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Graafsma J, Klopotowska JE, Derijks HJ, van de Garde EMW, Hoge RHL, Kruip MJHA, Meijer K, Karapinar-Carkit F, van den Bemt PMLA. Adoption of antithrombotic stewardship and utilization of clinical decision support systems-A questionnaire-based survey in Dutch hospitals. PLoS One 2024; 19:e0306033. [PMID: 38905283 PMCID: PMC11192363 DOI: 10.1371/journal.pone.0306033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024] Open
Abstract
Antithrombotics require careful monitoring to prevent adverse events. Safe use can be promoted through so-called antithrombotic stewardship. Clinical decision support systems (CDSSs) can be used to monitor safe use of antithrombotics, supporting antithrombotic stewardship efforts. Yet, previous research shows that despite these interventions, antithrombotics continue to cause harm. Insufficient adoption of antithrombotic stewardship and suboptimal use of CDSSs may provide and explanation. However, it is currently unknown to what extent hospitals adopted antithrombotic stewardship and utilize CDSSs to support safe use of antithrombotics. A semi-structured questionnaire-based survey was disseminated to 12 hospital pharmacists from different hospital types and regions in the Netherlands. The primary outcome was the degree of antithrombotic stewardship adoption, expressed as the number of tasks adopted per hospital and the degree of adoption per task. Secondary outcomes included characteristics of CDSS alerts used to monitor safe use of antithrombotics. All 12 hospital pharmacists completed the survey and report to have adopted antithrombotic stewardship in their hospital to a certain degree. The median adoption of tasks was two of five tasks (range 1-3). The tasks with the highest uptake were: drafting and maintenance of protocols (100%) and professional's education (58%), while care transition optimization (25%), medication reviews (8%) and patient counseling (8%) had the lowest uptake. All hospitals used a CDSS to monitor safe use of antithrombotics, mainly via basic alerts and less frequently via advanced alerts. The most frequently employed alerts were: identification of patients using a direct oral anticoagulant (DOAC) or a vitamin K antagonist (VKA) with one or more other antithrombotics (n = 6) and patients using a VKA to evaluate correct use (n = 6), both reflecting basic CDSS. All participating hospitals adopted antithrombotic stewardship, but the adopted tasks vary. CDSS alerts used are mainly basic in their logic.
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Affiliation(s)
- Jetske Graafsma
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joanna E. Klopotowska
- Department of Medical Informatics Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | | | - Ewoudt M. W. van de Garde
- Department of Pharmacy, St. Antonius Hospital, Nieuwegein, Utrecht, the Netherlands
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Rien H. L. Hoge
- Department of Pharmacy, Wilhelmina Hospital, Assen, the Netherlands
- Gaston Medical, Eindhoven, the Netherlands
| | - Marieke J. H. A. Kruip
- Department of Hematology, Erasmus MC, Erasmus University medical center, Rotterdam, the Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Fatma Karapinar-Carkit
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Patricia M. L. A. van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Graafsma J, Murphy RM, van de Garde EMW, Karapinar-Çarkit F, Derijks HJ, Hoge RHL, Klopotowska JE, van den Bemt PMLA. The use of artificial intelligence to optimize medication alerts generated by clinical decision support systems: a scoping review. J Am Med Inform Assoc 2024; 31:1411-1422. [PMID: 38641410 PMCID: PMC11105146 DOI: 10.1093/jamia/ocae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
OBJECTIVE Current Clinical Decision Support Systems (CDSSs) generate medication alerts that are of limited clinical value, causing alert fatigue. Artificial Intelligence (AI)-based methods may help in optimizing medication alerts. Therefore, we conducted a scoping review on the current state of the use of AI to optimize medication alerts in a hospital setting. Specifically, we aimed to identify the applied AI methods used together with their performance measures and main outcome measures. MATERIALS AND METHODS We searched Medline, Embase, and Cochrane Library database on May 25, 2023 for studies of any quantitative design, in which the use of AI-based methods was investigated to optimize medication alerts generated by CDSSs in a hospital setting. The screening process was supported by ASReview software. RESULTS Out of 5625 citations screened for eligibility, 10 studies were included. Three studies (30%) reported on both statistical performance and clinical outcomes. The most often reported performance measure was positive predictive value ranging from 9% to 100%. Regarding main outcome measures, alerts optimized using AI-based methods resulted in a decreased alert burden, increased identification of inappropriate or atypical prescriptions, and enabled prediction of user responses. In only 2 studies the AI-based alerts were implemented in hospital practice, and none of the studies conducted external validation. DISCUSSION AND CONCLUSION AI-based methods can be used to optimize medication alerts in a hospital setting. However, reporting on models' development and validation should be improved, and external validation and implementation in hospital practice should be encouraged.
