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Buy custom Reducing Adverse Medicine Reactions: A Global Issue essay

Introduction

The use of drugs to heal different ailments among people is one of the most innovative advancements that humanity has achieved today. With more and more people getting prone to various diseases as they advance in age, different medicinal applications have always come in handy to save people from diseases. The drugs are approved by various organizations such as the US Food and Drug Administration for their use in treatment of diseases. However, this approval does not mean that the drugs are completely safe for use and more often than not people get to react to the medicines for various reasons. Further, drugs are approved on the premise of their benefits outweighing the risks that are associated with their use. According to The John Robert Wood Foundation (2012), close to 8 percent of hospitalization cases are a result of adverse drug reactions (ADR) that increases as a patient advances in age.  This means that elderly patients are more likely to experience ADR than young patients simply because of the multiplicity of diseases that an elderly patient is likely to have. For instance, an elderly patient may have diabetes, hypertension, hypercholesterolemia, and arthritis all at the same time. This therefore means that such a patient will be under several drugs at the same time and the mixing of the drugs in the body may cause ADR to them.

In another study, The John Robert Wood Foundation (2012) found that out of the 100 hospitalized patients 7 will most probably experience a form of adverse drug reaction and about 3 out of 1000 patients may die because of adverse drug reactions. Some cases of adverse drug reactions have effects on the health of the patient such as permanent disability, life threatening, and even death. As such, different governments and health care stakeholders have always come up with ways of mitigating the effects of adverse drug reactions among patients and more specifically elderly patients who are more prone to it. This paper discusses the existing literature on ADR and highlights the identifiable gaps in the area of health care. Also, the paper proposes interventions from various groups and stakeholders being done to mitigate the occurrence of incidences of ADR in hospitals and proposes the evaluation plan for reducing ADR. The paper terminates with a summary and reflections on the available information about ADR.

Literature Review on ADR

According to World Health Organization (2010), adverse drug reactions can be defined as the, “an appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product.” The ADR can be classified into six types, i.e. dose-related (augmented), non-dose-related (bizarre), dose-related and time-related (chronic), time-related (delayed), withdrawal (end of use), and failure of therapy (failure). Zolezzi & Parsotam (2005) observed that ADR some patients have unusual reactions to the drugs that they are taking even after a prescription by a qualified medical practitioner. Normally drugs are supposed to help the patient to heal form the disease, but this is not normally the case as some patients might react adversely to the drugs to the point of dying.

The condition in which a patient’s body negatively reacts to the medication to the point of aggravating the situation, threatening their lives, or even causing death can be described as an ADR condition and occurs more frequently among the elderly patients. Many studies done on the condition have established a strong correlation of ADR and the increasing age of the patients especially in particular medical conditions. Besides the age factor, ADR can be cause by human error in the prescription of drugs by the medical practitioner where a wrong dosage is given to the patient. According to Zolezzi & Parsotam (2005), this form of ADR is avoidable through different programs by medical stakeholders that can help sensitize the medical practitioners including nurses, doctors, and caregivers to be more careful when giving the medicine to their patient.

Similarly, as already identified by The Henry J. Kaiser Foundation; World Health Facts (2012) and United Nations Population Division (2011), ADR are also common among the elderly people because of their susceptibility to a number of medicines which might be given to them and thus leading to the toxicity as a result of the combination of a number of drugs thus can lead to greater intensity in terms of effects of the drugs on the body functioning of the patient and this might lead to ADR in the patient. Several preventive measures have already been undertaken or are being undertaken by governments and health facilities including awareness programs, good communication, and development of effective therapeutic partnerships between the patient and the caregiver to ensure that cases of ADR are dramatically reduced in the health facilities. Similarly, Zolezzi & Parsotam (2005) noted that the use of technology in evaluating and estimating the ability of the patient’s body to withstand a combination of several drugs at once should also be exploited to avoid ADR related cases in the area of health services provision.

