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| Watch What You Take
Risks lurk within combined medications and supplements |
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By Janice Kleinschmidt
 Jupiter Images |
Adverse drug reactions account for more than 700,000 emergency room visits a year in the United States, about half of those among individuals 65 and older. One out of six patients requires hospital admission, observation in an emergency department, or transfer to another healthcare facility.
Those numbers, described as a conservative estimate, come from a two-year study by the U.S. Centers for Disease Control and Prevention, U.S. Consumer Product Safety Commission, and U.S. Food and Drug Administration. The study does not include deaths, because such cases are not completely captured by emergency department records. Nor did the study look at “adverse drug events” (ADEs) treated in doctors’ offices and urgent-care centers or those that went untreated.
For purposes of the study, “drugs” include not only prescription and over-the-counter drugs, but also vaccines, vitamins, dietary supplements, and herbal products. However, the five most common drug classes related to ADEs were insulin, opioid-containing analgesics (painkillers), anticoagulants (blood thinners), amoxicillin-containing agents (antibiotics), and anti-histamines/cold remedies. Sixteen of the 18 drugs most commonly causing ADEs have been in clinical use for more than 20 years.
“All of the 18 drugs most commonly implicated in ADEs are commonly used medications, and the fact that 16 of these have been in clinical use for more than 20 years attests to their usefulness, but it reminds us that even these familiar drugs can cause problems for some patients,” says Dr. Dan Budnitz, lead author of the study.
Individuals 65 years and older accounted for a quarter of ADEs and half of ADEs requiring hospitalization in hospital records analyzed from 2004 and 2005. Published in the Journal of the American Medical Association (Oct. 18, 2006), the study concludes that this finding “highlights the importance of directing ADE prevention efforts to this vulnerable population.”
“Identifying appropriate measures of drug exposure and evaluating drug risks in relation to drug benefits remain important challenges in improving the quality of outpatient drug therapy,” write six doctors involved in the study. “In the future, data from electronic health records may provide national, real-time data on outpatient drug safety. Until then, leveraging existing public health surveillance systems provides a feasible, cost-efficient way to monitor the national health burden of outpatient drug safety problems and helps target prevention strategies tailored to the specific events of greatest population burden.”
Budnitz of the Centers for Disease Control says the CDC continues to collect and analyze data to develop procedures that reduce ADEs. Those procedures include getting information out to patients through pamphlets and Web sites, encouraging doctors not to use abbreviations when writing prescriptions, and, in extreme cases, removing drugs from the market.
“In the future, we hope to see the data which we collect show that safety interventions are working to reduce the number of injuries due to adverse drug events,” Budnitz says.
Curtailing Bad Reactions
What should patients do?
“Many of the medications resulting in ADEs are life-saving, and patients should continue to take their medications as prescribed by their physician,” says Dr. Dan Budnitz of the U.S. Centers for Disease Control. Additionally, he says, patients should:
Recognize that all drugs have risks and learn more about the specific risks of the medications they are taking.
Bring their medications to doctors’ visits and inform their doctors what prescription drugs, over-the-counter drugs, and supplements they take.
Ask their doctors, nurses, and pharmacists about possible adverse effects and recommended monitoring of their drugs.
What should physicians do?
“This study should help remind doctors that it’s the well-known adverse effects of certain commonly prescribed drugs that cause the most serious adverse events leading to emergency visits,” Budnitz says. Doctors also should:
Inform patients of both benefits and risks of medications (and what do if adverse effects occur).
Work to ensure appropriate monitoring of drugs.
What should healthcare and patient safety organizations, government agencies, and other policy-makers do?
“Improving drug safety takes a partnership of all of these organizations, as well as individual patients and individual healthcare professionals,” Budnitz says. They also should:
Focus safety interventions on the drugs, patients, and circumstances that cause the most common and most severe ADEs. That includes diabetes medications, blood thinners, seizure medications, and other drugs that typically require regular monitoring of blood levels to prevent acute toxicity.
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