April 27, 2009
The patient in the heart-failure clinic had all the symptoms of digitalis toxicity from taking too much of the heart medicine digoxin. However, his dose was right and no one was sure what the problem was.
This was a riddle Herb Patterson, PharmD, a professor in the Division of Pharmacotherapy and Experimental Therapeutics who treats patients in the UNC heart-failure program, had to solve. Patterson quizzed the patient on the medicines he was taking and discovered he had received two prescriptions for digoxin by different doctors: one for the generic version and one for the brand name. The patient was having them filled at different pharmacies and was taking both, not knowing they were the same drugs.
That example is the kind of medication mistake that can cost people money, time, their health and sometimes their lives. It is also the kind of error that can be significantly reduced by closely involving a pharmacist in caring for patients with cardiovascular disease and high blood pressure, according to a new study from UNC Eshelman School of Pharmacy researchers published in the April 27, 2009, issue of the Archives of Internal Medicine.
People with high blood pressure and heart disease, including heart failure, were more than a third less likely to experience problems with their medications when under a pharmacist’s care than patients who received no special attention from a pharmacist, researchers found. Preventing unnecessary hospitalizations, emergency room visits and associated health-care costs saved approximately $2,600 per patient.
“By working closely with doctors and nurses, pharmacists can help people avoid problems with their medications for chronic conditions such as high blood pressure and heart failure with favorable effects on health and health-care costs,” said Michael D. Murray, Pharm.D, Mescal S. Ferguson Distinguished Professor at the UNC Eshelman School of Pharmacy and lead author of the journal paper.
In the study, researchers monitored two types of patients for approximately one year. Complicated patients had been previously diagnosed with heart failure, coronary heart disease, stroke, heart attack, or kidney problems. Uncomplicated patients had high blood pressure but no other evidence of a heart or kidney condition. All were taking at least one medication, with complicated patients taking an average of more than ten. The 800 patients had an average age of fifty-nine and received their care from Wishard Health Services, a city-county hospital in Indianapolis.
Complicated and uncomplicated patients assigned to the control group did not receive any extra attention from a pharmacist. Patients in the intervention group were assigned to a pharmacist who took a medical history, tracked medication refills, monitored body weights and laboratory tests, taught patients how to best take their medications, and communicated regularly with patients and their doctors and nurses.
Over the study period, 90 percent of all adverse events that occurred were experienced by participants in the complicated group who had more serious heart conditions. However, researchers found that a pharmacist’s guidance and advice reduced adverse drug events and medication errors by 34 percent.
Murray is chair of the school’s division of pharmaceutical outcomes and policy. The other authors of the paper are Mary Ritchey, a doctoral student at the UNC Gillings School of Global Public Health, and Wanzhu Tu, PhD, and Jingwei Wu, biostatisticians at Indiana University School of Medicine. James Young, PharmD, is the study pharmacist at Wishard Health Services in Indianapolis. Murray and Tu are also affiliated with Regenstrief Institute in Indianapolis.
The study was funded by a grant from the National Institutes of Health.
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