According to the Henry J. Kaiser Foundation; World Health Facts (2012), ADR can be caused by several factors acting independently or a combination of the factors to produce an abnormal reaction of the patient’s body to the drugs administered. Research has indicated that there are two types of ADR. Type A and type B with type A being common among the patients. Type A ADR involve an abnormal pharmacokinetics that might be caused by the genetic factors in the body of the patient or the comorbid diseases. Type B is the result of a combination of the drug administered and the disease or two drugs reacting in the body to produce ADR. Both types can be life threatening and requires a good understanding for better management of the effects.

As such, National Clearing House (2011) indicated that it is difficult to assess the causality of ADR in patients given that each case might be a combination of all the factors or a single factor. The three variables mostly identified as the major causes of ADR in patients include the patient himself or herself, the drug or drugs that are administered and the event that lead to the administration of the drugs. That is the health condition of the patient. As argued by Burgess et al (2005), some patients have a number of diseases whose effects to the functioning of the body can together lead to the ADR being evident in the patient upon the administration of drugs for treatment.

According to Center for Medicare and Medicaid (2012), there is no an empirical approach that can be used to identify ADR cases as a result of the complexities of the variables and causative factors. These complexities can easily lead to misunderstanding and even misinterpretation of ADRs. However, the use of computer aided systems can help in making decisions on where and how the ADR is going to affect the normal functioning of the patient.  The systems are not readily accessible to many countries across the world and this therefore means that medical practitioners still need to depend on the traditional methods of monitoring drug administration to ensure that the right dosage is given at the right time. Additionally, the use of electronic medical records are instrumental in communicating the information between the patient and their medical assistants and this is important in preventing the occurrence of ADRs in patients or better still prevent the exacerbation of the effects of an ADR in case it has already occurred. 

In more technologically advanced scenarios, automated ADR machines are used to search for keywords or phrases in the medical records of a patient so as to identify the drug therapies, laboratory results, or problem lists. This can provide a lead that a patient has already been treated for an ADR. Furthermore, such systems have the capacity to discover more ADRs which may not have been realized in the initial stages and therefore help in improving the services and care for patients prone to ADRs. Most of the available tools for assessing cases of ADR are lacking. The use of technologically advanced tools is likely going to solve the complexities involved in the assessment of the ADRs. Traditionally the critical causation variables have been used to identify the cases of ADRs with ease and thus the medical practitioners will probably benefit from using the electronic devices that have been developed for assessment of ADRs globally.

 A research by Burgess et al (2005) identified the elements to look out for in each of the variable in trying to comprehend the cause of an ADR in a patient upon administration of a drug of drugs. According to Durey & Thompson (2012), ADR are a common cause of admission to hospitals especially among the elderly patients. Even with little available data on the effects of ADR on the overall health status of the people Durey & Thompson (2012) argue that ADR cases are thought to be among the highest cause of morbidity and death among the elderly patients. In most cases the condition is a result of the human error in the administration of drugs, lack of compliance with the instructions from the medical practitioner, cases of overdose, drug abuse, and failure in therapeutic procedures among others. In the US the occurrence of serious ADR cases according to Goldberg (2010) is estimated 6.5 percent with 0.4 percent fatal cases reported among the 39 prospective studies that were done. As such, it is estimated that ADR is number four cause of deaths in the United States among the elderly patients.

According to Elliot (2006), ADRs cases are responsible for 21.6% of hospitalizations on a global average. In 2007, the cost of ADR-related visits was $333 per ED visit and $7528 per hospitalization for a total annual cost of $13.6 million on average. In countries like the United Kingdom where studies on the incidences of ADR have been studied, research indicate that ADR continues to cause a lot of expense both the government and the health facilities as a result of extra days that patients have to spent in hospitals are readmitted. For instance, the Department of Health statistics for year 2000 estimated that 38 000 admissions in the United Kingdom were ADR related and revealed that  ADR cases accounted for over 1.5 million extra bed-days,  which are could be equated to 13 average sized hospitals capable of attending to 400 patients in one year.

