Dec
31
Non-Adherence and Medication Error: Are We Confusing the Two?
Filed Under Medical errors, Patient Adherence
The Tennessean is carrying an article by Dr. William Stead that seems thoughtful and well-intentioned, yet introduces confusion by conflating two important issues: patient non-adherence and medication error. Dr. Stead is associate vice chancellor for strategy and transformation and director of the Informatics Center at Vanderbilt University Medical Center.
He starts the article with some useful and provocative statistics:
Sixty-one percent of patients fear being given the wrong medicine. Over 150 million phone calls requesting clarification from pharmacists to physicians are made annually because of the difficulty in interpreting the prescription.
And then inexplicably puts not medication error, but patient non-aderence at the crux of the problem.
As many as 125,000 die annually from non-adherence to their medications.
Dr. Stead chronicles a careful process he carried out at Vanderbilt to clean up the medication errors. All the while continuing to mix together issues that would be better dealt with separately.
As an example, here’s his critique of e-prescribing:
e-prescribing is better thought of as nine smaller processes — deciding what to prescribe; creating the prescription; transmitting the prescription to the pharmacy; pharmacist-prescriber dialogue; dispensing; filing the claim; taking the medication; monitoring for effect and adverse effect and refilling the prescription.
Notice that the process has a variety of vulnerabilities from a variety of sources. Both deciding what to prescribe as well as the pharmacist-prescriber dialogue are vulnerable to lack of information about other medicines the patient is taking (a medication error). They’re also vulnerable to patients withholding issues about beliefs and lifestyle that could keep them from filling or taking their medicines (nonadherence issues). Transmitting the prescription to the pharmacy is a pure technology issue. Dispensing is open to human error. Monitoring for adverse effects is often hindered by lack of trust between the physican and the patient (a nonadherence issue).
Tim’s Takeaway: Dr. Stead raises important issues. And thanksfully he’s attacking his challenges with a critical eye. If we’re going to get to the bottom of the problems, we’ve got to separate them out according to their root causes. Otherwise, we’ll be dealing with a conceptual tangle.
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