Medication Errors in the Elderly Are Costing at Least $4.2 Billion Annually: Proof-of-Concept Study Points to a Solution

REPORTERS’ CONFERENCE CALL JANUARY 23, 2013, 9:30 AM ESTDial-in Number: +1-866-818-8556 Access Code: 5430707

Newswise — (PHILADELPHIA) - Researchers at the Jefferson School of Population Health, working with colleagues at the Parma Local Health Authority in Italy, significantly reduced the prescribing of dangerous medications for older people during a three year, proof-of-concept study. The study was so successful that enrollees adopted its practices permanently.

The Jefferson School of Population Health will conduct a reporters’ conference call on January 23, 2013 at 9:30 AM EST. The study’s three co-authors, Vittorio Maio, PharmD, MS, MSPH (a Jefferson pharmacology expert); Scott Keith, PhD (a Jefferson biostatistician); and Stefano Del Canale, MD, PhD (a practicing physician in Parma) will discuss their work. The dial-in telephone number is: +1-866-818-8556 Access Code: 5430707

The rate of Potentially Inappropriate Medications (PIMs) dropped by 9.8 percent during the study. PIMs were reduced by 31.4 percent in Parma and 21.6 percent in the control community. Investigators believe that a third of that reduction (9.8 percent) was directly caused by the study interventions. The report appears in the current issue of the journal Drugs and Aging.

The study’s implications are dramatic for the US and other developed nations. In the US, 30 percent of all medications are prescribed for people over the age of 65.1 An Institute of Medicine2 study identified $21 billion in annual US healthcare spending caused by medication errors. Outpatient preventable medication errors cost $4.2 billion per year3.

Parma was chosen because people in Italy have universal health coverage, a uniform system easier to study than the one in the United States. Rather than focus on educating patients, researchers sought to change the behavior of physicians, each of whom treats hundreds of patients.

"The public doesn’t realize how many elderly patients are exposed every day to potentially dangerous medications that can severely affect their health," said Vittorio Maio, PharmD, MS, MSPH an author of the study. “Changing physician behavior is very difficult, but we showed it can be done.”

Jefferson and Parma researchers were able to reduce the prescribing of dangerous medications by 9.8 percent. This decrease in prescribing of the Beers List of PIMS could translate into hundreds of millions of dollars saved each year and thousands of health problems averted among the elderly.

“Elderly people are using so many medications that the choice of safe ones is an issue of paramount importance. Older people often ask their doctors for additional drugs for pain relief, but some of these drugs can be toxic for frail patients,” commented Dr. Del Canale.

The study engaged all 303 general practitioners in the Local Health Authority in Parma Italy, who together treat a total of about 100,000 people over age 65. Investigators first distributed the list of PIMs to the general practitioners, established a baseline level at which they were being prescribed, then conducted educational sessions with the general practitioners. Later, they tested the incidence with which general practitioners were still prescribing the PIMs. They also studied a very similar community nearby as a control group. After these interventions, prescribing of PIMs in Parma had dropped by 9.8 percent.

“Prescribing potentially dangerous medications to older adults is a serious, but preventable problem worldwide. Our efforts in Parma, Italy to change prescribing behaviors spared over 600 people exposure to these drugs in the Fall of 2009 alone,” said Dr. Keith.

Many practitioners are still unfamiliar with the PIM list, which includes commonly used medications such as ibuprofen, amitriptyline, and digoxin. Here is a recent update of the list: put the number of patients in the US killed by medication errors at between 48,000 to 98,000 per year or more. ------------------------------------Footnotes1. In the US, persons 65 years or older constitute about 15 percent of the total population but consume nearly one-third of all prescriptions (Fu AZ et al. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Medical Care 2007;45:472-476).

2. To Err Is Human, A report by the National Institute of Medicine,

3. Burton MM, Hope C, Murray MD, et al., The cost of adverse drug events in ambulatory care. AMIA Annu Symp Proc, 2007:90-93. Updated to 2007 figures.

Resource List: Older People and Medication Errors

• Medications (prescription, over-the-counter, and herbal preparations) are widely used by older adults. A survey in the United States of a representative sampling of 3005 community dwelling adults (aged 57 through 85 years) was conducted by in-home interviews and use of medication logs between 2005 and 2006. At least one prescription medication was used by 81 percent. Five or more prescription medications were used by 29 percent of the overall survey population and by 36 percent of people aged 75 to 85 years. Forty-six percent of prescription users also took at least one over-the- counter medication. (Qato DM et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 2008; 300:2867.)

• A number of factors in older individuals contribute to their increased risk for developing a drug-related problem. These include frailty, coexisting medical problems, memory issues, and use of multiple prescribed and non-prescribed medications.|• Drug-related hospitalizations account for 2.4 to 6.5 percent of all medical admissions in the general population; the proportion is much higher for older patients (Onder G et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 2002; 50:1962; Pirmohamed M et al.

• Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329:15; Lazarou J, Pomeranz BH, Corey PN.

• Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279:1200.).

• In the United States, it is estimated that annually from 2007 to 2009 there were 99,628 emergency hospitalizations for adverse drug events in individuals 65 years and older, with two-thirds due to unintentional overdoses (Budnitz DS et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365:2002).

• A meta-analysis found a fourfold increase in the rate of hospitalization related to adverse drug events in older adults compared with younger adults (16.6 versus 4.1 percent); it was estimated that 88 percent of the adverse drug event hospitalizations among older adults were preventable, compared with 24 percent among young persons (Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 2002; 24:46).

Thomas Jefferson University (TJU), the largest freestanding academic medical center in Philadelphia, is nationally renowned for medical and health sciences education and innovative research. Founded in 1824, TJU includes Jefferson Medical College (JMC), one of the largest private medical schools in the country and ranked among the nation’s best medical schools by U.S. News & World Report, and the Jefferson Schools of Nursing, Pharmacy, Health Professions, Population Health and the Graduate School of Biomedical Sciences. Jefferson University Physicians is TJU’s multi-specialty physician practice consisting of the full-time faculty of JMC. Thomas Jefferson University partners with its clinical affiliate, Thomas Jefferson University Hospitals.