Medication related problems (or MRPs) represent a primary symptom of “medication mis-adventuring” in today’s healthcare system.

• >21% of Medicare recipients receive wrong med¹
• 180,000 Adverse Drug Events (ADEs) per year that are fatal or near-fatal²
• 1.8 million ADEs per year in the elderly³
• 60% of ADEs are preventable⁴
• 1 in 12 office visits results in an inappropriate Rx⁵
• Potentially Inappropriate Rxs in LTC causing 33-78% inc risk for hospitalization and 31-87% inc risk for death⁶

Patients with complex medication regimens and chronic diseases are particularly vulnerable to drug-related problems, which can have significant humanistic and economic consequences. In fact, if MRPs were thought of as a disease they would be the fifth leading cause of death in the US.⁷ Why is this so?

• No data at the point of care
  • Only 50% chance of receiving recommended care in U.S.⁸
  • Each additional medication increases the ADE likelihood 10%⁹
• Prescribing decisions based upon preference instead of evidence
• Marketing of medications is persuasive and results in undue influence
  • “We want to make sure that when doctors decide which medication to prescribe, they select the most effective drug – not necessarily the one with the largest advertising budget,” PA Secretary of Health Dowd Eisenhower, 9/15/05
• Limited longitudinal monitoring of pharmacotherapy
  

¹Curtis LH et al.  Inappropriate prescribing in a large outpatient elderly population.  Arch Int Med (Aug 9/23, 2004) 184: 1621-25. (N=765,000)
²David Classen, MD. Medication Safety. JAMA,  289:9; March 5, 2003 p. 1154.
³Jerry Gurwitz MD, Incidence and Preventability of ADEs Among Older Persons In the Ambulatory Setting.  JAMA.  2003:289:1107-16. March 5, 2003.
⁴Tejal Gandi MD, MPH. N Engl J Med 348:16;1556. April 17, 2003.
⁵M Goulding, PhD, CDC.  Arch Intern Med. 164:305.  Feb 9, 2004.
⁶Lau, Dennis et al; Hospitalizations and Death Associated with Potentially Inappropriate Medication Prescriptions Among Elderly Nursing Home Residents.  Arch Intern Med . 165:1.  Jan 10, 2005
⁷Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998; 279: 1200 – 05.
⁸Kerr, E.A., McGlynn, E.A., Adams, J. et al. (2003, Sept/Oct).  Profiling the quality of care in twelve communities: Results from the CQI study.  Health Affairs 23(5):247-256).
Fischer, M.A., Avorn, J. (2004, April 21). Economic implications of evidence-based prescribing for hypertension: Can better cost less?  JAMA 291(15):1850-1856.
McGlynn, E.A., Asch, S.M., Adams, J. et al. (2003, June 26). The quality of healthcare delivered to adults in the United States.  N Engl J Med 348(26):2635-2645.
Landrow, L. (May 6, 2004) Wall Street J (D3). A carrot for the right prescription.
⁹Gandi, R.K., Weingart S.N., Borus, J., et al. (April 17, 2003).  Adverse drug events in ambulatory care. N Engl J Med 348(16): 1560.