Cost of medication errors in rheumatic patients in Mexico

Abstract

This study aims to measure the frequency of medication error (ME) in rheumatology outpatients of the Social Security System (SS) in Mexico and to measure the costs by comparing the days lost at work as direct consequence of the medication error against the theoretical cost of no error in the process. A prospective 6-month survey was conducted in a reference hospital in Guadalajara, Mexico. ME was defined as any discrepancy between the prescription and medicine taken by patients. The origin of the discrepancy was identified and registered. We present 381 patients: 292 with rheumatoid arthritis, 57 with ankylosing spondylitis, and 32 with systemic lupus erythematosus. One hundred twenty seven (33%) had medication errors. Ninety eight (77%) got worse in their condition due to ME. Forty percent of MEs were due to patients' decisions, 41% to a lack of availability of medication which should have been provided by SS, and 18% to a non-justified medical decision by primary-care providers. Patients lost in average 3 working days each month because of the ME. The cost of ME is high. In the case analyzed, opportune access to treatment represents a lower cost for the system, but it represents a significant loss of days at work each month. ME is a signal of a system failure. Inter-professional teamwork is needed to perfect the system.

Custo do erro de medicação e eventos adversos à medicação na cadeia medicamentosa: uma revisão integrativa

“…Dentre os estudos que se referiram a mais de uma etapa da cadeia medicamentosa (Quadro 3), dois (10,5%) incluíram prescrição médica e administração de medicamentos (Lada & Delgado Junior, 2007;Gharekhani et al, 2014). Por fim, nove (47,4%) pesquisas abarcaram as três etapas da cadeia medicamentosa (prescrição, dispensação e administração) (Ranchon et al, 2011;Aceves Avila et al, 2011;Paradis et al, 2009;Hug et al, 2012;Cohen et al, 2005;Schneider, 2013;Villar, 2013;Walsh et al, 2017;Choi et al, 2016). (Kopp et al, 2007) Determinar o custo evitável na utilização de intervenções do farmacêutico em prescrições de pacientes de cuidados intensivos Levantamento de ∏EAM e classificação da gravidade e das intervenções (Leape et al, 1999) Delineamento: descritivoestudo de caso Tipo de custo: diretosomatório dos custos dos medicamentos economizados, com base no índice de preço do consumidor (Bates et al, 1997 (Luo et al, 2017) Avaliar o impacto e o custo--benefício de intervenções farmacêuticas clínicas sobre o uso inadequado de ácido sulfídrico profilático em pacientes cirúrgicos hepatobiliares em um hospital terciário chinês Delineamento: estudo retroprospectivo caso-controle.…”

A systematic review of approaches for calculating the cost of medication errors

“…Some studies used the raw pharmaceutical cost of a medication to estimate the cost of an error5 6 18–20 23 30 and this was the only single direct cost involved in the calculation. Others expanded on this basic methodology, adding in additional direct costs related to the cost of a hospital stay, laboratory tests and labour costs.…”

“…Few studies assessed beyond direct costs; three studies mention indirect costs with Aceves-Avila et al 6 including the cost of a patient's wage for a day lost in their calculation and Samp et al 28 including the cost of permanent harm to the patient in their costing. Meissner et al 25 was the only study to consider the true economic cost of MEs by including opportunity cost in addition to just the accounting costs reported by all of the other studies.…”

“…Lampert et al 23 used a single input cost for a single stage calculation to investigate the cost of MEs, whereas Rottenkolber et al 27 used multiple inputs (‘every resource consumed’) into a multistage calculation for costing MEs. Aceves-Avila et al 6 calculated MEs using two inputs, for example, cost of medication and cost of a day's income for the patient, whereas Field et al 8 generated multiple inputs by taking into account the wider costs within the clinical environment. Field et al 8 inputted many costs including inpatient, outpatient and personnel costs and compared the difference 6 weeks before and after an ME.…”

“…Aceves-Avila et al 6 included a simple indirect cost into their calculation in the form of a single day's wage forgone for the patient as a result of an error. Samp et al 28 focused more heavily on indirect cost by including into the calculation the cost of any permanent harm to the patient as a result of an ME.…”