Patient/Medication Safety Media Analysis

 

This audit provides an analysis of the existing media coverage regarding patient medication safety, and where possible, medication issues on the outpatient side and for seniors. The timeframe for the audit is mid-August of 2002 until present.  Consumer newspapers and magazines as well as select trade publications during this time period were examined.  Also included are key articles that were published before mid-August, but are still relevant to the topic.

 

Predominately, coverage related to clinical data published in a top medical journal or presented at medical meetings.  In many other cases, coverage resulted from tragic drug-related incidences. 

 

This analysis also highlights “holes” in the coverage that in turn, present opportunities for the SOS Rx as the coalition shapes its key media messages.  A primary factor in SOS Rx’s ability to generate coverage is being the first to bring a specific message to the mainstream media.  These potential messages are addressed in the Opportunities for SOS Rx section.

 

This document ends with a numerical breakdown of the overall coverage by placement and topic, as well as an itemization of the specific outpatient safety stories, categorized by placement, story validation, suggested situational improvements and third parties. 

 

A listing of quoted experts is attached as an appendix, as is full listing of the media sources evaluated. Full articles are available upon request.

 

 

Trends in Overall Coverage

 

Following is an outline of reoccurring themes/trends in the coverage, not necessarily in order of which topics received the most coverage. Many of these topics received the same amount or more coverage as outpatient prescription drug safety related to usage and system issues:

 

Outpatient Prescription Drug Safety

 

·        Clinical studies published in leading medical journals and/or presented at medical meetings

o       Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM) statistics, results and discussions

o       Annual meetings of: American Association for Geriatric Psychiatry; American Association of Clinical Oncology; American Society for Bone and Mineral Research and the National Patient Safety Foundation

o       Quotes from lead investigators and organization leaders

 

·        Prevention strategies for doctors/healthcare providers, such as:

o       Increasing communications with patients, (e.g., how to take medications and recognize drug-drug interactions)

o       Developing closer patient monitoring systems/processes

o       Increased training to teach elderly about medications

o       Forming closer partnerships between physicians and pharmacists

o       Encouraging patients to be more involved in personal healthcare 

 

·        Prevention strategies for patients in outpatient settings, such as:

o       Carry a list of all current prescriptions

o       Learn about each medication and why it was prescribed

o       Buy all medication at same pharmacy

o       Form/become involved in patient advisory councils (mainly in-patient)

o       Increase patient compliance

 

·        System Changes currently being evaluated or implemented:

o       E-prescribing/order entry

o       Computerized mobile devices/decision support tools

o       Information-sharing between hospitals

 

·        The financial burden of Adverse Drug Events (ADEs):

o       Five percent of hospital visits are due to ADEs

o       Each visit cost an average of $16,000

o       Drug-related morbidity and mortality among outpatients costs $76.6 billion per year in the US

 

Prescription Drug Abuse/Overdose

 

·        Teen deaths caused by recreational use of prescription drugs

·        Methadone

·        OxyContin

 

In-Hospital Medical Errors

 

·        Lack of medical error reporting

o       Comparisons to airline industry

o       Government involvement

 

 

 

·        Institute of Medicine statistics re: medical errors

o       Every year 98,000 hospitalized Americans die

o       Costs the nation $29 billion annually

 

·        Computerized medical records as a means of prevention

o       Mobile devices/decision support tools

 

Negligent/Faulty Doctors

 

·        Patient deaths

·        Litigation-focused

·        Predominately in local media

 

 Lack of Representation of Seniors in Clinical Trials

 

·        International Longevity Center studies

·        American Association of Clinical Oncology data

·        No formal requirements or regulations to ensure older people are represented in trials

·        The National Institutes of Health Revitalization Act of 1994 requires women and minorities to be better represented in NIH-funded research

 

Key Findings

 

 

·        Not surprisingly, the coverage for inpatient drug safety issues dwarfed the coverage for outpatient drug safety issues.

 

·        Most outpatient drug safety stories were tied to:

o       Medical study releases: Of the 14 articles focused specifically on outpatient prescription drug safety, 11 noted clinical studies that were published in both or one of the two most reputable medical journals, the Journal of the American Medical Association and the New England Journal of Medicine. 

