Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles.

Sue Jordan,Patricia A Logan,Mojtaba Vaismoradi,Gerwyn Panes,David Hughes

doi:10.3390/pharmacy6030102

Abstract

The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers’ literature, would protect patients from iatrogenic harm, but this is rarely undertaken. We argue for the benefits of this approach using the example of the prescription of antipsychotics to older adults. Prescribing antipsychotics to control challenging behaviours associated with dementia is a controversial matter, and regulatory intervention is under discussion. Improved regulatory systems could protect against iatrogenic harm, such as over-sedation, falls, tremor, or drug-induced Parkinsonism. However, measuring the impact and outcomes of regulatory interventions has proved difficult, not least because there are rarely systematic records of all adverse effects of medicines. We indicate how regulatory initiatives to reduce antipsychotic prescribing can be supported by systematic monitoring and documentation of patients’ signs and symptoms of putative adverse drug reactions. Monitoring documentation then provides the rationale and support for professionals’ responses to identified problems. Longitudinal monitoring records would improve understanding of the impact and outcomes of adverse drug reactions (ADRs) on health and wellbeing, and the many costs of ADRs.

Highlights

Improvements in population health in Western countries in the first half of the 20th century were the culmination of several factors, including improved nutrition, public health measures, and lifestyle changes [1], but gains since the 1940s are at least partly attributable to better medicine [2,3]
Antipsychotics have not been exempt from adverse drug reactions (ADRs), as considered in the present paper [12,13]
We reflect on the social context of prescribing, the problem of preventable ADRs, our solution, and its congruence with the logic of regulatory interventions

Summary

Introduction

Improvements in population health in Western countries in the first half of the 20th century were the culmination of several factors, including improved nutrition, public health measures, and lifestyle changes [1], but gains since the 1940s are at least partly attributable to better medicine [2,3]. Pharmaceutical advances transformed treatments in the mental health field, with antipsychotics bringing significant benefits for illness management [7,8,9]. These benefits have been offset, to an uncertain degree, by new forms of iatrogenic disease associated with the adverse effects of prescribed medicines [10,11]. Antipsychotics have not been exempt from adverse drug reactions (ADRs), as considered in the present paper [12,13]. We reflect on the social context of prescribing, the problem of preventable ADRs, our solution, and its congruence with the logic of regulatory interventions

Results

Discussion

Conclusion