Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities.

OBJECTIVE: To analyse the frequency of mistakes in communication between the physician and the patient and their incidence in errors in self-administered drugs. METHODS: We undertook a descriptive, cross-sectional study based on interviews with a random sample of patients older than 65 years who were polymedicated (five or more drugs) and had multiple comorbidities. Data were analysed about the patients' reports of what the physician said, medication mistakes by the patients and their consequences. RESULTS: Responses were provided by 382 patients. A medication error in the last year was reported by 287 patients (75%), and 16 patients (4%) reported four or more errors. Most cases concerned the dosage, a similar appearance of the medication or a lack of understanding of the physician's instructions. Very severe consequences occurred in 19 cases (5%). Multiple comorbidities (P = 0.006) and a greater number of treatments (P = 0.002) were associated with making mistakes. Frequent changes in prescription (P = 0.02), not considering the prescriptions of other physicians (P = 0.01), inconsistency in the messages (P = 0.01), being treated by various different physicians at the same time (P = 0.03), a feeling of not being listened to (P < 0.001) or loss of trust in the physician (P < 0.001) were associated with making medication mistakes. CONCLUSIONS: Mistakes by polymedicated patients with multiple comorbidities represent a real risk that should be addressed by the professionals. A review should be made of the routine control questions that the physician asks the patient to identify what other drugs the patient may be taking that have been indicated by another physician.

What older complex chronic patients need to know about their everyday medication for safe drug use.

OBJECTIVE: To determine whether elderly patients with complex drug regimens have enough information to ensure safe drug use. METHODS: A cross-sectional study was conducted in Spain based on interviews of a random sample of 265 patients aged over 65 and taking at least five drugs for multiple comorbidities. General practitioners reported on diagnoses, drugs, dosage and biochemical laboratory results. Patients were asked about the medications they were taking (with higher scores indicating greater knowledge). RESULTS: The patients took an average of 7.9 medications (SD 3.0). The mean scores were low for precautions (mean 0.3, SD 0.7) and how to properly store medications (mean 2.0, SD 3.0). Scores were significantly higher when physicians regularly provided patients with information (F-test 3.3, p = 0.039) and were not related to gender, years of treatment or health status. Frequent changes in medication adversely affected the scores (p = 0.03). Higher scores were related to a smaller number of medication errors (t-test 2.2, p = 0.032, CI 95% of the difference 0.6 - 1.2). CONCLUSIONS: Older complex chronic patients are unaware of the precautions they must adopt to use their medications safely. Patient knowledge does contribute to reducing medication errors. When physicians change prescriptions, modify doses or introduce new medications, more information needs to be provided for safe use of the drugs.