AB1225 POSSIBLE EARLY DETECTION OF ADVERSE EVENTS USING REMOTE SYSTEMATIC WEEKLY ELECTRONIC MDHAQ

Abstract

Background: Adverse events of medications are reported to account for 5% of hospital admissions in the USA, including 10% in the elderly. Warnings from doctors and pharmacies concerning adverse events are given at initiation of new medications, but adverse events occur between visits and reporting depends primarily on communication between a patient and a health professional, which may be variable. Therefore, recognition and reporting of adverse events remain relatively haphazard. Several reports present strategies for systematic monitoring for adverse events, primarily involving telephone contacts from nurses to patients. A far less expensive systematic approach based on patient self-report using a remote electronic multidimensional health assessment questionnaire (MDHAQ) 60-symptom checklist may recognize most adverse events of medications. Objectives: To document recognition of adverse events using a remote weekly electronic MDHAQ completed by patients at home, as a cost-effective approach to reduce their morbidity, costs, and mortality Methods: The MDHAQ includes 0-10 scales for physical function, pain, and patient global assessment, compiled into a 0-30 RAPID3, fatigue and painful joint count, to assess treatment efficacy. The MDHAQ also includes a 60-symptom checklist to recognize comorbidities, review of systems, and symptom reduction; this checklist also recognizes adverse events associated with medications. Weekly remote completion of an electronic MDHAQ at home can monitor both efficacy and adverse events. Results: A flowsheet from a patient with pulmonary fibrosis monitored over 2018 illustrates remote electronic MDHAQ use. At a first visit of 19 Jan, a routine clinic-based MDHAQ indicated RAPID3 of 14/30, fatigue 6/10, and 10 symptoms (Flowsheet). Treatment with low-dose methotrexate and prednisone led to clinical improvement from 19 Jan to 2 Aug, RAPID3 to 3.5, fatigue 2, and 6 symptoms. On 15 Aug, a pulmonologist discontinued prednisone and methotrexate and prescribed pirfenidone, an anti-fibrosis agent. A telephone call from the patient on 24 Sep indicated distress. A home-completed remote MDHAQ indicated RAPID3 19.5, fatigue 9, 15 symptoms-7 not reported on 2 Aug were among 16 adverse events listed for pirfenidone. Discontinuation of pirfenidone and resumption of prednisone and methotrexate led to improvement of RAPID3 to 4.2, fatigue to 1.0, and resolution of pirfenidone-specific symptoms by 24 Dec, documented with weekly remote electronic MDHAQ (Flowsheet). A brief retrial of pirfenidone indicated an increase of RAPID3 to 6.0, which was discontinued in a timely manner. 78-year-old man monitored over 2018-all data from self-report on MDHAQ-pirfenidone highlighted (many entries deleted for space considerations) Conclusion: Weekly remote electronic MHDAQ monitoring of a high-risk medication for treatment response and adverse events may provide a cost-effective approach to reduce the morbidity and mortality of adverse events, involving about 10 minutes/weekly or 2 hours of patient time over 12 weeks.