§         Implication:  Any recently or soon-to-be released research (e.g., the upcoming IOM report release) may provide SOS Rx with a hook on which to leverage the issue at hand. To establish credibility and maximize potential for coverage, SOS Rx may want to partner with a lead investigator at a research institute currently conducting a medical study surrounding senior outpatient safety.  The lead investigator is typically the spokesperson for the study and will have the opportunity to incorporate the coalition’s messages. 

o       Adverse events associated primarily with misuse (largely teenagers);

o       A week or month of distinction (e.g., National Senior Week, etc.)

o       Campaigns that sought to educate the public about particular facets of drug safety (need for improved communications, etc.).

§         For example, a Health & Medicine Week article sites a study in JAMA addressing preventable drug-drug interactions. The findings in the study emphasize the potential dangers of commonly used medications and highlight the need for more timely collaboration between scientists who study drug-drug interactions and those who design computer systems intended to prevent them.  Dr. Juurlink is a PBM consultant.

 

·        There was no coverage of any campaign associated with the need for consumer action and system change to improve senior outpatient drug safety.

 

·        Some of the key messages that tended to appear repeatedly include:

o       One-quarter of adverse drug events (27.6%) are due to errors or negligence and could have been prevented.

o       Patients should routinely be questioned about all the drugs and supplements they are taking, and maintain an updated list of all medications.

o       As a group, older people get the vast majority of their health care outside nursing homes and hospitals; the primary responsibility for properly taking medication rests with the patients or their families.

o       Older people are underrepresented and even excluded from clinical trials.

o       There is an epidemic of young people dying of prescription drug overdoses.

o       Adverse events/ medication-related complications contribute to geriatric-associated conditions like falls, depression and memory problems.

o       Adverse drug events affect millions of patients each year and are responsible for up to 5% of hospital admissions.

 

 

More Detailed Findings and Opportunities for SOS Rx

 

Consumer-Driven Messages

 

As the majority of the stories focus on the published medical studies, they are written from a clinical perspective as opposed to a consumer/patient advocate angle.  There does not appear to be any real effort to translate the relevant data in layman’s terms. Ultimately, patients need to understand the information that is critical to their livelihood and overall health.

 

While most of the articles include a short paragraph addressing prevention methods, they are merely supplementing the article and not the primary focus.  For example, there were no consumer-oriented tips placed in top-tier national media outlets.  This presents an opportunity for SOS Rx to champion the patient-oriented message targeting the general press, such as morning/evening news shows and national dailies and weeklies. 

 

Using media as a vehicle, SOS Rx can empower patient-related audiences with information about consumer actions. These actions, however, must be reiterated by healthcare professionals in order to be remembered and acted upon by consumers. By reaching out to both consumer and professional audiences, SOS Rx has the opportunity to change attitudes and increase knowledge about patient empowerment.  

 

Furthermore, the majority of the human-interest stories featured the death of a teenager from a prescription drug overdose.  As for outpatient safety, there was a lack of “faces” given to the cause – real senior citizens who have learned how to manage the medications effectively.   Again the outpatient safety messages were focused on a clinical perspective and did not incorporate compelling human-interest stories that significantly impact readers.

 

Caregiver Involvement

 

In terms of preventing adverse drug events, the majority of the strategies focused on the patient and physician, each with a specific set of responsibilities.  However, there was no emphasis placed on the important role of the caregiver.  While it is essential that each patient learn about the medication he or she is taking, it is equally important that the primary caregiver (e.g., offspring, sibling, spouse) is well informed about the prescribed medication regimen.  Caregivers should also be aware of the signs of adverse drug reactions as he or she is often the first to respond. 

 

System Changes

 

Beyond a special report in The Wall Street Journal in early June 2002, there have not been major articles in national outlets providing comprehensive information about the impact that advances in IT will have on in-or out-patient safety.  The general public has not been given a basic understanding of how technology will provide significant improvements to the healthcare system.  The average consumer does not have accessible and clear information about e-prescribing and computerized order entry or how electronic medical files will be implemented. 

 

There is a significant need to define these system changes, identify their function in the healthcare work place, educate the professional in the implementation of the new systems and educate the patient in terms of treatment and monitoring. SOS Rx messages regarding system change, while primarily focused toward healthcare professionals with the leverage to bring about system improvements, should also address consumers who can provide support for such improvements.

 

While the media is still identifying and defining system changes, they have not addressed the national standardization of these emerging technologies.  As government or private entities establish this set of new standards, this complex information will need to be made clear to both the media and the general public.

