Patient-Re****ted Medication Symptoms in Primary Care
Saul N. Weingart, MD, PhD; Tejal K. Gandhi, MD, MPH; Andrew C. Seger,
RPh; Diane L. Seger, RPh; Joshua Borus, BA; Elisabeth Burdick, MA;
Lucian L. Leape, MD; David W. Bates, MD, MSc
Arch Intern Med. 2005;165:234-240.
Background Little is known about the prevalence and character of
medication-related symptoms in primary care and their relation****p to
adverse drug events (ADEs) or about factors that affect
patient-physician communication regarding medication symptoms.
Methods The study included 661 patients who received prescriptions
from physicians at 4 adult primary care practices. We interviewed
patients 2 weeks and 3 months after the index visit, reviewed
patients' medical records, and surveyed physicians whose patients
identified medication-related symptoms. Physician reviewers determined
whether medication symptoms constituted true ADEs. We used
multivariable regression to examine factors associated with patients'
decision to discuss symptoms with a physician and with physicians'
decision to alter therapy.
Results A total of 179 patients identified 286 medication-related
symptoms but discussed only 196 (69%) with their physicians. Physicians
changed therapy in response to 76% of re****ted symptoms. Patients'
failure to discuss 90 medication symptoms resulted in 19 (21%)
ameliorable and 2 (2%) preventable ADEs. Physicians' failure to
change therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In
multivariable analyses, patients who took more medications (odds ratio
[OR] = 1.06; 95% confidence interval [CI] = 1.04-1.08; P<.001) and had
multiple medication allergies (OR = 1.07; 95% CI = 1.03-1.11; P = .001)
were more likely to discuss symptoms. Male physicians (OR = 1.20, 95%
CI = 1.09-1.26; P = .002) and physicians at 2 practices were more
likely to change therapy (OR = 1.24; 95% CI = 1.17-1.28; P<.001; and OR
= 1.17; 95% CI = 1.08-1.24; P = .002).
Conclusion Primary care physicians may be able to reduce the duration
and/or the severity of many ADEs by eliciting and addressing
patients' medication symptoms.
Author Affiliations: Division of General Medicine and Primary Care,
Beth Israel Deaconess Medical Center (Dr Weingart), Division of General
Internal Medicine, Brigham and Women's Hospital (Drs Gandhi and
Bates, Mssrs Seger and Borus, and Mss Seger and Burdick), and
Department of Health Policy and Management, Harvard School of Public
Health (Dr Leape), Boston, Mass. Dr Weingart is now with Center for
Patient Safety, Dana-Farber Cancer Institute, Boston.
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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2005;165:136.
FULL TEXT
http://archinte.ama-assn.org/cgi/content/abstract/165/2/234?etoc
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