Screening for Adverse Drug Events: A Randomized Trial of Automated Calls Coupled with Phone-Based Pharmacist Counseling

Authors

Gordon D. Schiff, Brigham and Women's Hospital
Elissa Klinger, University of Pennsylvania
Alejandra Salazar, Brigham and Women’s Hospital
Jeffrey Medoff, Brigham and Women’s Hospital
Mary G. Amato, Massachusetts College of Pharmacy and Health Sciences University
E. John Orav, Brigham and Women’s Hospital
Shimon Shaykevich, Brigham and Women’s Hospital
Enrique V. Seoane-Vazquez, Chapman UniversityFollow
Lake Walsh, Brigham and Women’s Hospital
Theresa E. Fuller, Northeastern University
Patricia C. Dykes, Brigham and Women’s Hospital
David W. Bates, Brigham and Women’s Hospital
Jennifer S. Haas, Brigham and Women’s Hospital

Document Type

Article

Publication Date

10-5-2018

Abstract

Background
Medication adverse events are important and common yet are often not identified by clinicians. We evaluated an automated telephone surveillance system coupled with transfer to a live pharmacist to screen potentially drug-related symptoms after newly starting medications for four common primary care conditions: hypertension, diabetes, depression, and insomnia.

Methods
Cluster randomized trial with automated calls to eligible patients at 1 and 4 months after starting target drugs from intervention primary care clinics compared to propensity-matched patients from control clinics. Primary and secondary outcomes were physician documentation of any adverse effects associated with newly prescribed target medication, and whether the medication was discontinued and, if yes, whether the reason for stopping was an adverse effect.

Results
Of 4876 eligible intervention clinic patients who were contacted using automated calls, 776 (15.1%) responded and participated in the automated call. Based on positive symptom responses or request to speak to a pharmacist, 320 patients were transferred to the pharmacist and discussed 1021 potentially drug-related symptoms. Of these, 188 (18.5%) were assessed as probably and 479 (47.1%) as possibly related to the medication. Compared to a propensity-matched cohort of control clinic patients, intervention patients were significantly more likely to have adverse effects documented in the medical record by a physician (277 vs. 164 adverse effects, p < 0.0001, and 177 vs. 122 patients discontinued with documented adverse effects, p < 0.0001).

Discussion
Systematic automated telephone outreach monitoring coupled with real-time phone referral to a pharmacist identified a substantial number of previously unidentified potentially drug-related symptoms, many of which were validated as probably or possibly related to the drug by the pharmacist or their physicians. Multiple challenges were encountered using the interactive voice response (IVR) automated calling system, suggesting that other approaches may need to be considered and evaluated.

Comments

This article was originally published in Journal of General Internal Medicine , volume 34, issue 2, in 2019. https://doi.org/10.1007/s11606-018-4672-7

Recommended Citation

Schiff, G.D., Klinger, E., Salazar, A. et al. Screening for adverse drug events: A randomized trial of automated calls coupled with phone-based pharmacist counseling. J Gen Intern Med. 2019;34(2):285-292. https://doi.org/10.1007/s11606-018-4672-7

Copyright

Society of General Internal Medicine