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Elderly get wrong drugs Poor
communication to blame for errors, McGill study concludes By Aaron Derfel The
Montreal Gazette, September 16, 2003 At least one in three
Montreal-area seniors has been improperly prescribed medication by a
general practitioner, a new study has found. Some of the medication errors
can be fatal but are not necessarily the result of incompetence by a
physician, suggests the lead author of the study. Rather, poor
communication among doctors, patients and pharmacists is to blame. "It's shocking," said
Robyn Tamblyn, associate professor of epidemiology at McGill University. "The elderly really need to
demand a safer way of having their drugs prescribed and dispensed so that
they minimize their chances of getting the wrong drug at the wrong
time." The study, published in today's
Canadian Medical Association Journal, describes many common prescription
errors - from duplication of similar drugs to inadvertently allowing
patients to take a medication for an excessively long period. The researchers reviewed the
prescriptions for 12,560 Montreal seniors in 1997, and discovered that
more than 30 per cent had at least one "inappropriate"
prescription. Tamblyn and her colleagues
observed that often patients would see more than one physician for
prescriptions and go to more than one pharmacy to get them filled. Over time, a patient's list of
medications would grow, but unfortunately, the physicians and pharmacists
did not communicate with one another to make sure there weren't any
unforeseen duplications or unhealthy interactions. "Physicians had incomplete
information on what drugs were being prescribed," Tamblyn explained. The researchers decided to set
up a computerized network for 107 physicians that linked patient files
with the provincial drug-insurance board. Patients had to give their
consent to let their medication lists be shared. The study noted that there were
18 per cent fewer prescription errors among patients in the computerized
network compared with a group that didn't have access to it. Since then,
the researchers have worked out many glitches in the system. "There is a consensus that
to reduce errors related to drugs - which are extraordinarily high - a
computerized solution is the only way to go," Tamblyn said. David Woodsworth, a member of
the N.D.G. Senior Citizens' Council, said he wasn't surprised by the
study's findings, given the shortage of family physicians. "If anything, it's a
reflection of the fact that physicians are often too busy,"
Woodsworth said. "Many seniors don't have a family physician, and
they go to drop-in clinics where they run into doctors who don't know them
and don't know their history." Those whose prescriptions were
scrutinized were at least 66 years old. Among the most frequent errors: S Doctors prescribing a drug
like a non-steroidal anti-inflammatory for joint pain without knowing the
patient suffers from hypertension or an ulcer. Such anti-inflammatories can cause
gastric bleeding. S Doctors prescribing anti- depressants and sedatives to
patients who are too old. This could lead to some patients falling and
fracturing their hip. S Some patients took
benzodiazepine, a sedative, or anti- inflammatories for longer than
medically necessary. S Many patients were prescribed
two types of salicylate (Aspirin) when only one was required. S Drug interactions that led to
some patients building up toxic levels of a pill in their bodies. Medication errors are a growing
problem across North America and believed to be the sixth leading cause of
death. Up to 10 per cent of the elderly end up in the hospital because of
bad prescriptions, Tamblyn said. The McGill researchers are now
testing a more advanced version of the computerized prescription drug
network. Under the new system, 30 GPs and 31 pharmacists have access to
medication lists of patients, and the information is updated daily. That
differs from the Pharmanet program in British Columbia, in which only
pharmacists can exchange information. Tamblyn predicted that within
the next two or three years, similar computerized networks will pop up
across the country. Scenario of An Error A 72-year-old man has been
seeing a general practitioner for the last five years. One day, his GP
diagnoses high blood pressure and refers him to a cardiologist. The man
now has two doctors who prescribe medications for him that need to be
filled at two pharmacies. However, none of the doctors and
pharmacists communicate with one another. Later on, the man sees a third
doctor who prescribes a medication for his impaired kidney function that
reacts badly with his anti-hypertension drugs. Copyright
© 2002 Global Action on Aging |
