Better control of drug use can save 400 Swedish lives per year

Now these researchers in Sweden, at the Nordic School of Public Health (NHV) and elsewhere, have reviewed randomly selected deaths in three Swedish counties and found that 14 percent of these deaths could have been avoided if a drug had been replaced or if the dosage had been lowered.

In an earlier study the scientists showed that out of 1,574 deaths, 49 individuals had died from side effects of medicines. Now they have analyzed how many of these deaths could have been prevented. The researchers estimate that seven of the cases, 14 percent, might possibly have been avoided if the drug had been replaced or the dosage lowered. If the results are representative for the entire country, this means that roughly 400 people could be saved each year.

“The reason we can draw this conclusion is that we made a randomized selection among people who died in the region,” says researcher and pharmacist Anna Jönsson, project director at the Nordic School of Public Health in Gothenburg.

Most of the preventable deaths were caused by pain-relieving substances, and by drugs that inhibit the formation of blood clots, but also by blood-pressure-reducing pharmaceuticals.

“In the 'definitely preventable' cases, something clearly went wrong in the care process, such as the patient receiving a drug that was counterindicated or was prescribed at an excessively high dosage,” says Katja Hakkarainen, a pharmacist and doctoral candidate at NHV.

A chain of mistakes, organizational causes, such as lack of personnel, and long workdays probably contribute to side effects from drugs. Therefore there must be a system for crosschecking that would reveal any mistakes that were made. Healthcare personnel make mistakes sometimes, but so do patients. These mistakes , too, can be caught if sufficiently careful follow-ups are in place.

To avoid unnecessary deaths, the researchers suggest more and better education in pharmacology. Better support for those issuing prescriptions that provides relevant information about the side effects of drugs, and better routines for following up are concrete measures that the scientists believe could improve the statistics.

Anna K Jönsson adds, however, that that it must be borne in mind that most of the deceased persons included in the study were older individuals, which means that the conclusion is that drug side effects have contributed to their death. Various concepts have been used, and when it comes to the “possibly preventable cases,” the judgment is that the healthcare personnel could have done something more, such as carrying out more frequent follow-ups of the effects of the drugs.

The research team has studied deaths during 2001 in Jönköping, Kalmar, and Östergötland counties in three respects. “Incidence of fatal adverse drug reactions: a population based study” was published in 2007. “Fatal drug poisonings in a Swedish general population” came out in January 2009, and now the study “Preventable drug related mortality in a Swedish population” has been accepted by Pharmacoepedimiology and Drug Safety. Those taking part in this part of the study are Henrik Druid, Katja M Hakkarainen (NHV), Staffan Hägg, Anna K Jönsson (NHV), Karin Wester, Anne Hiselius, Olav Spigset, and Mikaela Tjäderborn.

Contact: Anna K Jönsson e-mail: anna.k.jonsson@nhv.se Phone: +46 (0)31 693989
Katja M Hakkarainen e-mail: katja.hakkarainen@nhv.se Phone: +46 (0) 31 69 3989
Pressofficer Monica Bengtson; monica.bengtson@nhv.se; +46 (0)31 693952