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While medication safety is more likely to be a priority within the health care community than in the board room, it should also be a major concern for employers.
The Institute of Medicine's report issued in July, which estimates that preventable medication errors injure at least 1.5 million Americans annually, brings into sharp focus the seriousness of this problem. The costs are not obvious, but they directly harm employers' bottom lines through additional hospitalization costs, increased disability payments and a drain on productivity in the workplace.
The report portrays a grim picture of the state of prescription medication use in the United States. However, there is room for optimism. Some managed care organizations and pharmacy benefit managers have been using many of the tactics outlined in the report to reduce prescription drug errors. These solutions need broader adoption to fully address the problem.
The solution is a matter of simple communication between all the parties taking part in providing care. Some of the recommendations are as basic as patients sharing lists of the medications, vitamins and supplements they use with their health care providers. Other solutions are technologically driven to ensure accurate communication between doctors and pharmacists, including having all prescriptions transmitted electronically by 2010 to avoid handwriting and transcribing errors. The Centers for Medicare and Medicaid Services estimates that use of e-prescribing could eliminate as many as 2 million harmful drug events nationally each year.
Information technology will play a huge role in making the leap to improving medication safety. Electronic patient records and integrated data networks that connect medical, pharmacy and diagnostic lab data are a major step toward preventing medical errors overall, as well as prescription drug errors.
However, these records need to be designed to alert doctors and pharmacists about potential conflicts in care. These conflicts come from drug-to-drug interactions, drug/disease interactions, errors of omission (failing to provide an essential treatment) or duplicative treatments, for example. Also, many e-prescribing programs have features that conduct drug reviews that check a patient's history and current medications and will alert pharmacists if there is a problem. For example, an electronic prescribing initiative in the Detroit area has resulted in 98,000 prescription changes due to drug interaction alerts since the program started in February 2005.
These solutions are in place, but slashing 1.5 million medication errors per year will require broader implementation of them.
The Institute of Medicine's report encourages health care suppliers to become "high reliability organizations preoccupied with improving medication safety." Businesses should ask their health care providers questions about programs to improve medication safety when shopping for health plans or determining what providers should be in their network.
While that might seem off the track from the core issues of price and coverage, medication errors skew overall costs. The report noted that each adverse drug event in a hospital added about $8,750 to the cost of a hospital stay, leading to about $3.5 billion in avoidable costs nationwide--a figure that the institute admits is extremely conservative, with real costs likely much higher.
This does not even account for additional costs to the employee and employer. Employers have to contend with hiring temporary help or making do with a smaller staff while an employee convalesces, as well as medical, disability and potential rehabilitation costs.
Addressing the problem of medication errors is one tactic toward chipping away at preventable health care costs. According to the Kaiser Family Foundation, health care coverage costs for a family of four is approaching $11,000 annually.
There needs to be an equal commitment on the part of business to improve health care quality on behalf of employees. A heightened awareness of medical errors will force employers to become more selective about their health care providers.
It will also drive employers and health plans to educate employees about this and also make them more demanding about the care they receive. This issue is too important for passivity.
Each day spent in the hospital exposes the patient to one medication error per day. Those odds are too serious for patients and employers to remain passive and the costs of poor quality in this realm are too significant.
Dr. Roger W. Anderson is senior vp, chief pharmacist at Medco Health Solutions Inc., based in Dallas.