What Can Be Done to Reduce Hospital Admissions Due to Adverse Reactions to Prescription Drugs?

The late anarchist philosopher, Ivan Illich, claimed that institutionalized Western medicine had become a threat to health, both because of its frequent therapeutic mishaps and because of the damage it did to people’s outlook on life. One would not have to go this far to recognize that medicine can do harm as well as good; according to a recent paper in the New England Journal of Medicine, up to 4 percent of emergency admissions to hospitals are caused by adverse reactions to prescribed drugs, at a cost (in the United States alone) of $19.6 billion – a figure that I find suspiciously precise.

An experiment conducted in Scotland attempted to establish whether primary care physicians could be induced to prescribe less dangerously, thereby – it was hoped – reducing the rate of hospitalization for adverse reactions to drugs. Sixty-six practices of primary care physicians were approached to take part in the study, of whom 34 agreed, one later dropping out. This in itself is important, because the results that apply to the willing practices might not apply to the unwilling ones.

The practices were offered three interventions: education by a pharmacist and written material on the hazards of simultaneously prescribing Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antiplatelet medications such as aspirin or clopidogrel; a computerized warning system informing doctors of hazardous prescribing; and a monetary incentive to follow up with patients at risk that amounted on average to 0.6 per cent of their income. The practices received these interventions at different times, and the prescribing behavior of the doctors was monitored before, during and after the interventions. (Hazardous prescribing is not necessarily wrong in itself, but the benefits to the patient should outweigh the risks, and it should be done consciously after due consideration, not by inadvertence.)

The adverse effects of NSAIDs prescribed with antiplatelet medications is one of the largest causes of emergency admission to hospitals for adverse drug reactions, though the authors do not tell us what proportion of such admissions are caused by the combination.