EMBARGOED FOR RELEASE: 6:30 P.M. (EST) THURSDAY, FEB. 26, 1998
Dolores Davies
(619) 534-5994
[email protected]
STUDY SHOWS MARKED INCREASE IN DEATHS DUE TO MEDICATION ERRORS
A study examining U.S. mortality rates has found nearly a three-fold increase in deaths from medication errors over a ten-year period, adding fuel to the growing concern that the nation's quality of health care may be suffering because of the shift to managed care. The study, to be published in the Feb. 28 edition of The Lancet, was conducted by sociologist and mortality expert David Phillips, psychologist Nicholas Christenfeld, and graduate student Laura Glynn, all of the University of California, San Diego.
The study, which reviewed mortality rates from 1983-1993, found that deaths from officially acknowledged medication errors -- either errors in the type of medicine or the dosage level prescribed to a patient -- increased at a higher rate (a 2.57-fold increase, from 2,800 to 7,390) than any other cause of death except AIDS. The authors compared trends in deaths caused by medication errors with other related causes of death, including poisoning and drug abuse (see attached graph). According to Phillips, the increase in medication-error deaths was highest - 8.4-fold - for outpatients.
"Although medication-error mortality rates increased over this period for both inpatients and outpatients," said Phillips, "the increase was especially marked for outpatients (8.4-fold vs. 2.3-fold). Given the increased emphasis on outpatient services among health care providers today, we need to ask whether changes in the way we deliver medical care may have increased the risk of death from certain causes."
During the ten-year study period, the number of outpatient visits for medical care increased by 75 percent, while the number of inpatient days fell by 21 percent, reflecting the national trend toward outpatient services imposed by managed care. Phillips and his co-authors postulate that two trends could be at work here. The shift to outpatient treatment implies that more medications are taken with the patient, not medical personnel, exercising quality control. In addition, it may be increasingly difficult for physicians to maintain the continuity and quality of their relationships with patients.
The study also examined the nine pharmacological categories listed in U.S. death certificates for medication errors: analgesics; barbiturates; sedatives/hypnotics; tranquilizers; psychotropic agents; central nervous system drugs (mainly anesthetics); antibiotics; and other drugs. The analgesic category showed the highest absolute increase in deaths, with anesthetics exhibiting the largest relative increase in deaths.
In terms of race and gender, black males experienced the highest increase in medication-error deaths, followed by white males, black females, and white females. The authors suggest that the high-risk groups may be those most likely to receive outpatient treatment.
Although the proportion of deaths from medication errors has always been greater for outpatients than inpatients, this proportion has increased markedly in recent years, according to the study. In 1983, medication errors caused one out of every 539 outpatient deaths compared to one out of every 1,622 inpatient deaths, indicating that the risk of death from medication error was three times greater for outpatients then inpatients. By 1993, this risk had increased to 6.5, with one out of every 131 outpatient deaths caused by medication errors versus 1 out of 854 inpatient deaths.
"We believe that this increase in deaths caused by medication errors cannot be explained by other factors such as an increase in the number of prescriptions," said Phillips. "From 1983-1993, the number of prescriptions issued in the U.S. increased by only 1.39-fold, while medication-error deaths rose at a much higher rate (2.57-fold).
According to Phillips and his co-authors, previous studies on the impact of medication errors on patient fatality have been conducted in hospital settings, and have not tracked nationwide trends. The current study is based on an examination of U.S. death certificates from 1983-1993 (the latest year available). The certificates indicate cause of death, race, gender, and inpatient/outpatient status.
"Our data suggest that medical personnel may need to compensate for changes in medical care by increased vigilance in the delivery and monitoring of medications, especially for outpatients," said Phillips. "There is a growing concern about the quality and continuity of physician-patient relationships; in the case of medication errors, this concern may be justified."
Phillips, a professor of sociology at UCSD, is a well-known authority on mortality trends and statistics, including suicide and the role of psychosomatic factors in delaying death in certain people. He recently completed a study that linked legalized gambling with higher suicide rates. His research has been published widely in numerous professional and academic journals including, The Lancet, New England Journal of Medicine, Science, and the American Journal of Sociology. Christenfeld, an associate professor of psychology at UCSD, is a specialist on human emotions and behavior patterns. His work covers a diversity of subjects, ranging from the human reaction to being tickled to the use of fillers and pauses in speech. His work has been published in major publications such as Nature and Cognition and Emotion.
Note: A copy of The Lancet paper can be downloaded from the UCSD University Communications Office web site: www-uris.ucsd.edu/ucomm/main/ by clicking on this news release. David Phillips is available for media interviews and can be reached at his office: (619) 534-0482; or home: (619) 453-2146.
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