Why Are There Still So Many Adverse Drug Events?

By Dr. Gidi Stein, CEO, MedAware
Twitter: @MedAwareRx

The US has a medication problem. According to a study conducted by Consumer Reports in 2017, the number of prescriptions filled by Americans has increased 85 percent over the past two decades, while the US population has only increased 21%. The main issue with this trend is that the more medications a patient takes, the higher the risk they have of incurring a negative drug interaction, creating a more complex medical scenario. The more complex the scenario, the higher the risk of suffering from an Adverse Drug Event (ADE).

ADEs impact more than seven million patients nationwide and cause more than 100,000 deaths per year. ADEs can occur anywhere and to anyone: in hospitals, long-term care settings, ambulatory settings and at home. They are more likely to occur to patients with complex medical conditions who take multiple medications, primarily the fragile, the sick and the elderly.

The statistics tell this story as well. Shockingly, according to a 2016 study, five percent of the US population accounts for 50 percent of all healthcare expenditures. Of the 15 million people that met the study selection criteria, 780,000 were classified as High Resource Patients (HRP), with multiple comorbidities observed in 41.2 percent. This makes the overall expenditure of the HRP population ten times greater than the rest of the population.

Unfortunately, people that fall into the HRP category, mostly having many co-morbidities, are often treated by different physicians and specialists who are not aware of what they are each prescribing their patients. Polypharmacy can lead to harmful adverse drug events and drug interactions.

This issue is exacerbated by the way in which the patient-doctor relationship has evolved. A single doctor collaborating with a single pharmacist to treat a patient is a thing of the past; forming a patient-doctor relationship over the span of many years is no longer the status quo. Today, patients head to the young freshly graduated pharmacist at the closest major retail pharmacy to fill their multiple prescriptions from multiple prescribers. This new patient-doctor relationship also plays a role in opioid abuse, as patients who may be addicted to strong pain killers seek multiple providers to receive multiple opioid prescriptions.

A three-layered solution 
On the provider level, implementing an AI-driven decision support system that actively scans patients’ medical records reduces the opportunity for potential ADEs. Doctors can be alerted and subsequently act to reduce medication-related risk and prevent harm. During the miniscule 7-10 minutes that providers have with each patient it is difficult to skim through the patient’s records to comprehend the in-depth medical situation. An AI-driven decision support can focus the provider on the emerging risks and make sure they are not buried under the heaps of clinical data buried in the EMR.

From the payor perspective, any risk reduction for the high HRP expenditures, translate to substantial cost reduction. Stopping adverse drug events before they mount to a risk reduces ER and hospital admissions, keeping patients at home and reducing overall cost.

The most important players in the struggle to prevent ADEs are patients and their family caregivers. By providing caregivers and patients with tools to proactively identify risks, they can be empowered to advocate for themselves. This means providing access to full medical records, providing AI solutions that can alert patients and caregivers to potential risks, and giving them the ability to seek medical consultation (directly contact physicians, or via a telehealth service) before harm is done.

Leveraging advanced AI technologies to provide alerts and interventions to patients, providers and payors, we can identify emerging ADEs before real harm is done and improve patient safety.