Drug-Related Visits to the Emergency Department: How Big Is the Problem?

Payal Patel, Pharm.D., Peter J. Zed, Pharm.D.

Disclosures

Pharmacotherapy. 2002;22(7) 

In This Article

Abstract and Introduction

Objectives: To review the literature concerning drug-related problems that result in emergency department visits, estimate the frequency of these problems and the rates of hospital admissions, and identify patient risk factors and drugs that are associated with the greatest risk.
Methods: A systematic search of MEDLINE (January 1966-December 2001), EMBASE (January 1980-December 2001), and PubMed (January 1966-December 2001) databases for full reports published in English was performed. The Ottawa Valley Regional Drug Information Service database of nonindexed pharmacy journals also was searched.
Results: Data from eight retrospective and four prospective trials retrieved indicated that as many as 28% of all emergency department visits were drug related. Of these, 70% were preventable, and as many as 24% resulted in hospital admission. Drug classes often implicated in drug-related visits to an emergency department were nonsteroidal antiinflammatory drugs, anticonvulsants, antidiabetic drugs, antibiotics, respiratory drugs, hormones, central nervous system drugs, and cardiovascular drugs. Common drug-related problems resulting in emergency department visits were adverse drug reactions, noncompliance, and inappropriate prescribing.
Conclusion: Drug-related problems are a significant cause of emergency department visits and subsequent resource use. Primary caregivers, such as family physicians and pharmacists, should collaborate more closely to provide and reinforce care plans and monitor patients to prevent drug-related visits to the emergency department and subsequent morbidity and mortality.

Drugs are prescribed for patients with various medical conditions to achieve an optimal therapeutic outcome. When the outcome is not optimal, a drug-related problem has occurred.[1] Drug-related problems can be classified into eight categories: untreated indication, improper drug selection, subtherapeutic dosage, failure to receive drugs (includes patient noncompliance), overdosage, adverse drug reaction, drug interaction, and drugs used without an indication.[1] Although many drug-related problems can be resolved without a major impact on patient health, some of them can be associated with significant morbidity and mortality.[2,3] A probability model estimated that morbidity and mortality associated with drug-related problems account for $76.6 billion in hospital costs, 17 million emergency department visits, and 8.7 million hospital admissions annually in the United States.[4] In this day of budget restraint and paradigm shift to a holistic preventive care approach, one would expect an aggressive interest in this area in an attempt to reduce the significant burden that drug-related problems place on our health care system.

Over the past few years, several published reports have addressed the problem of drug-related hospital admissions due to adverse drug reactions, which is only one of the eight categories of drug-related problems listed above.[2,3,5] Hospital admissions secondary to the total of all of the categories are likely much higher than those described for adverse effects only, and have not been quantified accurately. A systematic review of the English-language literature revealed that approximately 5% of all hospital admissions were drug related.[6] One study estimated that approximately 50% of drug-related hospital admissions were avoidable.[7] Unfortunately, many investigators have estimated only the rate of drug-related hospital admissions rather than the rate of drug-related visits to an emergency department. The latter may not be captured in many studies evaluating hospital admissions because many patients with drug-related problems who visit the emergency department do not require hospital admission. Thus, despite the enormity and importance of drug-related morbidity and mortality, little published information addresses patients with drug-related problems requiring medical attention in the emergency department.

Our objective was to review the literature concerning drug-related problems that result in emergency department visits, estimate the frequency of these problems and the rate of hospitalization, and to identify patient risk factors and drugs that are associated with the greatest risk.

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