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Pulse Home Health Care practices skilled health care procedures firmly rooted in the latest research and best practice policies. We routinely mail bulletins to physicians and other medical referral sources to highlight how we help patients and to explain the scientific basis for different services. On our home health website we share selected physician bulletins about Pulse's Home Health Services. If you have questions about how home health could help you, please contact us today.

A 2011 Report: Adverse Drug Events among Community Dwelling Patients


Adverse Drug EventsThis past October, the journal Health Services Research published the first U.S., nationwide study examining annual rates of adverse drug events (ADEs) in the ambulatory setting. (1) Dr. Urmimala Sarkar and colleagues conclude that at least 4.5 million adverse drug events occur in the U.S. annually.  Patients with adverse drug events are most likely to present to their primary care practitioner for help (over subspecialty practitioners and the emergency department).  Nearly one-third of these visits required ongoing medical care such as hospitalization or follow-up visits.  The greatest risk factor for ADEs was polypharmacy.  People with six to eight medications proved
3.83 times more likely to have a recorded adverse drug event.

The study authors state that, although their results underscore the importance of ADEs as a national health subject, their results likely understate the prevalence of ADEs.  A primary limitation of this study was that it examined national reports of ambulatory health care visits.  This study would not be able to capture data from ADEs where a visit did not occur or where the presence of an ADE was missed.  Older, center-based, studies using patient survey and chart review among the ADE detection methods have estimated ADE prevalence among adults age 65+ at 5% and greater. (2,3 )  

Of course, some adverse drug reactions will be unpreventable.  Gurwitz and colleagues conducted a large study of Medicare beneficiaries, with over 30,000 patient years of observation, and concluded that 28% of ADEs were avoidable. (4)  Dividing therapy into the acts of prescribing, monitoring, and compliance, researchers showed that more than 58% of the errors leading to preventable ADEs occur in monitoring and compliance.  Note that Pulse Home Health Care is well positioned to enhance the monitoring and compliance for your homebound patients. 
  
Medication Compliance Facts:

  • Most patients have problems following prescription labels. In one study, people were asked to read prescription labels and state how they would take the pills.  Nineteen percent gave incorrect responses.  More than half of the people giving correct responses demonstrated the counting out of pills incorrectly.  It was common to ignore warning labels such as “take with food.” (5)
  • Patients frequently fail to report all the medications they are taking at home. (6)
  • One study found that 67% of patients recently discharged from the hospital had medication discrepancies - most unintentional, nonadherence. (7 )
  • That same study found that in-home nursing follow-up detected more discrepancies than in-hospital review and telephone follow-up. 

Any time you prescribe new medications or a new therapeutic diet to a homebound patient, and you think that patient might benefit from nurse follow-up, that patient meets Medicare’s skilled need requirement for home health.  Please refer those patients to Pulse Home Health Care for comprehensive medication adherence services and chronic disease management.

References

  1. Sarkar U, Lopez A, Maselli J, Gonzales R. Adverse Drug Events in U.S. Adult Ambulatory Medical Care.  Health Services Research. October 2011; 46 (5): 1517-1533.
  2. Gandhi 2003  Gandhi T, Weingart J, Borus A, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003. 348 (16): 1556-64.
  3. Gurwitz J, Avorn F, McCormick D, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000. 109 (2): 87-94.
  4. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003; 289: 1107-1116.
  5. Davis T, Wolf M, Bass P, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006; 145: 8887-894.
  6. Costa L, Nelson T. Applying translation science to improve health outcomes. In: Poe S, White K, eds. Johns Hopkins Nursing Evidence-Based Practice: Dissemination and Translation. Indianapolis, IN: Sigma Theta Tau International; 2010: 222-225.
  7. Costa L, Poe S. Challenges in posthospital care: nurses as coaches for medication management. J Nurs Care Qual. 2011; 26 (3): 243-251.

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