Background

Studies suggest that the clinical, humanistic and economic outcomes of drug-related morbidity (DRM) and mortality are potentially substantial.^1-4 Measuring and improving the quality of the health-care system is now firmly on the health policy agenda. Recent Government reports,^5,6 and the introduction of the National Patient Safety Agency are indicative of this. Reducing preventable drug-related morbidity (PDRM) could potentially improve both the safety and the quality of health-care whilst reducing costs. This paper will describe how a series of PDRM indicators were operationalised and the potential benefits for patient care.

Setting

A three-partnered general practitioner (GP) practice with a list size of just over 6,000 patients, strongly committed to the use of the electronic patient record for recording all patient data.

Method

Following local research ethical committee approval, operationalisation of 29 indicators for PDRM, the derivation of which has been previously described,⁷ was undertaken in one pilot general practice. Each indicator takes the form of an adverse therapeutic outcome, or "event", resulting from an associated process or lack of patient care. The number of PDRM events was retrospectively assessed by a computer search of the patient database. The results of the study were fed back to the practice via a multidisciplinary discussion forum facilitated by CJM and attended by the GPs, practice nurses, practice pharmacist, practice manager and assistant practice manager.

Results

On reviewing the PDRM events identified by the operationalisation process, some important issues, related to (i) lack of monitoring of specific drug therapy (ii) inappropriate drug usage in patients with pre-existing co-morbidities and (iii) sub-optimal communication of laboratory test results which could potentially have a negative impact on patient care were recognized. Examples of the above include (i) lack of urea and electrolyte monitoring in patients prescribed angiotensin-converting enzyme inhibitors (ii) use of beta-blockers in patients with asthma and (iii) lack of communication of the international normalised ratio results between the community anticoagulant clinic and GP practice. The multidisciplinary discussion forum provided practice staff with the opportunity to review processes of care for specific groups of patients and explore possible solutions.

Discussion

A facilitated multidisciplinary discussion forum provided a practical and useful way of exploring possible preventable drug-related events in a primary care setting. It allowed potentially "critical" research data to be shared with the practice staff in an open, non-judgmental manner in order to facilitate improvements in patient care.

References

1. Nelson KM, Talbert RL. Drug-related hospital admissions. Pharmacotherapy 1996;16:701-707

2. Hallas J, Worm J, Beck-Nieslen J, Gram LF, Grodum E, Damsbo N, et al . Drug related events and drug utilization in patients admitted to a geriatric hospital department. Danish Medical Bulletin 1991;38:417-420

3. Lindley CM, Tully MP, Paramsothy V, Tallis RC. Inappropriate medication is a major cause of adverse drug reactions in elderly patients. Age and Ageing 1992;21:294-300

4. Johnson JA, Bootman JL. Drug-related morbidity and mortality: A cost-of-illness model. Archives Internal Medicine 1995;155:1949-1956

5. An organization with a memory . London: Department of Health, 2000.

6. Building a safer NHS for patients . London: Department of Health, 2001.

7. Morris CJ, Cantrill JA, Hepler CD, Noyce PR. Preventable drug-related morbidity in elderly patients - Transatlantic transcription of indicators. In: 7th Health Services Research and Pharmacy Practice Conference volume of abstracts. Nottingham: 2001: 25 (www.hsrpp.org.uk)