Curbing adverse drug events starts with provider.

Children with multiple prescriptions and those whose parents lack English skills are at increased risk of having preventable adverse drug events, according to a Boston study.

"Further attention should be directed toward improved communication among health care providers and patients," said Dr. Stephanie O. Zandieh of Cornell University, New York, and the Komansky Center for Children's Health at New York-Presbyterian Hospital and associates.

In the prospective cohort of patients aged under 21 years who were seen from July 2002 to April 2003 at six urban and suburban practice sites in Boston, Mass. The primary outcome measure was the presence of a preventable adverse drug event (ADE), defined as actual harm from medication use (J. Pediatr. 2008;152:225-31). Telephone surveys were used to gather information about race, ethnicity, reported annual family income, parental educational attainment, and parental self-reported English proficiency.

Independent variables, such as socioeconomic characteristics, poverty status, health care access, and medication regimen complexity, were determined by both telephone interviews and chart reviews.

The study logged more than 21,000 visits by 14,000 patients, 3,838 of whom received a prescription. Of those, the researchers studied 1,689 who completed the 10-day survey and had a chart review; they received 2,155 prescriptions.

The study population was about 49% white, 15% black, 21% Hispanic, and 14% "other," the investigators said. Two-thirds of Hispanics had limited English proficiency, compared with 16% of blacks, 3% of whites, and 23% of the "other" group of Native Americans, Asians, and Native Pacific Islanders. "We found 283 ADEs occurred in 242 children (14% [of total 1,689 patients]), of which 57 were preventable in 56 children and 226 were nonpreventable ADEs in 186 children," the investigators said, adding that about 10% of the children who had a preventable ADE also experienced a nonpreventable event. None of the preventable ADEs were life threatening or fatal, 14% were serious, and 86% were considered significant.

A total of 40 preventable ADEs (70%) occurred during parental administration of medication, and 15 (26%)occurred during ordering, they said, adding that the most common drugs involved in preventable ADEs were amoxicillin or amoxicillin-clavulanate (26%), inhaled steroids (11%), topical antifungals (7%), antihistamines (7%), and inhaled bronchodilators (5%).

In the univariate analysis of the data, the researchers found that children of parents who said they spoke English poorly were twice as likely to have a preventable ADE, compared with children of parents who spoke English very well. Similarly, children with less than a year of continuous care were more likely to have a preventable ADE. In multivariate anaylsis, children with chronic illnesses had more medications prescribed, increasing their risk of a preventable adverse event. Also, most preventable ADEs occurred during home administration, the researchers wrote.

The investigators derived two key policy implications from their findings. First, identification of parents' health literacy and appropriate tailoring of medication-related information are required. "It is imperative that parents clearly understand medication-related instructions and have their questions answered," Dr. Zandieh said. Secondly, for policy makers and providers who are interested in improving patient safety, better methods are needed to identify preventable ADEs.

BY BRUCE K. DIXON

Chicago Bureau