Emergency Department Visits for Adverse Drug Events Remain High

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Emergency Department Visits for Adverse Drug Events Remain High

Emergency Department Visits for Adverse Drug Events Remain High

In older adults, antithrombotic drugs, antidiabetes drugs, and opioids accounted for three fourths of these visits.

Adverse drug events (ADEs) pose substantial risk for patients, including emergency department (ED) visits and hospitalizations (NEJM JW Hosp Med Jan 2012 and N Engl J Med 2011; 365:2002). In this new study, investigators used a U.S. national surveillance database to estimate that, each year, 4 in 1000 people (0.4%) visit EDs due to ADEs (1 in 4 such visits result in hospitalization). In older Americans, the annual ED visit rate due to ADEs is even higher (1%), with nearly half of such visits resulting in hospitalization.

Whereas ED visits among children usually were due to ADEs caused by antibiotics and antipsychotics, three fourths of ADEs among older adults were caused by four drug classes — anticoagulants, antiplatelet agents, antidiabetic drugs, and opioid analgesics. Beers list medications (i.e., medications to avoid in older patients) were responsible for <4% of all ADE visits to EDs among elders.

COMMENT

Despite proliferation in the last decade of broad-based interventions to prevent ADEs (e.g., medication reconciliation, monitoring prescription of Beers list medications), and despite increasing emphasis on the harms of polypharmacy, the incidence of ADEs has not decreased. Interventions focused on drugs that rarely cause serious adverse events — including many Beers list medications — are unlikely to result in measurable public health improvements. Focusing instead on the highest-risk drug classes (anticoagulants, antidiabetic agents, and opioids) could yield larger ADE reductions. That approach might include more-extensive integration — into healthcare systems and primary care practice — of structured programs for anticoagulation management, diabetes education, and pain management aimed at decreasing opioid use for chronic noncancer pain.

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