Checking up on patients helps resolve drug reactions

Calling patients after they get their prescriptions could help identify side-effects related to the medications, Canadian researchers have found.

Many patients don't realize they're experiencing an adverse drug event, and doctors often don't ask. To try to prevent this problem, researchers used automated calls to check in with 629 patients at family practices in Quebec three days and again 17 days after a prescription with four simple "yes-or-no" questions.

Pharmacists' calls helped patients to manage some adverse drug reactions. (Derik Holtmann/Belleville News Democrat/Associated Press)

"The system is identifying the patient who has a problem, the pharmacist is talking to them and they change their prescription in such a way that the patient can continue to take the medications or take an alternative medication," said study author Dr. Alan Forster, scientific director of performance measurement at the Ottawa Hospital.

The system identified 46 per cent of adverse drug events and influenced how 40 per cent of those were managed, the researchers said in Monday's online issue of JAMA Internal Medicine, formerly Archives of Internal Medicine.

It's the first time that automated calls have been used to help patients this way, Forster said.

Symptoms related to medications also didn't last as long, compared with the normal system.

The main benefit was with compliance, which is important for blood pressure, diabetes and heart medications that can improve health if the drugs are taken. When provincial drug plans pay for medications that sit on a shelf then the patient doesn't derive any benefit.

In the automated calls, patients were asked about if they'd filled the prescription, had any symptoms or problems related to the medication and if they wanted to speak to a pharmacist. If the patient said yes, the pharmacist was emailed and called back.

The Canadian Institutes of Health Research is now funding a randomized control trial of the system to see if it improves patients' health in a cost-effective manner.

'Reaching out is necessary but not sufficient'

A journal editorial accompanying the study called reaching out to patients to identify adverse drug reactions exciting and highly promising, but not yet ready for widespread use.

"For most people, the simple act of reaching out is necessary but not sufficient," wrote Dr. Michael Steinman of San Francisco Veterans Affairs Medical Center.

Steinman suggested combining the approach with efforts to educate and encourage patients to be active partners in their own care.

David Gardner, a pharmacy professor at Dalhousie University in Halifax, agreed the study exposes a bigger issue: Failing to get followup care.

"Right now in community pharmacies, we have sometimes the technician say to the patient picking up their pills, 'Do you want to speak to the pharmacist?' The patient looks over and sees a busy pharmacist and says, 'Oh no, I won't bother.' But that patient may have five important questions that could affect their wellness."

With files from CBC's Pauline Dakin

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