Risk Watch e-column
July 2006
An update of risk management news, issues and items of interest
Herbals and Prescriptions May Not Mix
Patients who mix over-the-counter herbal and prescription medications may be putting themselves at risk. According to a recent study, the effects of mixing medicine typically goes unnoticed because patients don’t inform their doctors about all the medications they take.
The study, published in the March issue of Geriatric Nursing, analyzed 58 older women from North Central Florida. Each took at least one herbal and one prescribed or over-the-counter medication. According to the researchers, 74% of the study participants were declared to be in danger of a moderate or high-risk drug interaction. This conclusion was reached using the Gold Standard Multimedia’s Clinical Pharmacology Drug Interactions, a database that analyzes drug interactions.
During the analysis, 136 drug interactions were identified, with 41% being labeled high risk and 58% as moderate risk.
The most common and dangerous combination involved two or more nonsteroidal anti-inflammatory drugs (NSAIDS) or NSAIDS and ginko biloba. Other dangerous combinations included over-the-counter pain relievers such as ibuprofen and/or calcium supplements with prescribed medication.
(Source: Geriatric Nursing)
Survey Indicates Physicians Worry About Drug Safety
A survey released in May found that seven in 10 physicians are worried about the safety of the drugs they prescribe.
The survey—which was conducted by Forrester Research on behalf of Medco Health Solutions, Inc.—involved 3,200 Americans, including 300 practicing physicians. It was conducted in reaction to the 2004 withdrawal of Vioxx from the market.
Among the findings:
- 68% of physicians would prefer prescribing a drug that had been on the market at least 10 years. About a third felt that new or recently approved drugs are less safe than those that have been on the market 10 years or longer.
- 20% of physicians believe that generic drugs are less safe than brand-name medications.
- 25% do not believe that generic medications are identical to brand-name drugs, with 27% of physicians believing that generic medications will cause more side effects.
Additionally, 55% of consumers and 62% of pharmacists were concerned about the safety of medications on the market.
(Source: Reuters)
California Medical Board Can Fine, Cite for Failure to Provide Medical Records
Since January 1, 2006, the Medical Board of California has had the authority to cite and fine physicians who fail to provide the board with requested medical records in a timely manner. Though the board still has the option to pursue a civil action against physicians for this infraction, the new law allows the issuance of a citation and fine outside the judicial process, avoiding a lengthy and costly legal proceeding.
Fines range from $1,000 to $5,000 depending on the severity of the violation and whether the physician has a history of failing to provide the board with medical records.
According to the state’s Business and Professions Code, a physician has 15 business days from the date of a request to provide the board with medical records. If a physician is found to be in violation of the code, he or she may be fined and cited. The citation will be posted in the physician’s profile on the board’s website. The request would have to be fulfilled before the matter would be considered resolved.
(Source: Medical Board of California)
Medical Identity Theft Is a Growing Threat
According to a report by the World Privacy Forum, 250,000 to 500,000 patients have had their personal medical information stolen. This is the newest iteration of the biggest problem of the Internet age—identity theft.
The discovery of a false charge or an incorrect entry may come long after the theft occurred. It is recommended that patients request an accounting of disclosures annually from their insurance and healthcare providers in order to discover whether their medical information has been illegally accessed.
(Source: The Baltimore Sun)
Most ICU Patients Receive Poor Care
A report released by the U.S. Department of Health and Human Services (HHS) indicates that two-thirds of patients in critical settings are receiving suboptimal care. The HHS report blames the problem on the shrinking pool of hospital critical care physicians, also known as intensivists, and the increase in the size of the aging U.S. population.
The HHS predicts the problem will reach its peak by 2020, with a 35% shortage of intensivists. Because intensivists are typically based in large urban areas, the HHS report also predicts the shortage will be felt particularly in areas that already lack physicians.
The U.S. population over 65 is expected to increase by about 50% by 2020 and 100% by 2030.
Intensivists are the key element in improving outcomes in critical care settings. There are approximately 360,000 patient deaths each year in critical care units not managed by intensivists. Increasing the number of these physicians could save 54,000 lives per annum, according to the report. Only about one-third of all critical care patients are cared for by intensivists.
The report was written at the request of the U.S. Senate and the Critical Care Workforce Partnership, a group representing four medical societies: the American College of Chest Physicians, American Association of Critical Care Nurses, American Thoracic Society and the Society of Critical Care Medicine.
To increase the supply of intensivists, the partnership recommends that opportunities be expanded for U.S.-trained international medical graduates to practice in the United States, and to increase medical and nursing school capacity to train critical care providers. The partnership also recommends that there should be increased support for critical care research and for exploring alternative care options for seniors.
(Source: American College of Chest Physicians)
