Dutch doctors call for action on drug safety

Doctors, pharmacists, and patients' groups in the Netherlands are demanding government action on drug safety after a national study has concluded that drug related problems were responsible for twice as many hospital admissions as road traffic crashes.

The hospital admissions related to medication (HARM) study found that 41 000 hospital admissions a year in the Netherlands were caused either by the incorrect use of or adverse reactions to drugs (www.nvza.nl).

These admissions accounted for 5.6% of acute admissions and were twice as likely to involve patients older than 65 years.

Almost half—19 000 admissions—were deemed “possibly avoidable” and cost the health services €85m (£57m; $112m) a year. They were thought to play a part in an estimated 1254 deaths a year.

This first empirical study into the safety of medicines in the Netherlands screened all acute admissions in 21 hospitals over 40 days to see whether the reasons for admissions included drug related problems.

Patients identified as being at risk were those who had failed to take their medicines properly; had reduced competence; took more than five different drugs; and had more than one medical condition, in particular kidney failure.

These admissions typically involved conditions such as gastrointestinal bleeding, diabetes mellitus, and cardiovascular problems. The drugs commonly involved were antidiabetes drugs, blood coagulation inhibitors, and non-steroidal anti-inflammatory drugs.

The study argues that hospital admission rates can be reduced by paying closer attention to the drug treatment of patients at risk through a joint approach by all staff treating the patient.

Dr Patricia van den Bemt, a hospital pharmacist in Tilburg, who led the study, explained that patients should have an annual medication review. This should be done by a multidisciplinary team of doctors and pharmacists to show which drugs can be stopped and which side effects had been seen. “These things are not happening yet. Medication is often started for life with little review,” she said.

She also urged that data on patients be shared among all team members, including pharmacists. “Pharmacists do not have information on patients' morbidity, such as kidney function. We recommend they receive that information so medication checks can include these factors.”

The inspector general of heath care, Professor Gerrit van der Wal, says the study shows clearly what information is required. Former minister of health Els Borst said the study shows that hospital admission rates could fall if the patient's “pharmaceutical profile” was reviewed every time their drugs changed.

In response to the report, the Dutch Medical Association, the hospital pharmacists group, and the patients' umbrella organisation have called for the minister of heath to launch a taskforce with a strong mandate to improve the safety of drugs. MPs have called on the government to respond to the “serious situation.”