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Adverse drug reactions account for a significant number of emergency room visits in Canada each year, says a new study that highlights the link between some medications and serious health problems.
"Bad things can happen when patients take medication," said Peter Zed, an associate professor at Dalhousie University and lead author of the study published today in the Canadian Medical Association Journal. "The medications are clearly not benign."
Researchers studied 1,017 patients who went to the emergency room at Vancouver General Hospital over a period of 12 weeks in 2006.
They found that 12 per cent, or more than 1 in 9, of all emergency room visits were medication-related, ranging from patients who did not take their medication as prescribed to those who had a bad reaction to a drug.
People with preventable medication-related problems were much more likely than other patients to be admitted to hospital and have a longer stay, the study found. (Chris Stanford for The Globe and Mail)
Adverse drug reactions accounted for nearly 40 per cent of those visits, making them the most common medication-related problem that landed patients in the emergency room. Researchers found that 60 per cent of those visits were unpreventable - meaning that patients experienced problems after taking the medication as directed.
The link between drugs and serious health issues has come under greater scrutiny in recent years because of high-profile problems involving drugs such as Vioxx, Celebrex and Avandia.
Many of the adverse drug reactions in the study involved patients who experienced bleeding complications, rashes or other issues that required hospitalization in some cases.
Although only 10 per cent of adverse drug reactions noted in the study were severe, the issue emphasizes the dangers of some medications and the need for a greater focus on finding ways to avoid serious reactions, Dr. Zed said.
"We have to acknowledge we have a problem," said Dr. Zed, who is clinical co-ordinator in emergency medicine at Capital Health in Halifax. "We don't need more ED [emergency department] visits, we don't need people bouncing back to hospital just after being discharged with an adverse event."
The study also found that non-adherence - when patients don't take medication as directed - was responsible for about 30 per cent of medication-related emergency room visits. But unlike adverse drug reactions, problems with non-adherence are 100 per cent preventable, according to Dr. Zed.
"The patient makes a choice not to take their medications as prescribed and, as a result, something bad happens," he said. "It could be cost ... [or] they could be experiencing a minor side effect to the medication so they choose not to take it."
For instance, some patients with heart failure who take medication to remove fluid from their chests may stop taking it because it increases their trips to the bathroom, which can disrupt their sleep.
But if they do not take the pills, those patients may end up at the emergency room with critical health problems that could threaten their life, Dr. Zed said.
The link between medication and health problems is significant because it may cause a strain on health-care resources, he said.
People with preventable drug-related problems were also much more likely than other patients to be admitted to hospital and have a longer stay, the study found.
"Clearly that takes up resources," Dr. Zed said.
Patients may not realize the importance of taking medication exactly as prescribed because they don't understand the serious consequences that can arise as a result, according to Dr. Zed.
"We're often times focused on telling a patient how to take their medication," he said. "We're not very good, health-care professionals in general, at telling patients what the consequences of non-adherence are."
The findings also underscore the fact some patients may be on several different kinds of medication, which can greatly increase the risk of drug-related health problems.
It may be time for health-care professionals to put renewed focus on determining whether certain drugs are necessary for some patients, particularly if that patient is already taking other medication, Dr. Zed said.
"Many times medications are used for symptom relief where there may be alternatives not to use medication at all," he said.
The most common drug categories associated with problems were antimicrobial agents, which include antibiotics, painkillers containing opioids and anti-psychotic drugs.
Over all, about 75 per cent of the medication-related problems documented in the study were considered moderate, 10 per cent severe and about 15 per cent mild. Some of the most common issues were pain, delusion, paranoia and hallucinations, as well as vomiting and other gastrointestinal problems.
