an editorial about this research, Kessler et al 5 argued that the ‘insidious and pervasive diffusion of responsibility’ is a key factor contributing to preventable medication harm, and that…”

DTB Select: 2 | February 2017

“…Comment: The authors of an associated editorial highlight the USA's fragmented healthcare system as one of the possible contributory factors,2 and call for greater collaboration across healthcare providers to help reduce adverse reactions. Previous analysis in the UK found that four drug groups accounted for > 50% of preventable drug-related hospital admissions and 12 drug groups accounted for 80% of such admissions 3,4.…”