It has been reported by the American Academy of Actuaries that in 2016, the U.S. spent about $3.3 Trillion, or 17.9 percent of the gross domestic product (GDP), on national health expenditures. Out of this, $329 billion was spent on prescription drugs. The Academy did an analysis of the high prescription drug spending and concluded that the important cost drivers are increasing drug utilization, increasing average cost, and changes in drug mix (Prescription Drug Spending, 2018). A lot of attention was given to possible strategies of reducing prescription drug spending while maintaining or improving health outcomes; however, there was no mention of the costs of medication related morbidity (illness) and mortality (death). Johnson and Bootman (as cited in Plumridge et al. 1998) used a cost-of-illness model and estimated that in 1994, the cost of drug-related morbidity and mortality in the ambulatory setting in the US (US $76.6 billion) exceeded prescription pharmaceutical use (US $73 billion) in the same year. A recent study in 2018 estimated annual cost of drug-related morbidity and mortality resulting from non-optimized medication therapy was $528.4 billion, equivalent to 16% of total US health care expenditures in 2016 (Watanabe, McInnis & Hirsch 2018). Consequently, the cost of medication-related morbidity and mortality should be a major consideration when analyzing healthcare costs.
As pointed out by researchers like White et al. (1999) and Gyllensten et al. (2012), adverse drug events occur frequently and lead to a significant number of fatalities each year. White further states that there are estimates that fatalities directly attributable to adverse drug reactions are the fourth to sixth leading cause of death in US hospitals. As far back as 20 years ago, the economic burden resulting from drug-related morbidity and mortality was estimated at $30 billion dollars annually, exceeding $130 billion in a worst-case scenario (White et al. 1999). Many adverse drug events are considered preventable, and therefore, prevention of drug-related morbidity and mortality has become an increasingly important requirement for reducing healthcare expenditures (White et al. 1999).
Drug-related morbidity includes unwanted effects of drugs, such as adverse drug reactions (ADRs), drug dependence and intoxications by overdose, as well as insufficient effects of medicines. Drug-related morbidity has been suggested not only to affect the clinical outcome of drug treatment, but also as a cause of increased healthcare use resulting in major costs (Gyllensten 2012). The results of a study of the health care cost of drug-related morbidity and mortality in nursing facilities found that the cost of drug related morbidity and mortality with the services of consultant pharmacists was $4 billion compared with $7.6 billion without the services of consultant pharmacists (Bootman et al. 1997 ).
In an attempt to address the growing medication related morbidity and mortality, pharmacists had used numerous methods to improve drug use (including formulary controls, drug-use review, drug stability testing and prescriber education), however, the focus was on drug therapy rather than involvement of patients or outcomes of therapy (Plumridge et al. 1998). This led to the introduction of the concept of Pharmaceutical Care which Plumridge et al. (1998) state is the responsible provision of medication for the purpose of achieving definite outcomes that improve a patient’s quality of life. They further described it as the process through which a pharmacist cooperates with both the patient and other healthcare professionals in designing, implementing and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient (Plumridge et al. 1998). The outcomes of such a therapy provision include (i) cure of disease, (ii) elimination or reduction of a patent’s symptoms, (iii) arresting or slowing of a disease process, or (iv) preventing a disease or symptoms (Plumridge et al. 1998).
How can we reduce illness or death caused by medications?
There are many ways of reducing illness or death caused by medications but two important ways are ensuring the availability of patient information as well as the provision of patient education.
Patient information – As stated by Grissinger et al (2005), lack of information about patients or their prescribed medications contributes to more than one half of all serious, preventable adverse drug events. These would include allergy information, height, weight, diagnosis (including pregnancy and lactation), and an up-to-date medication profile that includes prescription (including those from other prescribers), over-the-counter (OTC), and herbal medications.
Patient education – With the patient being the last individual in the medication use process, the healthcare practitioner-patient interface can play a significant role in capturing medication errors before they occur (Grissinger et al. 2005). Three important factors that play a role in any patient interface and determine the outcome of error prevention efforts are direct patient education, healthcare literacy, and patient compliance (Grissinger et al. 2005). Among other things, healthcare practitioners are to encourage patients to become active participants in treatment decisions and point out individual problems that could inhibit proper medication use. Patients should also keep a medication profile which should include the name, strength, dose, and frequency of dosage of all prescription medications; the name of all OTC medicines, vitamins and herbal products, and dietary supplements; known medication and food allergies; and medications that the patient used to take and the reason why each medication was discontinued (Grissinger et al 2005).