 

Industry Experts

 

Drs. Gurwitz and Classen have thus far established themselves as the leading authorities on the issue based on their published studies.  In addition, Donald Berwick of the Institute for HealthCare Quality was quoted in several of The Wall Street Journal articles speaking to the importance of knowledge sharing and technology.  However, the limited number of articles (12) that one or both were mentioned, poses an opportunity for SOS Rx to create a voice/spokesperson who will be recognized as a leading industry expert. 

 

Based on this analysis, it is apparent that the media has responded to the senior medication safety problem, but does not report on available solutions.

 

ARTICLE/PLACEMENT BREAKDOWN

 

ARTICLES

60

MAINSTREAM MEDIA

49

TRADE PUBLICATIONS

12

 

 

TOPIC BREAKDOWN

 

OUTPATIENT SAFETY

14

ABUSE/OVERDOSE

11

IN-HOSPITAL ERRORS

10

BAD DOCTORS/DECISIONS

7

SENIORS IN CLINICAL TRIALS

5

OTHER

15

 

 

 

OUTPATIENT SAFETY STORIES

 

PLACEMENTS

 

MAINSTREAM MEDIA

9

TRADE PUBLICATIONS

5

 

VALIDATION

 

MENTIONS JAMA STUDIES

8

MENTIONS NEJM STUDY

2

MENTIONS BOTH

1

MENTIONS NEITHER

3

 

 

SUGGESTED IMPROVEMENTS

 

MENTIONS SYSTEM CHANGES

4

MENTIONS CONSUMER TIPS

2

MENTIONS BOTH

6

MENTIONS NONE

2

 

THIRD PARTIES

 

QUOTES ONLY DR. JERRY GURWITZ

2

QUOTES ONLY DR. DAVID CLASSEN

0

QUOTES BOTH

4

QUOTES DR. WILLAIM TIERNEY

2

QUOTES OTHER

2

 

 

APPENDICES:  QUOTED EXPERTS

 

Dr. Jerry H. Gurwitz, lead author of JAMA article, executive director, Meyers Institute

 

Jim Martin, president, 60 Plus Association, Arlington, VA

 

Alan F. Holmer, president and chief executive officer, Pharmaceutical Research and Manufacturers of America, Washington, D.C.

 

Ryan Baker, Health Canada

 

Dr. Paula Rochon, geriatrician and researcher, Baycrest Centre for Geriatric Care, Toronto

 

Dr. Koenraad Blot, director of clinical research operations, Pfizer Canada Inc.

 

Peter Hotez, chairman of microbiology, George Washington University

 

Edward H. Kaplan, professor of public health and management sciences, Yale University

 

Lynn Frank, public health chief, Montgomery County, chairwoman, regional panel of city and county public health directors

 

David Juurlink, MD, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, (Jurlink has served as a consultant to AdvancePCS)

 

Paula Rochon, MD, MPH, Toronto, Ontario

 

Steve Young, Director, Department of Inspections and Appeals

 

Patrick J. Palmersheim, executive director, Iowa Commission of Veterans Affairs

 

Dr. Robert N. Butler, president, Longevity Center

 

Dr. Christine de la Paz, manager, recruitment and retention core for clinical trials, Claude Pepper Center on Aging at the University of Connecticut Health Center, Farmington

 

Dr. Lilliam Siu, Princess Margaret Hospital, Toronto

 

Dr. Lilia Talarico

 

Dr. Hyman Muss, University of Vermont

 

Dr. Sanjay Gupta, CNN Medical Correspondent

 

Judith Garrard, Ph.D., professor, University of Minnesota School of Public Health, Minneapolis. 

 

Rosemary Adiletto, cofounder of Project MEDS (Medication Education Designed for Seniors), PA

 

Zane Robinson Wolf, dean and professor of nursing, LaSalle University, Philadelphia

 

Dr. David Classen, health-care information consultant and professor at the University of Utah, (JAMA editorial accompanying study)

 

Dr. Tejal Gandhi, instructor in medicine and director of patient safety, Brigham and Women's Hospital

 

William Tierney, MD, professor of medicine, Indiana University School of Medicine and research scientist, Regenstrief Institute, Inc.

 

Dennis O'Leary, president, Joint Commission on Accreditation of Healthcare Organizations

 

Beverley Johnson, president, Institute for Family-Centered Care

 

Lucian Leape, professor, Harvard School of Public Health

 

Diane Cousins, vice president, Center for Advancement of Patient Safety.

