Every year, people are sent to the emergency room (ER) for adverse drug events, creating unnecessary expenses and putting people’s lives at risk.
The Centers for Disease Control defines an adverse drug event (ADE) as an “injury resulting from the use of medication.” Examples of ADEs include medication side effects, such as bleeding from blood thinners or extremely low blood sugar from diabetes medications or drug interactions, such as combining a high dose of blood pressure medication with a diuretic to create extremely low blood pressure.
The Journal of the American Medical Association (JAMA) published an article in the November 22, 2016 issue entitled, “U.S. Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014,” that reported that each year, four out of every 1,000 people (.4 percent) are sent to the ER as a result of ADEs, and about 27 percent of them will be hospitalized.
How important is it to prevent ADEs for your employee health plan?
For an employee health plan with 500 employees and a total of 1,000 lives, ADEs cause approximately four ER visits a year and one of those ER visits will result in hospitalization.
From a cost perspective, an ER visit might cost about $800 and a three-day hospitalization might cost about $5,000. As a result, you would expect the financial impact of ADEs to be about $8,200 per year. If the average total healthcare cost each year is about $9,000 per employee, then this same 500 employee health plan would have a total annual healthcare spend of $4.5 million. $8,200 is 0.18 percent of $4.5 million. So from an overall health plan cost perspective, it’s a fairly minimal impact.
The study also reported which types of medications are likely to be associated with ADEs:
- Almost 50 percent of all ADE-related ER visits were caused by three types of medications: 1) anticoagulants (i.e. blood thinners), 2) antibiotics and 3) diabetes medications.
- Blood thinners (e.g. Coumadin/Warfarin) can cause excessive bleeding.
- Antibiotics can cause allergic reactions, such as a severe rash, etc.
- Diabetes medications can lower blood sugar too much, which can cause light headedness and even loss of consciousness.
Focus on Three Types of Medications to Reduce Your Employees Having Adverse Drug Events
Rather than try to boil the ocean by addressing ALL types of medications, focus on three categories that are responsible for almost half of all ADE ER visits.
What can an employer, pharmacy benefits manager (PBM), insurance carrier or healthcare provider (physician practice, health system, etc.) do to reduce the number of ADEs for these medications?
- Blood Thinners & Diabetic Medications: I recommend 1) targeted patient education, 2) close monitoring and 3) frequent follow-up communication. Physicians who have created dedicated “Coumadin-Clinics” with nurses and nurse practitioners solely focused on education, monitoring and follow-up communication have seen decreases in blood thinner ADEs.
- Antibiotics: The JAMA article suggests that to reduce allergic reactions from antibiotics it’s important to reduce inappropriate antibiotic prescriptions. Here is a list of the antibiotics most associated with ADE ER visits: Amoxicillin, Bactrim, Azithromycin, Augmentin, Cefdinir, Keflex, Clindamycin and Penicillin.
According to the article, 50 percent of antibiotic prescriptions “for children aged 14 or younger are for acute respiratory tract infections, which are commonly viral, or infections for which watchful waiting is recommended.” In other words… if you want to reduce allergic reactions to antibiotics, don’t take an antibiotic unless you really need to.
ER visits caused by ADEs are rare and have minimal financial impact on employee health plans. However, they shouldn’t happen.
To reduce the risk of ADEs among your employees:
- Connect your employees to physician practices that have dedicated teams to monitor blood thinner and diabetes medication
- Educate your employees to talk to their doctor about if they ‘really’ need an antibiotic, as taking one does pose the possible risk of a significant allergic reaction
To learn more:
- Read Compass blog: Antibiotic Prescribing by Doctors Often NOT Evidence-Based
- Read Compass blog: Top 5 Most Overprescribed Antibiotics
To learn how Compass works with more than 2,000 employers to make healthcare simpler and smarter for their employees, watch this short video: