Patient Safety: An Ounce of Prevention is Worth a Pound of Cure
Benjamin Franklin knew what he was talking about. As our healthcare system faces a number of challenges, the focus is appropriately shifting toward prevention of harm. Health care costs are rising and, as a result, health care reform is well underway. To date, cost containment mechanisms have been largely focused on limiting patient access to higher cost services and medications. However, this method often leads to preventable patient harm.
Medication misuse is a growing problem in the United States due to the complexities of our health care system. Medication misuse can interfere with treatment and lead to harmful reactions. It also leads to additional physician visits, urgent care and emergency department use, and hospitalizations, which are avoidable. At least 1.5 million preventable adverse medication events occur in the U.S. each year. [1] More than $290 billion annually is attributed to poor medical adherence, suboptimal prescribing, medication administration and diagnosis. [2]
The main problem is that patients are confused and it’s easy to understand why. There are over 10,000 prescription drugs and biologics and over 300,000 over-the-oounter (OTC) medications. OTC medications and herbal remedies also contribute to avoidable drug interactions but their use is often not reported to healthcare providers. Patients are forced or financially incentivized to use mail-order pharmacies, yet 90 million Americans read below the 5th grade level [3], and 98% of consumer medication information sheets are written between a 9th – 12th grade level. [4] Coupled with the inaccurate and misleading medication information on the internet, it’s a perfect storm for medication misuse and avoidable patient harm.
Patients have multiple physicians and ARNPs, which creates communication deficits and incomplete patient information. They often utilize multiple pharmacies leading to undetected duplication of therapy, over-utilization and under-utilization of medications, and drug interactions. Juggling complex therapies for multiple diseases is difficult for confused patients. Most patients need an in-depth review of how all their medications, OTC products, and disease states impact their health. The passing of Washington State’s SSB 5213 was a huge win for Medicaid managed care patients. It requires Medicaid managed care plans to include comprehensive medication management as a covered service for patients who need an in-depth review of their medications.
Effective January 1, 2015, the new law requires “provider reimbursement methods within medical billing processes that incentivize pharmacists and other qualified providers” to provide comprehensive medication management services in health homes for Medicaid managed care patients with multiple chronic conditions.
This is a huge step for patient safety. We must continue to develop mechanisms to ensure safe medication use of prescription and OTC medications. Comprehensive medication reviews for chronic complex patients help ensure safe and appropriate medication use and reduce avoidable emergency room visits, reduce hospital readmissions and hospitalizations.
- Aspden P, Wolcott J, Bootman JL, Cronenwett, LR eds. Preventing Medication Errors: The Quality Chasm Series. Washington DC: The National Academies Press; 2007
- Thinking outside the pillbox: A NEHI research brief. New England Health Institute. August 2009.
- Kirsch IS, Jugebut A, Jenkins L, Kolstad A. Adult literacy in America: a first look at the results on the national adult literacy survey. Washington DC: Department of Education 1993.
- Roper ASW. Health Literacy & The Prescription Drug Experience: The Front Line Perspective From Patients, Physicians, and Pharmacists. May 2002. Available at: www.ethnicphysicians.org/publications/
Jeff Rochon, PharmD
Chief Executive Officer
Washington State Pharmacy Association
Past Chair, Washington Patient Safety Coalition Steering Committee
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