MEDICATION MISADVENTURES RESULTING IN EMERGENCY DEPARTMENT VISITS AT AN HMO MEDICAL-CENTER

Medication misadventures resulting in visits to the emergency departme nt of a health maintenance organization (HMO) were studied. The record s of patients who visited the emergency department at a California HMO between August 1992 and August 1993 were evaluated for evidence of me dication misadventures brought to the department. The definition of mi sadventure included noncompliance and inappropriate prescribing but ex cluded intentional overdoses and substance abuse. If it seemed probabl e that a misadventure occurred, a pharmacist interviewed the patient b y telephone. During the 12-month study, 1,074 (1.7%) of 62,216 visits to the emergency department were due to medication misadventures. The patients who had had a misadventure were predominantly female (62%); 3 8% were 15-44 years of age and 33% were 65 or older. Interviews were p ossible with 962 patients. Only 30.6% of the patients had a good under standing of the potential adverse effects of their regimen, and only 2 9.0% had a good understanding of the potential interactions. Misadvent ures were most often due to allergies or medication underuse among pat ients less than or equal to 14 years of age and to adverse effects and inappropriate dosage in elderly patients. Of the 1,074 misadventures, 152 (14.1%) resulted in hospital admission. Three areas of particular concern were identified: (1) non-compliance with respiratory agents i n the young, (2) non-steroidal anti-inflammatory use leading to hospit al admission, and (3) the frequency of problems in the elderly. Medica tion misadventures accounted for 1.7% of emergency department visits a nd 1.0% of hospital admissions at an HMO medical center.