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Affiliation(s)
- Jetske Graafsma
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, 9713GZ, The Netherlands
| | - Rachel M Murphy
- Department of Medical Informatics Amsterdam UMC, University of Amsterdam, Amsterdam, 1000GG, The Netherlands
- Amsterdam Public Health Institute, Digital Health and Quality of Care, Amsterdam, 1105AZ, The Netherlands
| | - Ewoudt M W van de Garde
- Department of Pharmacy, St Antonius Hospital, Utrecht, 3430AM, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, 3584CS, The Netherlands
| | - Fatma Karapinar-Çarkit
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, 6229HX, The Netherlands
- Department of Clinical Pharmacy, CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, 6229ER, The Netherlands
| | - Hieronymus J Derijks
- Department of Pharmacy, Jeroen Bosch Hospital, Den Bosch, 5200ME, The Netherlands
| | - Rien H L Hoge
- Department of Pharmacy, Wilhelmina Hospital, Assen, 9401RK, The Netherlands
| | - Joanna E Klopotowska
- Department of Medical Informatics Amsterdam UMC, University of Amsterdam, Amsterdam, 1000GG, The Netherlands
- Amsterdam Public Health Institute, Digital Health and Quality of Care, Amsterdam, 1105AZ, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, 9713GZ, The Netherlands
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Hek K, Lghoul-Oulad Saïd F, Korevaar JC, Flinterman LE, van Dijk L, van den Bemt PMLA. Adherence to coprescribing of laxatives with opioids and associated characteristics in general practices in the Netherlands. BMC PRIMARY CARE 2022; 23:312. [PMID: 36464672 PMCID: PMC9721085 DOI: 10.1186/s12875-022-01911-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend to prescribe a laxative with an opioid to prevent constipation. We aimed to determine the adherence by general practitioners (GPs) to this recommendation and to explore which GP- and patient related factors were associated with it from the perspective of the GP. METHODS: We conducted an observational study using GPs' prescription data from the Nivel Primary Care Database combined with a questionnaire asking for reasons of non-adherence. The proportion of first opioid prescriptions prescribed together with a laxative was determined as primary outcome. Possible explanatory factors such as the quality of registration, the level of collaboration with the pharmacy, familiarity with the recommendation and use of a clinical decision support system were explored, as were the self-reported reasons for non-adherence (classified as either GP-related or patient-related). We assessed the association of factors with the primary outcome using univariable multilevel logistic regression analysis. RESULTS The recommendation was measured in 195 general practices. The median proportion of first opioid prescriptions prescribed together with a laxative in these practices was 54% (practice range 18-88%). None of the determinants was consistently associated with the primary outcome. GPs from 211 practices filled out the questionnaire and the most frequently mentioned reason not to prescribe a laxative was that the patient has laxatives in stock, followed by that the patient doesn't want a laxative; both were patient-related factors. CONCLUSION There was room for improvement in following the guideline on laxative prescribing in opioid use. A main reason seemed to be that the patient refuses a laxative. Improvement measures should therefore focus on communication between GPs and patients on the relevance of co-using a laxative with opioids. Future studies need to establish the effect of such improvement measures, and determine whether reasons for non-adherence to the guideline changed over time.
