Adverse drug reactions: A problem and an opportunity

April 16, 2003

The likelihood of adverse drug reactions are on the rise as individuals live longer and take more medications during the course of their lifetimes. In an editorial in the April 17, issue of the New England Journal of Medicine, William Tierney, M.D., professor of medicine at the Indiana University School of Medicine and a research scientist at the Regenstrief Institute Inc., discusses the troubling issue of adverse drug reactions and suggests a course of action to decrease their frequency. The editorial accompanies a study of outpatients conducted by researchers from Boston's Brigham and Women's Hospital.

"Reducing the number and severity of adverse effects of drugs will require vigilance and cooperation of doctors, pharmacists, and other health care providers," says Dr. Tierney. "They need to be looking for and asking about such problems on a regular basis. Using electronic medical record systems can help this happen by reminding the providers which drugs a patient is taking and which side effects to look out for. Such systems can also improve communication between various health care providers."

Not all 'bad' side effects of medication, are due to the medication itself. "The adverse (side) effects found in the study of four academic primary care practices in Boston were not such unusual effects that one would automatically blame them on one of a person's drugs," says Dr. Tierney. "They were often non-specific problems such as weakness, fatigue, and upset stomach. It is also unclear at times whether adverse effects attributed to drugs are due to the drugs themselves or the conditions they are treating."

Drug side effects are more common in older persons and in those with several chronic conditions who take multiple medications according to Dr. Tierney, who is the director of General Internal Medicine and Geriatrics at the IU School of Medicine.

In the New England Journal of Medicine editorial, Dr. Tierney calls for broader studies based on more timely data of adverse drug reactions and notes that most studies of medication errors and their adverse effects have focused on errors of commission (the drugs prescribed). He writes that errors of omission (missed opportunities to prescribe appropriate medications) should also be studied as "they may be even more common and the adverse effects of overlooking such opportunities may be huge."

And he encourages regular screening of patients for potential drug-related symptoms, utilizing computer-based medical records systems which can also eliminate preventable errors caused by illegible handwriting, inappropriate dosing, known drug interactions and allergies.
Editorial note: To learn about an electronic medical record systems see The Regenstrief Medical Record System, one of the first and now one of the oldest and largest (300 million on-line clinical results) electronic medical record system, includes EKG tracings, radiology images (CTs, MRIs), digital radiography, laboratory results, pathology reports, diagnostic studies, operative notes and discharge summaries used as the source of clinical data for day-to-day patient care.

Indiana University

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