Drug-induced iatrogenesis refers to all adverse effects and negative consequences on a patient's health caused by taking medications. It includes not only the adverse effects specific to a drug, but also drug interactions and errors related to medication intake. In other words, even if a treatment is prescribed to improve health, an iatrogenic risk remains, which can compromise the effectiveness of care or lead to complications.

This problem is particularly concerning in elderly people, who often take several treatments simultaneously. Preventing drug-induced iatrogenesis is a challenge for healthcare professionals such as doctors, pharmacists and nurses. The goal is to optimize patient safety by reducing as much as possible the adverse effects associated with medications.

What is drug-induced iatrogenesis?

Definition and implications

Drug-induced iatrogenesis refers to the harmful effects that medications can cause in a patient, even when the treatment is correctly prescribed. Unlike a medical error, it concerns the side effects or complications directly related to the medication, its combination with other treatments, or a mismatch between the treatment and the individual. These adverse effects can cause new symptoms, sometimes serious, and impair the patient's health.

Frequent causes of iatrogenesis

The origins of iatrogenic medication are multiple and require rigorous monitoring to prevent complications. Here are the main causes:

- An overdose, often linked to poor management of treatments. This is particularly common in elderly people, due to cognitive disorders or polypharmacy.

- Allergies or intolerances to certain medications, which vary from patient to patient, particularly with antibiotics, anti-inflammatory drugs, or cancer treatments.

- Slowed elimination of active substances by the liver or kidneys, leading to a toxic accumulation of medications.

- Drug interactions between several treatments taken simultaneously. These interactions can intensify side effects or reduce the effectiveness of care.

- Inappropriate dosages that do not sufficiently take into account the age, weight, or general condition of the patient.

- Self-medication not supervised by a healthcare professional, likely to interfere with a prescribed treatment.

These factors increase the iatrogenic risk, sometimes severely. Increased vigilance on the part of healthcare professionals is essential to ensure safe and effective use of medications and to avoid iatrogenic accidents.

Populations at risk

Elderly people: increased vulnerability

Elderly people are the most vulnerable population to drug-induced iatrogenesis. This fragility is explained by several factors: the frequent presence of polypathologies, the simultaneous intake of numerous medications (polypharmacy), and the physiological alterations linked to age, such as a decrease in renal or hepatic function. These elements significantly increase the iatrogenic risk by multiplying drug interactions and making treatment management more complex.

Furthermore, the frailty of the elderly can be exacerbated by a deficit in functional autonomy, an insufficient nutritional status, or a precarious social situation. These aspects must imperatively be taken into account by healthcare professionals to adapt prescriptions and reduce risks.

Other at-risk populations

In addition to the elderly, other groups are at increased risk of iatrogenesis. These include patients with multiple pathologies, who must manage complex treatments, as well as infants and young children, whose metabolism is still immature. Pregnant women are also affected, as their tolerance to medications may differ due to the physiological changes associated with pregnancy.

Individuals with renal or hepatic insufficiency, or those with cognitive disorders affecting medication intake, are also part of the at-risk populations. Finally, patients receiving care in healthcare facilities, where coordination between professionals may sometimes be insufficient, are exposed to an increased risk of medication errors. These situations require particular vigilance to minimize complications.

Principles for the Prevention of Drug-Induced Iatrogenesis

Rationalizing drug prescribing

The first essential step in preventing drug-induced iatrogenesis is to optimize the prescription of medications. The attending physician must carefully evaluate the relevance of each treatment, taking into account the patient's characteristics, such as age, renal and hepatic function, and general condition. It is important to adhere to the official indications and adjust the dosage to avoid adverse effects related to overdose or toxic accumulation.

Concurrently, limiting polypharmacy plays a key role, as combining multiple products increases the risk of drug interactions and iatrogenic complications.

Promote communication between healthcare professionals

Another cornerstone of prevention is effective communication. effective communication and enhanced coordination between different healthcare professionals: doctors, pharmacists, nurses and other specialists. The exchange of information, in particular via tools such as the Pharmaceutical File, provides an up-to-date medication record. This ensures that everyone involved has a complete overview of current treatments.

This collaboration reduces the risk of omission, dosage error, or undetected interaction. In short, the prevention of iatrogenic risk relies on collective vigilance and effective sharing of health data to ensure safe care for patients.

Prevention strategies for the patient

Educating patients on medication adherence

It is essential to inform patients on how to properly follow their treatment to prevent any risk of drug-induced iatrogenesis. Clear communication on the objectives of the treatment, the methods of administration (such as times, frequency, and dietary conditions), as well as on possible side effects, plays a key role in improving therapeutic compliance and limiting the risks of misuse.

This approach also includes awareness of the dangers of self-medication, while emphasizing the importance of promptly consulting a healthcare professional in the event of an unexpected effect. Therapeutic education, often conducted by a pharmacist or nurse, can also involve the patient's relatives to ensure appropriate and effective support.

