July 1, 2005
Americans Endure 4 Million Drug Reactions a Year
And the actual number is probably higher, researchers say
Adverse reactions to medications forced an estimated 4.3 million Americans to see doctors in 2001, federal researchers report, in what they call the first national survey of its kind.
That represents a significant increase from 2.7 million such visits in 1995, according to results of the review.
Most drug reactions were associated with antibiotics and other "anti-infectives." This was closely followed by hormones and other synthetic substitutes. Skin rashes and nausea, vomiting and abdominal pain were the most frequent complaints. The rates of adverse reactions were highest for people 65 to 74 years of age, with women suffering more adverse reactions than men, the researchers report.
The researchers believe their estimates of the extent of the problem are conservative, making adverse drug reactions a "significant threat to patient safety in the United States."
"This can be translated into a big financial burden to the health care system," said Dr. Chunliu Zhan, lead author of the report and a research fellow with the Agency for Healthcare Research and Quality (AHRQ).
The survey was compiled by AHRQ and the National Center for Health Statistics. The findings appear in the July issue of the Joint Commission Journal on Quality and Patient Safety.
The researchers looked at a representative sample of visits to physician offices, hospital outpatient departments, and emergency departments. The records they analyzed were those that identified an adverse drug reaction as the first-listed cause of the visit.
"We found that of 500 people, seven would see a doctor for an adverse drug reaction in one year," Zhan said. "If you are a doctor, of every 270 patients there will be one who has an adverse drug reaction. If you are an emergency room doctor, then one patient out of every 133 will be seen for an adverse drug reaction.
Seventy-four percent of people with adverse drug reactions were seen at a doctor's office, 20 percent went to hospital emergency rooms, and 6 percent were seen at hospital outpatient departments, according to the report.
To combat the problem, Zhan said that both medication safety and patient safety need improving. Existing data don't reveal the cause of adverse reactions, whether it is medication error or misuse by patients, he said.
Zhan noted there is a push to improve patient and medication safety in the United States. "We are emphasizing the use of computer prescribing systems, decision support systems," he said. "There is a lot of activity going on to improve the medication system."
One expert, Martin J. Hatlie, president of the Partnership for Patient Safety, believes the study will be helpful in identifying a major problem.
"Everyone in patient safety knows that adverse drug reactions are a significant problem," said Hatlie, whose Chicago-based consulting firm works to "advance the reliability of healthcare systems worldwide," according to its Web site.
"But there haven't been studies that help us know how many of these things go on," he said.
Hatlie said this study could raise public awareness of the problem of drug reactions. "There is a huge gap between what the health-care system knows and what the public knows about the safety of the health-care system," he said.
He said he also thought the estimated 4.3 million doctor visits a year for adverse drug reactions is low. "There are many more medications out there than there used to be," he said. "Medications are getting stronger, so their interactions with other medications are also getting stronger. So it's a natural thing to expect that there will be more adverse drug reactions."
Hatlie suggested that hospitals and doctors need to turn to computerized systems to replace written records, which are rife with errors. Doing this can help health care providers make fewer errors when prescribing, he said.
In addition, patients and their families need to be included when medications are discussed to ensure they understand what they are taking and how and when to take it, he said.
The Institute for Safe Medication Practices can tell you more about medication errors.