Consumer health Informatics
Consumer health informatics (CHI) is an emerging field that utilizes technology to provide health information to enhance health-care decision-making by the public (Flaherty, Hoffman-Goetz, & Arocha, 2015). The widespread availability of the internet has led to the growing interest in consumer health informatics and more US adults are using the Internet rather than doctors to obtain health and medical information (Hoyt & Yoshihashi, 2014). Consumers are increasingly comfortable using the internet as a research tool for condition and treatment information and the role of consumer oriented online health information has soared, however healthcare professionals still appear to have the strongest effect on consumer health behavior (Hoyt & Yoshihashi, 2014).
There are many excellent medical websites but online searches can yield low quality or incorrect answers especially when personal (and not professional) websites are searched (Hoyt & Yoshihashi, 2014). Healthcare professionals, including pharmacists, should therefore play an active role in coordinating and providing quality healthcare information on the internet.
Who is a pharmacist?
In order to understand the role of pharmacists in patient education, we must first know who a pharmacist is and what pharmacists do.
The answer to this question may be slightly different depending on the country; however the University Of Iowa College Of Pharmacy in the United States has provided an answer in very simple terms. (“College of Pharmacy”)
“Pharmacists are medication experts, responsible to patients for achieving the best medication treatment outcomes and at the same time assuring cost-effective and safe therapy.
Pharmacists working with health care teams advise other health professionals on the proper dose, availability, side effects and monitoring parameters for effective medication usage. In some settings pharmacists work independently or within collaborative practice agreements to manage patients’ drug therapy.
Pharmacists are also legally charged to manage appropriate access to medication information and products.
In order to practice as a pharmacist, one must complete at least six years of college, graduate from an accredited college of pharmacy and successfully complete their state board licensure examination. Upon graduation, many pharmacists complete an additional 1 to 2 years of residency training acquiring specialty knowledge and skills necessary for today’s advanced team-based practice environment. This additional knowledge and skill set is demonstrated through specialty board certification.”
More information about the pharmacy profession is available on the website of the American Pharmacists Association. (APhA)
Pharmacists can apply their wealth of knowledge on medications to educate the public on the safe and responsible use of medications. With the growing trend of public reliance on the internet for healthcare information; pharmacists would need to recognize this opportunity and develop skills to help them reach consumers with quality medication information.
My next post suggests ways and approaches by which pharmacists can provide medication information to the public through the active use of the internet.
APhA. (2018). The Pharmacy Profession. Retrieved October 31, 2018, from
Bootman J. L., Harrison D.L., Cox E. The Health Care Cost of Drug-Related Morbidity and
Mortality in Nursing Facilities. Arch Intern Med. 1997;157(18):2089–2096. doi:10.1001/archinte.1997.00440390083011
College of Pharmacy. (n.d.). Retrieved October 31, 2018, from https://pharmacy.uiowa.edu/what-does-pharmacist-do
Flaherty, D., Hoffman-Goetz, L., & Arocha, J. F. (2015). What is consumer health informatics?
A systematic review of published definitions. Informatics for Health & Social Care, 40(2), 91–112. https://doi-org.nec.gmilcs.org/10.3109/17538157.2014.907804
Grissinger, M. C., & Kelly, K. (2005). Reducing the Risk of Medication Errors in Women. Journal of Women’s Health (15409996), 14(1), 61–67. https://doi-org.nec.gmilcs.org/10.1089/jwh.2005.14.61
Gyllensten H, Jönsson AK, Rehnberg C, Carlsten A, Jönsson, A. K., (2012). How are the costs of drug-related morbidity measured?: a systematic literature review. Drug Safety, 35(3), 207–219. https://doi-org.nec.gmilcs.org/10.2165/11597090-000000000-00000
Hoyt, R. E., & Yoshihashi, A. (2014). Health informatics: practical guide for healthcare and information technology professionals: sixth edition (6th ed.).
Plumridge, R. J., & Wojnar-Horton, R. E. (1998). A review of the pharmacoeconomics of pharmaceutical care. PharmacoEconomics, 14(2), 175–189. Retrieved from http://nec.gmilcs.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&Auth; Type=cookie, ip,url,cpid&custid=danforth&db=aph&AN=9526717&site=ehost-live&scope=site
Prescription Drug Spending in the U.S. Health Care System. (2018). Retrieved October 30, 2018, from http://www.actuary.org/content/prescription-drug-spending-us-health-care-system
Watanabe, J. H., McInnis, T., & Hirsch, J. D. (2018, September). Cost of Prescription Drug-Related Morbidity and Mortality. Retrieved December 6, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/29577766
White, T. J., Arakelian, A., & Rho, J. P. (1999). Counting the costs of drug-related adverse events. PharmacoEconomics, 15(5), 445–458. Retrieved from
I look forward to your comments and questions
Dr O Williams Pharm D, MBA