Empowering Patients with Knowledge on Adverse Drug Interactions for Better
By: Olivia Lounsbury, Patient Safety Movement Foundation
In 2004, at age 43, Roberta Powell was a successful management consultant with two school-age children. Life was great, or it seemed to be, until Christmas Eve, when Roberta found a lump in her breast which turned out to be breast cancer.
Over the course of her breast cancer treatment, Roberta was overwhelmed by all of the medical terminology and confusing numbers involved. The relentless stream of information, coupled with infinite acronyms and complicated test results, made it difficult for her to understand her treatment plan. Things quickly became very complex, not to mention dangerous.
On one occasion, as Roberta, who is also diabetic, discusses in a TEDxBrownU talk, she was mistakenly provided with a lethal dose of insulin from her local pharmacy. Luckily, she noticed this medication error before she got home, and was able to report it to the pharmacy to get the proper insulin dosage. Many people in her situation, who may not have expected the pharmacy to make an error, would have unknowingly accepted the wrong — and ultimately fatal — dosage.
This dangerous experience prompted her to think about “health agency” — a term Roberta coined which refers to the ability for patients to interpret and contextualize their own personal health information. With the significant number of medication errors occurring across the world daily, she knew something had to be done.
At age 44, after successfully completing cancer treatment, Roberta went back to school and, at age 47, became a nurse educator. Roberta worked in this field for a decade, helping people advocate for their own health.
Dangerous Medication Errors Persist in Our Healthcare System
Roberta’s experiences as both a cancer patient and a nurse reminded her of the persistent problem of Adverse Drug Events (ADEs). ADEs including medication errors, reactions, and overdoses, are one of the most common, yet most preventable, sources of patient harm and death annually and can occur in inpatient or outpatient settings. In inpatient environments, ADEs account for 33% of hospital adverse events. In outpatient settings, ADEs cause about 1 million emergency department visits each year (Classen, et al., 2020).
Over two decades after the IOM identified them as the most common preventable medical errors in medicine (Classen, et al., 2020), ADEs remain a major problem, even after the implementation of Electronic Health Records (EHR), which were believed to significantly reduce medication errors.
ADEs affect over 2 million people a year, resulting in 1.5 million hospitalizations and over 100,000 deaths. As the fourth leading cause of death, ADEs cost the medical system $136 billion a year. Although the federal government tracks medication interactions and errors, there is no centralized location for patients to take control of their medication regimen and communicate with their providers about safer options.
Health Agency in Medication Management
Assisting patients in the development of health agency could help reduce the high numbers of ADEs that occur annually. Health agency is the patient’s ability to contextualize their own personal health information. Patients cannot rely solely on doctors and nurses – they’re people: busy, human, and susceptible to mistakes. However, given that most people don’t have the proper knowledge to make informed health decisions, new tools and methods must be developed to empower patients to be their own best advocate in the healthcare system.
This is easier said than done. It can be challenging to know where to go for questions among busy doctors and overwhelmed nurses. Patients may worry about being burdensome while others with poor health literacy may not feel empowered. Many may not understand their medications or understand that drug interactions even exist.
Adverse medication interactions can be amplified when numerous doctors are prescribing without communicating or when the patient does not understand the potential interaction of prescription drugs with over-the-counter medications. This lack of patient education and communication sometimes results in major, fatal medication interactions and is especially threatening in the older population or individuals who may take numerous medications.
Reducing ADEs by Building Health Agency
One way to reduce ADEs is to empower patients to take control of their medication management by identifying their own potential drug interactions. New tools and technologies are needed to decrease ADEs. Reducing ADEs will lead to safer health care services, better quality of healthcare, reduced health care costs, more informed and engaged customers, and improved health outcomes.
How does one make an informed health decision with regard to medication management to avoid drug interactions? It’s not entirely clear, but having the best information available on drug interactions can go a long way; yet, this information can oftentimes be very multifaceted and confusing.
In her work, Roberta noticed that the fragmentation and inaccessibility of health information was directly related to ADE risk. She realized that it would be easier to create a patient-facing tool than to try to change an enormous healthcare industry that was steeped in years of “tradition.”
Roberta left the field of nursing, launching a company called Health Education and Learning LLC (HEAL, LLC). The company’s product, the Quantitative 2 Qualitative Health (Q2Q Health) App, is a smartphone-based app that simplifies healthcare and empowers patients to advocate for their health. The app’s name, “Q2Q Health,” is derived from the app’s function — to translate data (e.g., scanning over-the-counter drugs like Benadryl) into actionable insights (e.g., alerting patients about drug interactions) to improve health quality. Ultimately, her goal is to offer the app as a free resource for everyone, including caregivers, to help reduce adverse drug events and improve quality of care.
Once developed, the free app will support informed health decision making and enhance the person-centeredness in care. Given that 88% of patients are health illiterate, this app seeks to fortify what Roberta calls patients’ “health agency.” Roberta will matriculate in a Nursing PhD program at the University of Rhode Island in Fall 2020 to more closely examine how patients develop health agency.
Patients should be the drivers of their own care, but they are often not empowered with the tools to do so. Roberta’s mission over the past decade, inspired by her own breast cancer journey, has focused on helping patients develop health agency so that they can be their own best advocates. Her Q2Q Health App seeks to improve quality of care and lead to better patient outcomes by contextualizing personal health data.
Now more than ever, it is crucial to provide interactive, educational, autonomous technology to help patients navigate fragmented mountains of information. Tools like the Q2Q Health App improve clinical outcomes and patient experience and, ultimately, enhance the person-centeredness of healthcare by leveraging the technological capacities of the new digital age.