Overall, 70% of adverse drug events are considered preventable. Since managed care companies are always looking to improve patient care and prevent adverse outcomes, it is no wonder that patient safety is a concern in this healthcare environment.
Patient safety is a top healthcare priority. Billions of dollars are spent annually on adverse drug events (ADEs). The Institute of Medicine estimates that 1.5 million ADEs occur annually in the United States. In addition, 28% of emergency room visits are related to ADEs and of these, 24% result in hospitalization. Overall, 70% of ADEs are considered preventable. Since managed care companies are always looking to improve patient care and prevent adverse outcomes, it is no wonder that patient safety is a concern in this healthcare environment.
According to information presented at the 22nd annual meeting of the Academy of Managed Care Pharmacy in San Diego, Optima Health, a division of Sentara Healthcare located in Virginia Beach, Va., uses a number of different programs to improve patient safety at different levels. Programs include alerts and edits at the point-of-sale (POS), education of providers, education of members, and prospective evaluations of medical and pharmacy claims data.
Optima’s Clinical Pharmacy Specialist, Elizabeth L. Brusig, PharmD, presented information related to some of the programs the health plan uses to improve patient safety. At the POS these include using soft edits messaging and hard edits for very dangerous drug interactions (eg, nitrates and phosphodiesterase inhibitors) and quantity limits. Plans can evaluate the effectiveness of the programs by evaluating rejected pharmacy claims and reviewing claim percentages for conversions to other drugs. Safety interventions directed toward providers include programs related to polypharmacy and Beer's criteria. For serious safety concerns, a phone call/fax would be sent to the provider alerting them to a patient-specific safety issue. For less serious safety issues, a provider letter can be mailed. However, frequently most providers will not read the material so plans should consider the importance of the information to reduce information overload (eg, the "noise effect"). Case managers could be used to reinforce these programs, as can clinical pharmacists, and medical directors from health plans or PBMs.
Electronic medical records and e-prescribing have the potential to significantly change the way providers are educated and respond to patient safety issues. All healthcare providers will have easier access to patient-specific test results, prescriptions, and other health data, to improve patient outcomes.