Study: Medication Problems Cause 12% of ER Visits
One in nine patients shows up at the ER because of medication-related problems, Canadian docs are reporting.
Side effects accounted for 38% of the drug-related problems that sent people to the ER, while failing to take medicine as prescribed led to 28% of the cases, the authors found. Also included in the total were cases where patients were prescribed a non-optimal dose of a drug, or had a known problem that should have been treated with medication.
Most of the cases–68%–were deemed preventable.
The study is based on a close look at all the patients who showed up at the ER of Vancouver General Hospital over a 12-week period last year. It was a collaboration between ER docs and pharmacists, and it’s published in the Canadian Medical Association Journal.
The figures suggest a far higher percentage of medication-related cases than some previous reports. This 2006 analysis from JAMA found that drug side effects accounted for only 0.6% of ER visits in the U.S. That study didn’t look at things like problems with adherence or dosage levels. And the CMAJ study may have picked up more cases by including pharmacists in the research process, the authors note.
“We have to acknowledge we have a problem,” the lead author told the Globe and Mail in Canada. “We don’t need more [emergency department] visits, we don’t need people bouncing back to hospital just after being discharged with an adverse event.”
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Based on a comparison of the Canadian study vs. the JAMA study of 2006, it’s clear that Canada has a 20 times greater incidence of ER visits for medication-related problems than the USA. Perhaps under the Canadian socialized type of healthcare system doctors don’t spend as much time explaining how and when to use medications as USA doctors do, and perhaps patients don’t listen as well. While our system is not perfect it certainly has many advantages. Something for the presidential candidates to think about.
Robert Cykiert, M.D.
WhatDoctorsThink.com
Duh. Medication is used to treat EVERYTHING. Failure to take medicine as prescribed? If you miss one dose, I guess that’s failure to take medicine as presscribed. Bill Clinton didn’t take his cholesterol medication and blood pressure mediciation when he was in the White House. I guess the fact that he needed bypass surgery a few years ago can be attributed to medication noncompliance.
Dr. Cykiert, you might want to look at this site on medication sense regarding deaths in the US.
“Prescription medications are vitally important for treating medical conditions, but they are also the #4 leading cause of death, cause more than 1 million hospitalizations annually, and are a major cause of disability and drug dependency.3 Over-use of medications is rampant.”
As one who has suffered numerous side effects from meds, including a hearing loss, I am so tired of the patient being blamed. Of course, my complaints were routinely minimized which isn’t surprising in light of a survey showing that patients complaints about anti cholestorol drugs were blown off.
AA
My mom uses a pharmacy packaging system to keep all her medications in order. It’s called Dosetrak.
dosetrak.com
It appears that the ER is used in a different fashion between the US and Canada. Many of those in US ERs are without ANY doctor at all. Others use it for routine care like a UTI that could easily rendered elsewhere.
Dr Cykiert—He was just kidding, or at least I hope so..
Patients need care from their physicians and pharmacists to assure proper medication use, follow up and adjustment when needed. Other than professional pride, there are no economic incentives to spend the time required with patients to do this. The challenges of health literacy and medication complexity need to be faced by policy makers in order to construct a more effective mechanism for rational medication use and behavior.
One American dies in a US hospital from the “proper” prescription of drugs every 5 minutes, 300/day, as per JAMA http://www.ncbi.nlm.nih.gov/pubmed/9555760?dopt=Abstract while 20 times more suffer ’serious’ side effects defined as: permanent disability, more hospitalization or causing death. Add to that the hospital visits for home prescription drug use and: Houston, we’ve got a problem. Those deaths represent 1 jumbo jet/day and if airline companies would crash one 365 days a year above the U.S., we’d all be taking the bus. Any doctors taking responsibility for those deaths and doing something about it? Minimizing the problem Dr. Cykiert does not help.
Old news, Eddie. REALLY old news. The patient population for that study went back to 1966, and it only included people so sick that they were already in the hospital. It was a metaanalysis, and did nothing to look at which deaths were due to the illness vs which were due to an adverse drug reaction. ADRs are an issue we all take seriously, but in real time… not using a meta-analysis on drugs from 40 years ago. Looks like you are paranoid about all drugs, not just statins, eh?
This statistic just cannot be true. Lets not fall prey to the liberal media and its selective reporting on issues like this. Pharmaceutical companies are the backbone of of healthcare system and should not be implicated on issues like this. This is irresponsible reporting.
a major problem with any and all of these studies is that cause and effect are not completely clear. reviewing charts and then trying to discern whether a drug was related is nearly impossible - which is one reason we have such a contentious litigation environment. taking the reported data as gospel is fairly unsophisticated. that there is a problem related to medication administration, compliance and usage is clear. but, as with most things, the issue is not uni-factorial in its constituents and in its causality - which, tangentially and sadly, is why stories such as this get press (because it is reported as a black and white matter) - americans can no longer synthesize complex information and think critically beyond quick sound bites…
Dear Tort Reform, am I missing something? You call the Canadian and American Medical Association Journals ‘liberal media‘. What journals should I be reading instead and where else should Pharma advertise?
As an newly positioned ED pharmacist,in the US, I have witnessed that compliance, adverse drug reactions account for more than 0.6% of our visits. I would estimate the number probably at about 20%.
I agree with ED pharmacist. Just because someone explains how to take medications or the side effects of new medications, does not mean they understand. We must start using teachback to determine what the patients really understood. And finding out if they can get the medication. Patients with low health literacy usually will not admit it and are very good at hiding it.
What blows my mind is that while searching for a way to manage my medications, what I am told to do is to “organize” all of them into one container. Now they are all mixed up and touching each other. This supprised the heck out of me! I found a product that helps me keep track of the doses I am taking thoughout the day and lets me keep my medicine in the original bottle. It’s called Take-n-Slide. It’s very easy to use and very inexpensive. Everyone should definately check into it.
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