SYSTEM NEEDED TO THWART ADVERSE DRUG INTERACTIONS.

Byline: Dixon Arnett

RECENT studies indicate that 15 percent of the nation's hospital admissions result from the adverse reaction to prescription drugs. California officials declare that 19 percent of all nursing home admissions are a result of mismanagement of medications. Clearly, medication mismanagement affects the elderly disproportionately as they tend to be more in need of health care in general and prescriptions in particular.

Believe it or not these statistics are an improvement over a few years back. However, the problem is still too big and too costly. It simply must be solved. A recent study from the University of Arizona calls national medication mismanagement a $76 billion national disgrace. That is a stunning amount. Even if it is cut in half, there would be sufficient savings to provide full access to medical care for every man, woman and child in our nation.

Let me offer a solution. To date, no effort has been made to conduct a measurable, focused, consistent educational outreach to the elderly. Can there be doubt that an effective campaign would have a direct relationship in the decline in hospital admissions?

The average cost per day in a hospital is $1,779. Multiply that cost by the number of inpatient days nationwide and you get $461 billion

The Arizona study says 15 percent of hospital admissions are a direct result of mismanagement of prescription medication. Fifteen percent of $461 billion is $69 billion. That is the potential savings to be achieved by better medication systems and consumer and provider education.

Through a strong outreach effort, which teaches consumers and providers alike about good management practices and shows what the current technology is for institutional management systems, the savings would be astronomical. Is there anyone who, given a choice, would not choose to stay out of the hospital?

Most major medical centers and managed care hospitals have in-house management systems developed by research which started 20 years ago among chain drug stores. At that time, the chain stores advertised that customers who brought their pharmaceutical business to them would have the advantage of a computerized record against which each new prescription could be checked to determine, in advance, whether an adverse reaction (which could cause hospitalization) would result.

When all the chain drug stores possessed such systems, the competitive edge between them was diminished. Then, through budget language, the Health Care Financing Administration of the U.S. Department of Health and Human Services picked up the responsibility to keep the original chain drug store system up to date. When medical centers and managed care hospitals needed the up-to-date programs, they were available.

Historically, what stimulated the development of the technology was the desire of one set of health care providers (chain drug stores) to compete with each other, and smaller pharmacies, and to pocket the profits from the increased business. But since then, no other major provider segment has championed the cause of medication management except managed care (with the incentive to save health care costs by fewer hospitalizations) and major medical centers (which must compete with managed care to survive).

What is at stake is no less than the care that any patient has a right to expect (that hospitalization, for any reason, is a choice of last resort, not a matter of when-in-doubt medical routine) and the very ability of the nation and employers to pay for greater access to health care while saving billions through better patient care. This is simply too simple, and too important, not to try.