Medication Problems May Spur Many Child ER Trips, Study Finds

Bad reactions, misuse are the common culprits, researchers say

Monday, February 2, 2015

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MONDAY, Feb. 2, 2015 (HealthDay News) -- Medication-related problems -- from side effects to improper use -- may be the cause of many kids' trips to the emergency room, a new study suggests.

Researchers found that at one Canadian children's hospital, medication-related problems accounted for one in 12 ER visits over a year. And about two-thirds of those incidents were preventable, the researchers concluded.

The findings, published online Feb. 2 in Pediatrics, do not mean that parents should be afraid to give their children needed medications, the researchers noted.

Instead, parents -- and older kids -- should have a "clear understanding" of why a medication is being prescribed and how to use it properly, said lead researcher Peter Zed, a pharmacist and associate professor at the University of British Columbia in Vancouver, Canada.

His team found that allergic reactions and drug side effects were commonly behind pediatric ER visits. But so was prescription misuse -- such as when kids did not use their asthma medication properly or, in the case of type 1 diabetes, did not take their insulin.

When children have chronic medical conditions or multiple conditions treated by more than one doctor, it's especially important for parents to ask questions about medication use, Zed said.

A pharmacist who was not involved in the study agreed.

"It's good for parents to ask questions," said Laura Pizzi, a professor at Jefferson School of Pharmacy in Philadelphia.

Busy doctors may not delve into all the details of a medication's proper use or potential risks, Pizzi said. So parents should feel free to question either their child's doctor or the pharmacist who fills the prescription, she said.

The study findings are based on more than 2,000 children and teenagers -- average age 6 -- who arrived at a pediatric ER in Halifax, Nova Scotia over the course of a year. Overall, about 8 percent were considered to have "medication-related" symptoms.

Adverse drug reactions were the culprit 26 percent of the time, while "non-adherence" to a prescription was to blame in 17 percent of cases. Another 19 percent of kids were not taking a high enough medication dose, and in 12 percent of cases, an "improper" drug was prescribed, the study found.

The researchers only had information on general drug classes. The most commonly implicated ones were those that treat infections or asthma, or that act on the central nervous system -- which includes medications for attention-deficit/hyperactivity disorder, migraines and depression.

Zed's team also found that among all kids who landed in the ER, certain ones were at increased risk of a medication-related problem. That included kids with multiple health conditions or more than one prescribing doctor.

Pizzi noted that this study took place at a specialized pediatric hospital, and the children treated there would tend to have more underlying health conditions, putting them at greater risk of medication problems.

"If you did this study at a general hospital, the proportion of medication-related visits could be lower," she said.

Zed said doctors and other providers need to do their part to prevent these kinds of ER trips, too.

He suggested that they need to be vigilant that they are prescribing the best medication for a child's symptoms, at the optimal dose. They also need to follow up with parents, to make sure that not only is a drug not causing problems, but is working adequately, Zed added.

Parents' choice of pharmacy also matters. Pizzi said it's best to fill all prescriptions at one pharmacy, and, ideally, at one where you feel comfortable talking to the pharmacist.

"There's a trained medication expert available right there, and the advice is free," Pizzi said.

At some busy pharmacies, she acknowledged, it can be hard to get much face time with the pharmacist. "Look for a less-busy pharmacy where you feel comfortable approaching the pharmacist," she suggested. "Don't be afraid to shop around."

Zed pointed out that prescription drugs are not the only medications that require careful use.

"Parents can always ask the pharmacist questions about over-the-counter drugs, too," he said.

SOURCES: Peter Zed, Pharm.D., associate professor, faculty of pharmaceutical sciences, University of British Columbia, Vancouver, Canada; Laura Pizzi, Pharm.D., M.P.H., professor, pharmacy practice, Jefferson School of Pharmacy, Philadelphia; March 2015, Pediatrics

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