Patient-reported medication symptoms in primary care.
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).


CONCLUSIONS
Primary care physicians may be able to reduce the duration and/or the severity of many ADEs by eliciting and addressing patients' medication symptoms.
Weingart
Saul N
SN
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA. saul_weingart@dfci.harvard.edu
Gandhi
Tejal K
TK
Seger
Andrew C
AC
Seger
Diane L
DL
Borus
Joshua
J
Burdick
Elisabeth
E
Leape
Lucian L
LL
Bates
David W
DW
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D001900:Boston; D015331:Cohort Studies; D003142:Communication; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D012647:Self-Assessment