Encourage the use of a shared medical record

The use of a shared medical record (SMR) is an effective method of reducing the risks associated with drug-induced iatrogenesis. This record centralizes all medical information and current treatments, and is accessible to all healthcare professionals involved in the patient's care.

This tool facilitates care coordination by enabling the verification of drug interactions, preventing redundant or incompatible prescriptions, and ensuring safer care. By encouraging patients to regularly update and share their records, the risk of medication errors is significantly reduced, especially in elderly patients or those on polypharmacy.

Monitoring methods to minimize risks

The role of medication reconciliation

The medication review is an essential tool for detecting, preventing, and reducing drug-induced iatrogenesis. Conducted primarily by the pharmacist in collaboration with physicians, it consists of a structured and critical analysis of all the medications a patient takes.

The aim is to assesscompliance and tolerance, detect any adverse effects and identify high-risk situations. This is particularly important for patients with multiple medications, or after hospitalization. It enables treatments to be optimized by adjusting or withdrawing certain drugs, while taking into account the patient's clinical condition and care objectives.

In summary, the medication reconciliation contributes to improved therapeutic management and the prevention of treatment-related complications.

The importance of deprescribing in certain cases

Deprescribing is a strategy aimed at reducing the number of medications when they become unnecessary or represent a significant iatrogenic risk, particularly in elderly patients. This approach must be carried out with caution and in consultation with the attending physician, the pharmacist, and the patient, in order to avoid abrupt or inappropriate treatment interruptions.

By reducing polypharmacy, deprescribing helps to limit adverse drug effects, prevent harmful interactions, and improve patients' quality of life. It is part of a comprehensive approach to preventing iatrogenic risks and optimizing medication care.

The role of the various healthcare players

The attending physician

The attending physician plays a central role in the prevention of drug-induced iatrogenesis. They are responsible for the initial prescription and regular monitoring of treatments, taking into account the age, comorbidities, and overall health status of the patient.

The physician must adjust dosages, avoid superfluous treatments, and frequently reassess the relevance of prescriptions to limit polypharmacy and its associated risks. The physician also plays a key role in coordinating with other healthcare professionals, thereby ensuring safe and well-organized medication management.

Pharmacists and other healthcare professionals

Pharmacists have an essential mission in preventing adverse drug effects. They ensure the safe delivery of treatments, conduct medication reviews, and provide advice to patients for optimal use of medications. In addition, they detect potential drug interactions that could harm patients' health.

Nurses, nursing assistants, and other healthcare professionals also actively participate in the monitoring and follow-up of treatments. They report any abnormalities or adverse effects that may occur, thereby contributing to the safety of care.

This collective mobilization is essential to ensure effective prevention of iatrogenic risk in all care settings.

Conclusion

Drug-induced iatrogenesis is a critical public health issue, particularly among elderly individuals or those undergoing polypharmacy regimens. To prevent it, it is important to prioritize rational prescribing, ensure seamless communication between different healthcare professionals, and provide patients with clear education to ensure medication intake in complete safety. Tools such as medication reconciliation and deprescribing play a fundamental role in reducing iatrogenic risk.

Do not hesitate to actively collaborate with your attending physician and your pharmacist to better organize your treatment and preserve your health.

FAQ

What are the main risk factors for drug iatrogenicity, and how can they be identified?

Drug-induced iatrogenesis is often linked to several factors such as polypharmacy, advanced age, and the presence of chronic diseases. Classes of high-risk medications include anticoagulants, cardiovascular medications, anti-inflammatory drugs, and psychotropic drugs.

To identify these risks, it is essential to assess the number of medications taken, to identify atypical symptoms such as falls or episodes of confusion, and to consider the clinical context.

What are the best practices for preventing iatrogenic medication use?

To prevent drug-induced iatrogenesis, it is recommended to:

• Limit prescriptions to medications that are truly essential.
• Adjust the dosage based on renal function.
• Favor molecules with a good benefit/risk ratio.
• Simplify treatment regimens wherever possible.
• Communicate clearly with the patient to ensure their understanding.
• Implementing regular monitoring to verify the effectiveness and tolerance of the treatment.

How to recognize symptoms suggestive of drug-induced iatrogenesis, particularly in the elderly?

In the elderly, symptoms suggestive of drug-induced iatrogenesis include:

• Unexplained fatigue.
• Visual impairment.
• Skin rash.
• Gastrointestinal bleeding.
• Frequent falls.

Polypharmacy, non-compliance with prescribed doses, and drug interactions are factors that significantly increase this risk. Any new symptom should be followed by a thorough iatrogenic examination.

What role can the patient and the pharmacist play in preventing and managing the risks associated with adverse drug reactions?

The pharmacist has an important role in the prevention of drug-induced iatrogenesis. They can:

• Identify potential risks.
• Inform and support the patient.
• Carry out shared medication reviews to optimize treatment.

For their part, patients should be actively involved by:

• Follow the advice given by healthcare professionals.
• Reporting any adverse effects.
• Scrupulously respecting his treatment.