OBJECTIVES: Unreported adverse drug reactions (ADRs) are of big concerns to medication safety in the outpatient setting. To improve ADR reporting, we used a Telephonic Interactive Voice Response System (IVRS) that interoperates with EHR (electronic health records) and pharmacist to assess and detect possibility of ADRs symptoms related to outpatient medications. In this study we estimated the cost of possible ADR symptoms reporting using IVRS.
METHODS: 5872 eligible patients from a large health system in greater Boston were identified. To be eligible they had to be an adult patient seen in primary care at one of 8 participating clinics, received a new prescription for an oral medication to treat hypertension, diabetes, depression, or insomnia. Using IVRS, we contacted patients 4-6 weeks and again at 4-6 months after the date the drug was prescribed, to document any patient-reported symptoms related to ADRs. Costs per patient contacted, respondent patient, and patient reporting a possible ADR were estimated. Direct health care costs and cost of patient’s time for the intervention were included in the analysis. Costs of health care resources and personnel were derived from the hospital financial accounting system.
RESULTS: Of the total patients contacted (5872), 10.3% responded, 7.3% were transferred to pharmacist and 5.2% reported symptoms to the IVRS. The total cost per patient contacted was estimated at $12.29. Pharmacist’s salary represented 66.7% of the cost per patient contacted. The cost per respondent patient, cost per call transferred to pharmacist and cost of symptoms reported per patient were estimated to be $118.51, $167.85 and $235.86 respectively.
CONCLUSIONS: Systems like IVRS with real-time linkages to a clinical pharmacist, may facilitate early detection of possible ADRs related to prescription medications and do so with relatively little cost per patient. Earlier detection of adverse drug reactions may help reduce the costs related to primary care visits and hospitalizations.
