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New Meta-Analysis Shows Effects of Interventions on Adverse Drug Reactions

February 14, 2019

Adverse drug reactions (ADRs) in older adults are common, costly, and account for significant numbers of hospital admissions every year in the United States. Errors in prescribing or poor prescribing methods account for far more ADRs than do such things as nonadherence, allergies, or the usual and expected pharmacological effect.

Joseph T. Hanlon, PharmD, MS, BCGP, is a tenured professor of medicine in geriatrics with secondary appointments in pharmacy and therapeutics and epidemiology at the University of Pittsburgh School of Medicine. Dr. Hanlon also is a health scientist at the VA Pittsburgh Healthcare System Geriatric Research Education and Clinical Center (GRECC). For more than 30 years, Dr. Hanlon has explored a diverse variety of topics through his research in geriatric pharmacotherapy and pharmacoepidemiology, having won numerous awards for his contributions to science.

Focused interventions and strategies can be effective in reducing and preventing ADRs. Dr. Hanlon and collaborators conducted what was likely the first randomized controlled trial of an intervention protocol in 1996. This study along with a dozen others were recently analyzed by Dr. Hanlon and colleagues as part of a broad systematic review and meta-analysis of interventions designed to optimize medication use in older adults and their effect on mitigating adverse drug reactions.

Published in the Journal of the American Geriatrics Society in 2018, the meta-analysis is the first of its kind to look at ADR interventions broadly. The reviewed studies varied in size, type of intervention, setting, and geographic location. They also varied in terms of the interventions being pharmacist-led, clinician-led, or an education or technology intervention. Overall, the intervention cohort was 21 percent less likely to experience an ADR versus the control. On subsequent analysis, looking specifically at the pharmacist-led interventions, those groups were 36 percent less likely to experience an ADR regardless of setting.

“The bottom line is that a majority of ADRs are preventable, either through a focused intervention within a setting or through education of some sort, given how high the incidence of ADRs related to prescribing is. It probably seems intuitive, but interventions of any kind, and specifically those that are pharmacist-led, can have a really significant impact limiting ADRs. Yes, it’s complicated given the disparate health care settings and fractured payments system in this country, but it’s a problem that can be solved,” says Dr. Hanlon.

References and Further Reading

References and a sample of published papers from Dr. Hanlon follow. For a complete listing of past works, please consult the library.

Gray SL, Hart LA, Perera S, Semla TP, Schmader KE, Hanlon JT. Meta-analysis of Interventions to Reduce Adverse Drug Reaction in Older Adults. J Am Geriatr Soc. 2018; 66(2): 282-288.

Gray SL, Hanlon JT. Anticholinergic Drugs and Dementia in Older Adults. BMJ. 2018; 25: 361.

Hanlon JT, Zhao X, Naples JG, Aspinall SL, Perera S, Nace DA, Castle NG, Greenspan SL, Thorpe CT. Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents. J Am Geriatr Soc. 2017 Jun; 65(6): 1183-1189.

Gray SL, Hanlon JT. Anticholinergic Medication Use and Dementia: Latest Evidence and Clinical Implications. Ther Adv Drug Saf. 2016; 75(5): 217-224.