With increased research in medical practices, scientific development, and the need to remain vigilant due to increasing cases of ADRs, the linkage between an increasing elderly population and the incidences of ADRs cases has already been established (Goldberg , 2010). This is important especially in the quest to bring the cases under the control of medical practitioners given that a good number of those cases have resulted in deaths. According to World Health Organization (2010), there is a need for a collective approach from all stakeholders in the health sector to chat out the leadership roles of medical practitioners in assessing the global views on how to address the ADRs cases in elderly patients through mechanisms such as drug monitoring, education, and adverse drug reaction reporting. This forms only a small part of the measures that are being proposed for medical practitioners to follow in the process of handling ADR cases. Further measures could include the establishment of support invention systems that will help in reducing the adversity of the drugs on the patient through the medically tasted means such as drug monitoring. 

Merson, Black & Mills (2012), also noted that there was need to bring the private stakeholders such as private hospitals and private insurance companies to participate in the process of establishing measures to address the occurrence of ADR cases as they also represent an important section of health care to the elderly people, majority who are beneficiaries of their services. Zolezzi & Parsotam (2005) argues that there are many ways through which the private stakeholders in the provision of quality services can contribute to the management of ADR cases in hospitals such as supporting bills that make it mandatory the monitoring of inappropriate medications to the elderly people to reduce the ADR cases among the elderly people.

As indicated by Merson, Black & Mills (2012), it is not yet possible to precisely anticipate a patient who is going to experience ADRs as research in the area has not revealed any predictors for the occurrence of cases of ADRs among patients. The fact that most patients who experience ADRs are not homogenous makes the prediction of the cases difficult. Merson, Black & Mills (2012) further argues that despite that indication of the correlations between age, intensity of treatment, and age on one hand, and cases of ADRs on the other hand, there is still no evidence of cause and effect in linking the patients who experience ADRs and their ages, comorbidity or the amount of drugs that they are given.

This is contrast with Roudarsi et al (2005) observations that there was a relationship between the age of the patient and the probability that such a patient could experience ADRs when given certain medications. The two agree on the findings that ADRs can result in life threatening situations especially to patients who are in intensive care units as compared to other patients. Pattanaworsate et al (2010) agree that the type of medication can also not be used as a predictor of incidences of ADRs among patients. This is because all kinds of drugs have at least given side effects that are normally discovered during the clinical trials. More side effects can be discovered when the medication is administered to the patient and this therefore sometimes reveal themselves in the form of ADRs to the patient. This implies that some of the causes of ADRs can be traced back to the manufacturing and the chemical content of the medicines that are prescribed to the patient thus expanding the area of causative factors of ADRs among patients.

The detection and prevention of ADRs among patients largely depend on the systems of detection that are in place in health facilities. Studies done by Roudarsi et al (2005) indicated that it is possible to have up to 95 percent of ADRs detected and prevented. This will however, depend on the collective efforts that are undertaken by all stakeholders in the health industry to ensure that cases of ADRs are reduced among the patients. It is important to use medically proven systems in detecting and preventing or minimizing the intensity of the ADRs in cases where such incidences cannot be avoided. For instance, studies by Roughhead, Anderson & Gilbert (2007) and Stevens (2006) revealed attributed 60 percent of ADR occurrences to excessive dosages are per the age and weight with regard to their health conditions.

Technically, most average hospitals have systems that can help medical practitioners to identify and rectify such anomalies in administering medication to the patient. Furthermore, the use of computerized systems can easily and effectively help in early detection of ADRs to enable heath care providers to instigate intervention measures with the aim of reducing the effects and lessen the reaction severity. Due to lack of such facilities, many health care centers and hospitals still rely on the reports by the staff to track ADRs, improve on the quality of service delivery, and assess the associated risks. This form of detection is only capable of capturing only 6 percent of all ADR cases in hospitals especially now that more people are susceptible to such cases.

