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Saul N. Weingart, MD, PhD; Tejal K. Gandhi, MD, MPH; Andrew C. Seger, RPh; Diane L. Seger, RPh; Joshua Borus, BA; Elisabeth Burdick, MA; Lucian L. Leape, MD; David W. Bates, MD, MSc

Arch Intern Med. 2005;165:234-240.

Background  Little is known about the prevalence and character of medication-related symptoms in primary care and their relationship to adverse drug events (ADEs) or about factors that affect patient-physician communication regarding medication symptoms.

Methods  The study included 661 patients who received prescriptions from physicians at 4 adult primary care practices. We interviewed patients 2 weeks and 3 months after the index visit, reviewed patients’ medical records, and surveyed physicians whose patients identified medication-related symptoms. Physician reviewers determined whether medication symptoms constituted true ADEs. We used multivariable regression to examine factors associated with patients’ decision to discuss symptoms with a physician and with physicians’ decision to alter therapy.

Results  A total of 179 patients identified 286 medication-related symptoms but discussed only 196 (69%) with their physicians. Physicians changed therapy in response to 76% of reported symptoms. Patients’ failure to discuss 90 medication symptoms resulted in 19 (21%) ameliorable and 2 (2%) preventable ADEs. Physicians’ failure to change therapy in 48 cases resulted in 31 (65%) ameliorable ADEs. In multivariable analyses, patients who took more medications (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.04-1.08; P<.001) and had multiple medication allergies (OR = 1.07; 95% CI = 1.03-1.11; P = .001) were more likely to discuss symptoms. Male physicians (OR = 1.20, 95% CI = 1.09-1.26; P = .002) and physicians at 2 practices were more likely to change therapy (OR = 1.24; 95% CI = 1.17-1.28; P<.001; and OR = 1.17; 95% CI = 1.08-1.24; P = .002).

Conclusion  Primary care physicians may be able to reduce the duration and/or the severity of many ADEs by eliciting and addressing patients’ medication symptoms.

Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Dr Weingart), Division of General Internal Medicine, Brigham and Women’s Hospital (Drs Gandhi and Bates, Mssrs Seger and Borus, and Mss Seger and Burdick), and Department of Health Policy and Management, Harvard School of Public Health (Dr Leape), Boston, Mass. Dr Weingart is now with Center for Patient Safety, Dana-Farber Cancer Institute, Boston.

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