 

Donald Berwick, founder, Institute for Healthcare Improvement

 

Suzanne Delbanco, Leapfrog Executive Director

 

Joseph E. Scherger, dean, College of Medicine, Florida State University.

 

Mark Chassin, chairman, Department of Health Policy, Mount Sinai School of Medicine

 

Gregg Meyer, director of patient safety programs, Federal Agency for Healthcare Research and Quality

 

Dick Taylor, chief executive officer, N.C. Academy of Trial Lawyers

 

Arthur Levin, Institute of Medicine panelist, director of the Center for Medical Consumers, New York

 

Gary Mecklenburg, chief executive, Northwestern Memorial HealthCare

 

APPENDICES:  Articles Evaluated

 

 

“AAHP to Congress: Use Private Health Plans as Model for Medicare Prescriptions.” BestWire, 7 August 2003.

 

“Adverse Drug Events: Clinicians Should View ADEs as Both Problem and Opportunity.” Managed Care Weekly Digest, 5 May 2003.

 

“Adverse Drug Events: Inappropriate Medications Are Taken by Many Elderly Patients Who Live at Home.” Drug Week, 27 September 2002.

 

“Adverse Drug Events: Many Hospital Admissions for Medication-Related Effects Avoidable.” Health& Medicine Week, 21 April 2003.

 

Azad, Nahid, et al. “Adverse Drug Events in the Elderly Population to a Tertiary Care Hospital.” Journal of Healthcare Management, v47 n5, September 2002.

 

Becka, Holly and Tanya Eiserer. “Patient deaths lead to raid on doctor's office.” Dallas Morning News, 11 June 2003.

 

Becka, Holly and Selwyn Crawford. “DA Combs Patients' Records.” Dallas Morning News, 14 June 2003.

 

Berens, Michael J and Bruce Japsen. “Study: Agency Shields Troubled Hospitals, Panel's Role as Guardian of Public's Health Is Called Into Question.” Charlotte Observer, 10 November 2002.

 

“Bias Seen in Cancer Care for Elderly; Older People Often Excluded From Tests.” Associated Press, 1 June 2003.

 

Boodman, Sandra. “Medical Industry Does Little to Fix Fatal Errors, Reason: Resistance to do Mandatory Reports.” Charlotte Observer, 4 December 2002.

 

Bowman, Lee. “Medicine Problems Plaguing Senior Citizens.” Scripps Howard News Service, 4 March 2003.

 

Cannizaro, Steve. “Drug Deaths Plague Parish; Prescriptions Killing Young People.” Times-Picayune, 15 November 2002.

 

Cooney, Elizabeth. “Drug Errors Plague Elderly; Study Says 1 in 20 Outpatients Affected.” Worcester Telegram & Gazette, 5 March 2003.

 

Edgar, Amy. “S.C. Lawmaker Fights for Patient Rights; Bill Seeks Safeguards Against Hospital Errors, Access to Actual Doctors.” Associated Press, 11 April 2003.

 

“Elderly Face Drug Errors.” HealthScout News Service, 9 March 2003.

 

Falkenberg, Lisa. “Texas Doctor Probed in 11 Patient Deaths.” Associated Press, 18 June 2003.

 

Forster, Stacy. “Drug Dosing Is Major Cause of Hospital Errors.” Wall Street Journal, 4 December 2002.

 

Garloch, Karen. “Keeping Quiet: Health Professionals' Errors Very Often Go Unreported.” Charlotte Observer, 30 March 2003.

 

Garloch, Karen. “Surgery Safety Proposal on Table.” Charlotte Observer, 16 July 2002.

 

Goldstein, Avram. “Healing Thyself, a Tempting Option With Serious Side Effects.” Washington Post ,16 March 2003.

 

Graedon, Joe and Teresa. “Don’t Take Cough Syrup When on Antidepressants.” Augusta Chronicle, 22 April 2003.

 

Haney, Daniel. “Elderly Often Excluded From Studies of Cancer Drugs.” Associated Press, 31 May 2003.

 

Hench, David. “Woman Charged for Role in Drug Overdose Death.” Portland Press Herald, 23 November 2002.

 

“How safe are generic drugs?” San Francisco Chronicle, 9 February 2003.

 

Kauffman, Clark. “Drug Rules, Insurance Conflict.” Des Moines Register, 5 August 2003.