 

Identified Gaps in Service or Care

The study and understanding of ADRs presents several challenges to the industry players given the fact that it is a relatively developed area of medicine and it has complex variables which can be problematic to detect and identify (Elliot, 2006). As such a number of gaps can be identified in service or care delivery to patients experiencing ADRs. Initially, the focus has been to address the problem of ADRs whenever it occurs. However, as noted by Stevens et al (2006), this is a reactive approach rather than a proactive one and thus it difficult to tackle the problem of ADRs wholesomely given that the root cause is not addressed.  The fail to identify the causes of ADRs through research is one gap that is still affecting the service and care delivery by many medical practitioners. Since, the practitioners do not have a clear understanding of the combinations of factors that can lead to ADRs in certain patients; it has become problematic to address the challenge of ADRs cases because the practitioners lack an anchorage onto which they can start addressing the problem. Furthermore, they require expertise to be able to effectively deal with the cases because they cannot use their patients to do tests to determine how certain causative factors can affect their performance. This touches on their ethical issues in the practicing of their profession (National Clearing House, 2011).   

Likewise, United Nations Population Division (2011) noted that it is evident that modern detection and prevention of ADRs require sophisticated and expensive equipments and computers that can help in analyzing the data about the medical records of a patient and be able to come up with information on the probability of such a patient to develop ADRs up on administration of a given dosage. This arguably is an important innovation that can help medical practitioners and care givers to reduce on the occurrences of ADRs, some of which have been fatal in nature. However, acquiring such equipments can be costly and expensive to some of the common health facilities without the support from the government and other stakeholders in the health industry. When some health facilities are using different equipments in treating ADR cases while others are using a different system, it becomes difficult to effectively harmonize the delivery of health services as far as ADRs are concerned. As such, this might result to a general deficit in economic feasibility of making use of a standardized approach across all health facilities in a region. It is important that the services and care are harmonized to reflect a uniform and cohesive approach to the confronting of the problem of ADRs among elderly people (Elliot, 2006)

As such, the effective use of ADR detection and prevention mechanisms is affected by the lack of a standard system in place to guide both the medical practitioners and patients on how they can coordinate the handling of ADR cases whenever they occur. As recommended by Zolezzi & Parsotam (2005), ADR handling depends very much on the communication between the medical practitioner and the patient and thus a break down in the communication process can also worsen an ADR case. The process of communication has since been advanced through technology and therefore it is now possible for a patient to reach the doctor in emergency causes and vice versa. But the communication can be hampered by the technicalities of the terms that are used in the ADR control and therefore the doctor is required to use a simple language that will be easy to understand by the patient.

The government and other partners in the health sector play an important role in providing funding for the running of various activities in the hospitals. It is therefore important that the funders do not delay in their provision of funds towards implementation of ADR programs. This is important some of the ADR cases can easily turn fatal and thus affect the life of the patient and the reputation of the hospital. It is therefore important the funders prepare themselves to provide all the required funds in the acquisition of equipment and management of processes directly associated with the service and care to ADR patient. However, this is not the case as most governments cannot provide the necessary financial resources to support ADR programs in all of their health facilities. Medical insurance also do not oblige to pay cases of ADRs as they are considered abnormal cases. These challenges can easily derail the implementation of ADR programs and services to patients who might need those services (Elliot, 2006).

Moreover, there are little global resources and recognition of the increasing problems among the elderly with problems associated with ADRs. A lack of general appreciation and the volatility of the area has make many potential researchers to shy away from studying and coming up with scientific solution to challenges in the detection and prevention of ADR cases. The world of health has not fully come to recognition of ADR and other effects associated with drugs since it is generally thought that the regulators in place are able to identify the inherent side effects and therefore only recommend drugs which are perfectly proven to be void of causing harm to the patient. As already argued by Andrews, Backstrand & Boyel (2010), the clinical tests that are done on drugs cannot help in detecting all the risks that are associated with the use of a particular drug especially now that drugs are used by different people with different characteristics and elements. The media also highlights more than is necessary the incident of ADR thus affecting or derailing the efforts that are being done by different health institutions to ensure that they identify and document the causes of certain ADRs among certain patients. The media is quicker to highlight the negative side of ADR and fail to appreciate that such cases are sometimes bizarre even to the medical profession itself and therefore require an uninterrupted approach in trying to understand and address the challenge.

