A recent Canadian study found that adverse drug reactions account for a significant number of emergency room visits in that country annually, highlighting the link between some medications and serious health problems. “Bad things can happen when patients take medication,” said Peter Zed, an associate professor at Dalhousie University and lead author of the study published today in the Canadian Medical Association Journal. “The medications are clearly not benign.”
Researchers studied 1,017 patients treated in the ER at Vancouver General Hospital over a 12-week period in 2006 and found that 12 percent—over one in nine—of all ER visits were medication-related. Adverse drug reactions accounted for nearly 40 percent of the visits and 60 percent of those were unpreventable. In other words, patients experienced problems after taking the medication as directed. Some of the most common issues were pain, delusion, paranoia, and hallucinations, as well as vomiting and other gastrointestinal issues. Many involved bleeding complications, rashes, or other issues that required hospitalization; about 10 percent were severe.
The study also found that non-adherence—when patients don’t take drugs as described—was responsible for about 30 percent of medication-related ER visits. Zed explained that problems with non-adherence are 100 per cent preventable. “The patient makes a choice not to take their medications as prescribed and, as a result, something bad happens,” he said. “It could be cost … [or] they could be experiencing a minor side effect to the medication so they choose not to take it.” As an example, some patients with heart failure on medication to remove fluid from their chests may stop taking the medication because it increases urination, which can disrupt sleep. If such patients do not take their medication, they may end up in the ER with critical, life-threatening health problems, Zed said.
“We have to acknowledge we have a problem,” said Zed, clinical coordinator in emergency medicine at Capital Health in Halifax. “We don’t need more ED [emergency department] visits; we don’t need people bouncing back to hospital just after being discharged with an adverse event.”
People with preventable drug-related problems were also much more likely than other patients to be admitted to hospital and have a longer stay, the study found. “Clearly that takes up resources,” Zed said. The link between medication and health problems is significant because it may cause a strain on health-care resources, he said. Also, patients may not realize the importance of taking medication exactly as prescribed because they don’t understand the serious consequences that can arise as a result, said Zed. “We’re oftentimes focused on telling a patient how to take their medication,” he said. “We’re not very good, health-care professionals in general, at telling patients what the consequences of non-adherence are.”
The findings also underscore the fact some patients may be on several different kinds of medication, which can greatly increase the risk of drug-related health problems. The most common drug categories associated with problems were antimicrobial agents, which include antibiotics, painkillers containing opioids, and anti-psychotic drugs.
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