 

Kornacki, Steve. “4 Teens On Respirators After Prescription Drug Overdose.” Tampa Tribune, 4 August 2003.

 

Landro, Laura. “The Informed Patient: Errors? You're First Line of Defense.” Wall Street Journal, 13 March 2003.

 

Landro, Laura. “Health Care Goes Digital: Doctors and Hospitals Find They Can't Stay Offline Any Longer.” Wall Street Journal, 10 June 2002.

 

Lovelace, Brett. “Reinholds Boy, 13, Dies of Apparent Drug Overdose.” Intelligencer Journal, 27 March 2003.

 

“Many Drug Problems in Elderly Avoidable.” United Press International, 4 March 2003.

 

Medina, Cristina. “Overdose Suspected in Man’s Death.” Monterey County Herald, 5 December 2002.

 

”New Research Focuses on Safety and Efficacy of Drugs in Elderly Patients.” Psychopharmacology Update, v14 n4, April 2003.

 

Nichols, Judy. ”Man Dies as Online Chat Pals Look On.” Arizona Republic, 4 February 2003.

 

O’Neill, Robert. “Misuse of Prescriptions Imperils Seniors.” Philadelphia Inquirer, 26 January 2003.

 

Othon, Nancy. “Moms Push Drug Control; Women Lost Sons to Prescriptions.” Sun-Sentinel, 9 April 2003.

 

“Parents Warned to Lock Up Prescription Drugs.” Associated Press, 3 March 2003.

 

“Patient Safety: Adverse Drug Events Common and Often Preventable in Outpatient Settings.” Managed Care Weekly Digest, 24 March 2003.

 

Pies, Ronald. “To Sleep, Perchance To Take OTC Antihistamines.” Geriatric Times, 1 May 2003.

 

“Plan to Halt Overdoses Needs One More Point; Addicts Can't Sell or Divert a Drug They Don't Take Home, Can They?” Portland Press Herald, 23 October 2002.

 

“Prescription-drug Toxicity: a Major Epidemic.” Townsend Letter for Doctors and Patients, 1 July 2003.

 

“Prescription for Drug Safety.” Consumer Reports On Health, v15 n3, March 2003.

 

Pugh, Tony. “Seniors Waste Billions Buying Supplements.” Charlotte Observe,r 11 September 2001.

 

Ricks, Delthia. “Outpatient Drug Risk; Study: 1 in 4 Experience Adverse Reaction to Prescriptions.” Newsday, 17 April 2003.

 

Rioux, Paul. “OxyContin Suspect Released.” Times-Picayune, 18 February 2003.

 

Schulte, Fred. “More Pain Unit Patients Die.” Sun-Sentinel, 29 August 2002.

 

Smith, Susan. “Prescription Drugs Should Be Locked Up, Parents Told.” Springfield News-Leader, 3 March 2003.

 

“Staff Prescription Medication: Safety and Privacy Concerns.” Camping Magazine, 1 January 2003.

 

“Study Probes Use of Antiepileptic Drugs in Nursing Homes; Surprising Number Placed on Medications After Admission.” AScribe Newswire, 6 May 2003.

 

“Take-Home Methadone Clearly a Flawed Policy.” Portland Press Herald, 29 August 2002.

 

“Teen’s Death After Operation Leads to Changes at Hospital.” Associated Press, 17 June 2002.

 

Thomas, Kyle. “Bridgewater Teens Hospitalized.” Courier News, 27 June 2003.

 

“Too Much of a Good Thing: Seniors and Children Seldom Have Been Included in Trials for Drugs They Take.” Toronto Star 13 September 2002.

 

Tsong, Nicole. “Patients' Families Testify Against Van Houten: Two Wives Call Prescriptions a Factor in Their Husbands' Deaths.” Anchorage Daily News, 7 September 2002.

 

“Unit-dose Packaging to Go: Blister Packs Offer Portability and Protection.” Business and Industry, v7 n4, May 2003.

 

Vann, Korky. “Seniors Missing From Drug Trials.” Hartford Courant, 11 March 2003.

 

Vann, Korky. “Studies Neglect Seniors.” Sun-Sentinel, 16 March 2003.

 

“When it Comes to Drug Safety, Don't Pander to Seniors.” St. Petersburg Times, 2 August 2003.

 

Zoler, Mitchel. “Osteoporosis Drugs 'Vastly Underused'.” OB GYN News, v37 n23, December 2002.