Physical Therapists’ Role in Drug Safety and Elderly Re-hospitalization

Rehospitalization is a prominent issue in the United States, affecting patients’ health and the healthcare economy. According to the Medicare Payment Advisory Commission, expenditures on preventable hospitalizations are as high as $12 billion a year. (1) Healthcare providers, including physical therapists (PTs), play a significant role in preventing rehospitalization. Adverse drug events (ADE) are frequent contributors to the rehospitalization crisis. (2) Some key determinants found by the National Action Plan for ADE Prevention are changes in providers, lack of access to accurate health information, inappropriate monitoring, incorrect transfer procedure, and provider knowledge deficit. (3) PTs are vital healthcare providers and sometimes the first providers after hospital discharge. (2) As a result, it is essential to understand the role PTs play to ensure a safe transition of care and drug safety. 

NSAIDs are one of the most used medications among physical therapy patients to reduce pain, inflammation, and blood clotting. (4) Although the use of NSAIDs carries great short-term benefits, taking them involves possible risks and adverse effects. The most common side effect is gastrointestinal (GI) problems such as ulcers and bleeding. (5) Age is also a distinguishing factor in risk severity. Adults over 60 taking NSAIDs have a 4 to 5-fold higher risk of GI ulceration or bleeding. (4) Another life-threatening side effect is the risk of heart attack and stroke. In 2015, the FDA strengthened its existing warning that NSAIDs increase the chance of heart failure in patients with or without heart disease and can occur in the early weeks of NSAIDs use. (6) Since PT’s commonly use NSAIDs, they would greatly benefit their patients by recognizing their potential adverse effects.

It is important that PT’s remain aware of pharmacology as they manage patients’ care. PTs have more opportunities to see patients in home settings than physicians, which gives them the ability to evaluate medication adherence and proper medication administration. It is reported that 40% of elderly patients (65 years and older) take five or more medications; with multiple medications, the risk for ADEs increases. (7) Although medication management is primarily the responsibility of primary care physicians, nurses, and pharmacists, PT’s still play a small role in identifying possible side effects during mobility activities. For example, PT’s can identify fall risks when taking anticoagulation medication, and they can reduce the risks of taking oral opioids for pain management. PT’s also have the ability to monitor vital signs during exercise after patients begin taking new medicine post-hospitalization. (8)

The Improving Post Acute Care Transformation Act (IMPACT) passed in 2014 requires performing drug regimen reviews across all post-acute care settings extending to long-term care hospitals, skilled nursing facilities and inpatient rehabilitation facilities. (7) Implementing the participation of more healthcare providers like PT’s allows for more thorough drug regimen reviews and better communication between providers during immediate post-hospitalization.  

With a growing elderly population and increased instances of polypharmacy (the simultaneous use of multiple drugs), improved transition of care post-hospitalization is a needed change in the United States. To improve patient’s health, all health care providers can act by improving communication between providers and patients, health care literacy, and conducting comprehensive medication reviews. By improving these errors throughout the process, the rehospitalization rates and frequency of ADE will likely decrease.  

How often do you see ADEs in your physical therapy practice? What changes can you make in order to prevent ADEs from happening?

Citations:

1. Jencks, S., Author AffiliationsFrom an independent consulting practice, Epstein, A., M. Gandhi and G. W. Rutherford, B. R. Bloom and Others, & Ehre, C. (2009, April 02). Rehospitalizations among Patients in the Medicare Fee-for-Service Program: NEJM. Retrieved September 17, 2020, from https://www.nejm.org/doi/10.1056/NEJMsa0803563?url_ver=Z39.88-2003
2. Janes, M., Adamski, H., Strunki, E., Kornetti, D., Langham, B., & Walsh, J. (2019, April). Medications and Physical Therapy Practice. Retrieved September 17, 2020, from https://www.homehealthsection.org/assets/docs/Medications%20and%20Physical%20Therapy%20Practice%202019.pdf
3. National Action Plan for Adverse Drug Event Prevention. (n.d.). Retrieved September, 2020, from https://health.gov/sites/default/files/2019-09/ADE-Action-Plan-Prevention-Approaches.pdf
4. Biederman, R. E. (2005). Pharmacology in Rehabilitation: Nonsteroidal Anti-inflammatory Agents. Journal of Orthopaedic and Sports Physical Therapy. doi:10.2519/jospt.2005.1759
5. Hecht, M. (2019, July 23). NSAIDs and Side Effects: Common & Urgent. Retrieved September 17, 2020, from https://www.healthline.com/health/side-effects-from-nsaids
6. Center for Drug Evaluation and Research. (n.d.). FDA Drug Safety Communication. Retrieved September 17, 2020, from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory
7. Janes, M., & Kornetti, D. (n.d.). Medications: Defining the Role and Responsibility of Physical Therapy Practice. Federation of State Boards of Physical Therapy. Retrieved September, 2020, from https://www.fsbpt.org/Portals/0/documents/free-resources/WinterForum2017Medications.pdf?ver=pf8bn4ZwoorAAg1PECZLfw%3d%3d
8. Falvey JR, Burke RE, Malone D, Ridgeway KJ, McManus BM, Stevens-Lapsley JE. Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community. Phys Ther. 2016;96(8):1125-1134. doi:10.2522/ptj.20150526