Patients older than 65 years experience a drug error rate nearly seven times greater than those younger than 65, according to a recent analysis by prescription benefit manager Medco Health Solutions. The analysis is based on Medco’s drug insurance claims from 2.4 million adults in 2004. Drug errors were noted in cases when a patient was prescribed a drug that was incompatible with medicines already being taken; when a drug could exacerbate another medical condition; or when an incorrect dosage was prescribed.
Researchers found that seniors were at the greatest risk of prescribing errors, and the error rate for seniors increased for those patients who were treated by more doctors and prescribed more drugs. Some details of the findings are as follows:
- Seniors treated by two doctors received an average of 27 prescriptions per year and were at risk of 10 errors on average.
- For older adults treated by five doctors, the number of prescriptions they received in one year nearly doubled to 42, and the number of potential drug errors increased 60 percent to 16. Nearly one-quarter of seniors in the analysis received prescriptions from five or more doctors.
- When seniors received prescriptions from seven physicians the number of prescriptions increased to 52 and the number of potential drug errors more than doubled to 22 in one year, compared to those only seeing two physicians.
- When the care team reached 10 different physicians, patients filled an average of 66 prescriptions, and potential errors tripled.
Another factor that increased the rate of prescription errors was the number of pharmacies people use. In the analysis, nearly one-quarter of the seniors filled their prescriptions at three or more pharmacies, with some seniors using as many as 11 different pharmacies for their prescriptions.
These findings, along with the Institute of Medicine’s (IOM) recent report on medication errors, call into question how well different doctors and specialists caring for patients over 65 exchange information about the medications they are prescribing, and statistically correlates a larger care team with a greater risk for preventable medication errors. They also emphasize that although many pharmacies regularly cross-check for potentially dangerous interactions when filling a prescription, that step alone is insufficient to prevent harmful drug interaction.
Recommendations from California’s Medication Error Panel
In May 2006, California Senator Jackie Speier set up a Medication Errors Panel to address issues similar to those highlighted in Medco’s analysis and IOM’s recent report. In particular, they focused on addressing the incidence and/or severity of medication errors that occur in community pharmacies, i.e., drug stores or pharmacy departments of retail stores, and at locations, such as private residences, where consumers administer medications without assistance from professional health care providers. California Health Advocates’ Referral Specialist, John Gallapaga has served on this panel, and with the other panel members recently published a report with recommendations on: ways to reduce these medication errors; how to improve the health care system so as to prevent errors in delivering people’s prescription and over-the-counter medications; and effective methods of education and outreach in community settings. In total the report includes 14 recommendations divided into six specific topics:
- Communication – These recommendations address communication between prescribers, pharmacists, and patients. When pharmacist-patient consultation occurs, it is often compromised to some extent because of a lack of knowledge by the pharmacist of the prescriber’s treatment objectives, including such basic information as the condition being treated. In addition, a basic problem with writing legibility has been a long-standing obstacle between pharmacists and prescribers in their efforts to correctly communicate the desired drug product and instructions for use. Fixing these two problems with fundamental communication between prescriber and pharmacist has been shown to substantially decrease medication errors. Confirming prescriber intent with the patient at the dispensing site is an additional means of confirming that the medication treatment is understood and properly implemented. Changes to labeling and packaging to improve readability and understanding by the consumer will help reinforce compliance. These changes include addressing language and cultural barriers as well.
- Consumer education – These recommendations deal with the need to increase consumer awareness of the use and misuse of prescription and over-the-counter medications as a key factor in decreasing medication errors. Consumers often do not appreciate the risks involved in the use of the “dangerous drugs” that are widely advertised and promoted on television and in print media. In addition, improving compliance with prescribed therapies will result in improved health and reduced overall health care costs. The panel recommends that the California Board of Pharmacy spearhead this educational effort.
- Pharmacy consumer services standards and incentives – These recommendations focus on the need to review and update pharmacist-patient consultation requirements that were established in the early 1990s. They also advise setting standards for medication therapy management (MTM) programs as a way to avoid medication errors, especially among ‘high risk’ populations (children under a specified age, persons age 65 or older, users of five or more medications, persons with chronic diseases or health conditions, and persons with a higher propensity for medication errors, non-compliance with medication instructions or at risk for more serious types of errors).
- Provider training – These recommendations speak to the growing need of new educational and training requirements for pharmacists as their tasks with offering medication therapy management and standardized consultation services go beyond their traditional dispensing roles. Communication skills are essential. Educational efforts to sensitize prescribers and pharmacists to the needs of consumers when it comes to understanding the proper use of medications they have been prescribed, the importance of complying with a prescribed treatment regimen and the need to report problems with therapy to their prescriber or pharmacist are also necessary.
- Research about prevalence and occurrence of medication errors – These recommendations address establishing and supporting efforts to collect data regarding the nature and prevalence of medication errors and prevention methods for reducing errors, especially with people at high risk for medication errors and in community, ambulatory and outpatient settings.
- Other topics to be addressed – These recommendations focus on requiring payers, insurers and/or physician groups to provide a comprehensive medication review for new patients, and an annual comprehensive medication review for ongoing patients. They also advise providing paid compensation for pharmacists’ consultation services.
This report will be turned over to the state legislature where the recommendations will be drafted into bills. As over 1.5 million U.S. residents (including over 530,000 Medicare beneficiaries treated in outpatient settings) are injured or killed each year because of medication errors, turning these recommendations into law is an important step in improving the public’s health and reducing the number of so many unnecessary deaths.
For more information on prescription drug safety tips for consumers, see the following information:
AARP’s webpage Using Medications Wisely. This page has a number of excellent informational resources including the following:
- Let’s Talk About Meds – a document in English and Spanish that provides tips on managing medications wisely for good health and safety.
- Medicines and You (online tutorial)
- My Personal Medication Record
- Over-the-Counter Drug Fact Labels
- Over-the-Counter Safety Tips
Links on Medco’s website:
- Medicine-Related Problems for Older Adults
- Medication Safety: 10 Recommendations For Your Protection
- Ask About Your Medicines
- Medicines: Overuse
Information for this article was contributed in part by California Healthline article, “Seniors Experience Higher Rate of Medication Errors,” 9/16/06.