Drug-Induced Disorders
EILEEN G. HOLLAND, PHARM.D., and FRANK V. DEGRUY, M.D.
University of South Alabama College of Medicine, Mobile, Alabama
Recent estimates suggest that each year more than 1 million patients are injured while in the hospital and approximately 180,000 die because of these injuries. Furthermore, drug-related morbidity and mortality are common and are estimated to cost more than $136 billion a year. The most common type of drug-induced disorder is dose-dependent and predictable. Many adverse drug events occur as a result of drug-drug, drug-disease or drug-food interactions and, therefore, are preventable. Clinicians' awareness of the agents that commonly cause drug-induced disorders and recognition of compromised organ function can significantly decrease the likelihood that an adverse event will occur. Patient assessment should include a thorough medication history, including an analysis of all prescribed and over-the-counter medications, vitamins, herbs and "health-food" products to identify drug-induced problems and potentially reversible conditions. An increased awareness among clinicians of drug-induced disorders should maximize their recognition and minimize their incidence.
Drug-induced disorders, in the form of adverse drug events or drug interactions, occur daily in all health care environments. Unfortunately, significant morbidity and mortality are often the consequence of these reactions. Several studies have reported that an average of 10 percent of all hospital admissions may be attributable to drug-induced disorders; this percentage may be a significant underestimate.1 Furthermore, an evaluation of a large sample of 30,195 randomly selected hospital records revealed that 1,133 patients (3.7 percent) experienced a disabling injury caused by medical treatment while hospitalized.
2 Other studies report that hospitalized patients have a 1.5 to 43.5 percent chance of having a drug-induced disorder.1 Using the conservative figure, that 4 percent of hospitalized patients have an adverse event due to medical treatment, and extrapolating to the United States, each year over 1 million patients are injured while in the hospital, and approximately 180,000 die as a result of these injuries.3
In the ambulatory care environment, the incidence of drug-induced disorders not causing hospitalization or death is less well known because different, less effective methods are used to collect data. Reported rates have ranged from 2.6 to 50.6 percent, depending on the source of the data.4 The lower rates generally reflect data collected from physicians, and the higher rates come from patient surveys.
Drug-related morbidity and mortality are estimated to cost more than $136 billion a year in the United States.5 A recent study6 of hospitalized patients demonstrated that adverse drug events extended the hospital stay by nearly two days and increased the cost of hospitalization by about $2,000. Furthermore, patients experiencing an adverse drug event had an increased risk of death that was nearly two-fold greater.
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