Proposed Intervention

The identified challenges in the ADRs require concerted efforts from all stakeholders to ensure that the programs are brought to their reasonable conclusions and that elderly people are saved from the effects of ADRs. In addressing the challenges, all stakeholders including the media and the patients themselves need to exercise the spirit of tolerance, mutual respect, and compassion in dealing with cases of ADR s to avoid emotions and hurried statements and conclusions that cannot help in the management of ADR cases in health facilities. It is important that all stakeholders also commit themselves to contribute to the research on the causative factors to be able to come up with standardized approach in the handling of ADR cases across the globe. The equipments that are used in the analysis of medical records of patients also need to be subsidized from the manufacturers to enable many more hospitals acquire the essential systems in the detection and prevention of ADR cases (Andrews, Backstrand & Boyel, 2010).

Moreover, Burgess et al (2010) argued that there is need to establish a uniformed standard in the treatment and control of ADR cases across the world to enable people to access those services whenever they travel. Globalization has made the world a small village and thus people are travelling from one point to the other. It is important such people can access ADR services and care from wherever they may be irrespective of their nationality or any other characteristics that might prevent them access their medical services. In addition, there is need to have comparable medical services that are of high quality to avoid human errors in the administration of drugs to reduce the cases of ADRs around the world. Merson, Black & Mills (2012) observed that the World Health organization established the Commission of the Social Determinants of Health (CSDH) has already taken step towards this objective by initiating programs to “gather evidence on social and environmental causes of health inequities…and to discuss how to overcome them” This and many other steps will contribute to the invention programs that are undergoing in the health industry to mitigate the ADRs on patients.

Proposed Evaluation Plan

There is need to have a clear plan on the evaluation of the programs that aims at mitigating the impact of ADRs on patients. Evaluation will enable different stakeholders to monitor progress in the management of adverse drug reactions among patients and propose way to improve or change approach strategies with a view of reducing ADR incidences around the world (Merson, Black & Mills, 2012). To this end, it is important that all stakeholders collect data on the progress of their efforts in mitigating ADR cases in health care facilities. This is important especially in planning and implementing future strategies in the administration of drugs to patients who are old and therefore susceptible to ADRs. Further, the collected information will be important in assessing the causative factors and help researchers in determining and establishing a standardized guideline on the detection and prevention of ADR cases among the elderly patients.

Moreover, the data collected will be availed to government and other health care stakeholder for analysis and recommendation concerning standards in the practice of medication to patients that are prone to ADRs. It is also important in evaluating the financial expenditures that are coming from the government and sponsors of such programs so that there can be further funding in future programs. In addition, there is need for surveying the providers with the aim of eliciting responses to the implementation of such programs (Roughhead et al, 2007). The service and care providers need to be trained and informed about new development in the management of ADR cases in their institutions as a way of understanding and controlling the cases of ADR among patients around the world. It is also important to share the information on the findings from various countries since patients are not homogenous and there are possibilities that the results will be inconsistent with the others from different regions or different countries.

Summary and Conclusion

Cases of ADR are on the increasing especially among the elderly patients. There is limited knowledge about the causes of ADRs among patients and this is partly because of the complexities of the variables that are involved in the process. As such, the available literatures reveal that there is a strong correlation exists between the age of the patient and the occurrence of ADR cases. Some of the cases of ADRs are caused by human error such as a wrong administration of drugs or over dosage. Such cases can easily be prevented through education and awareness to medical practitioners. The use of technological tools such as computer systems has made it easier to assess the risks that are associated with the administration of drugs to patients who are deemed susceptible to ADRs. However, the acquisition of such tools is hampered because they are costly and expensive. The government and other stakeholders provide funds towards programs aimed at implementation of ADR programs in different hospitals.

In conclusion, this paper has examined the measures that are available for mitigation of ADR cases among the elderly patients. It is noted in the paper that more elderly patients are exposed to ADRs around the world. It is therefore the duty of all stakeholders in health industry to align their efforts towards establishing control measures against the occurrence of ADR cases in patients. The government should continue to support the efforts for implementation of such programs and allow the sharing of information collected with a view of enabling players to come up with more formidable control measures.

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