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Affiliation(s)
- Karin Hek
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands
| | - Fouzia Lghoul-Oulad Saïd
- grid.5132.50000 0001 2312 1970Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Gorlaeus Laboratories, Leiden University, Leiden, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands ,grid.5645.2000000040459992XDepartment of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joke C. Korevaar
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands
| | - Linda E. Flinterman
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands
| | - Liset van Dijk
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, PO box 1568, 3500 BN Utrecht, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of PharmacoTherapy, -Epidemiology and -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| | - Patricia M. L. A. van den Bemt
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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Choi E, Kim S, Suh HS. Exploring the prevalence and characteristics of adverse drug events among older adults in South Korea using a national health insurance database. Front Pharmacol 2022; 13:1047387. [DOI: 10.3389/fphar.2022.1047387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Adverse drug events (ADEs) in the elderly frequently occur because of their multiple chronic diseases and complexity of drug therapy. To better understand adverse drug events, the prevalence and characteristics of adverse drug events in elderly South Korean patients were assessed.Methods: The National Health Insurance databases for 2015 and 2016 were used for the analysis. We included patients aged ≥65 years that had at least one claim with the diagnosis codes ‘drug-induced,’ ‘poisoning by drug,’ and ‘vaccine-associated’ each year for the base-case analysis. To minimize the underestimation of adverse drug event prevalence, we also used an extended definition analysis by adding the ‘adverse drug event very likely’ codes. We estimated the prevalence of adverse drug events by sex, age group, and type of insurance and examined the frequent types of adverse drug events in 2015 and 2016.Results: In the base-case analysis, adverse drug event prevalence in individuals aged 65 years and older was 2.75% in 2015 and 2.77% in 2016. With advanced age, the prevalence of adverse drug event tended to increase, peaking in the age group of 75–79 years. In addition, the adverse drug event prevalence was higher in females and Medical Aid enrollees. The most frequently occurring adverse drug event was ‘allergy, unspecified,’ followed by ‘other drug-induced secondary parkinsonism,’ and ‘generalized skin eruption due to drugs and medicaments.’ When we examined the extended definition analysis, the prevalence of adverse drug events was 4.47% in 2015 and 4.52% in 2016, which significantly increased from those estimated in the base-case analysis.Conclusion: Among the older adults, the prevalence of adverse drug event was higher in advanced age, females, and Medical Aid enrollees. In particular, allergy and drug-induced secondary parkinsonism frequently occurred. This study provides evidence that health policies addressing the prevention and management of adverse drug events should be a priority for the most vulnerable elderly patients.
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Hassan D, Versmissen J, Hek K, van Dijk L, van den Bemt PMLA. Feasibility of a protocol for deprescribing antihypertensive medication in older patients in Dutch general practices. BMC PRIMARY CARE 2022; 23:280. [PMID: 36352363 PMCID: PMC9644553 DOI: 10.1186/s12875-022-01894-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Older patients using antihypertensive medication may experience Adverse Drug Events (ADEs), and thus benefit from deprescribing. The lack of a practical protocol may hamper deprescribing. Therefore, we aimed to develop a deprescribing protocol, based on a review of literature, combined with a feasibility test in a small number of patients. METHODS A deprescribing protocol for general practitioners was drafted and tested in older patients using multiple antihypertensive medication in a single arm intervention. Patients were included if they were 75 years or older, were using two or more antihypertensives, had at least one ADE linked to antihypertensive medication and deprescribing was considered to be safe by their general practitioner. The primary outcome was the percentage of patients for whom one or more antihypertensive drugs were stopped or reduced in dose after 12 months of follow up while maintaining safe blood pressures. Secondary outcomes were the proportion of patients reporting no ADEs after 12 months and the number of deprescribed antihypertensives. Patient's opinions on deprescribing and enablers and barriers for study participation were also collected. RESULTS Nine general practitioners included 14 patients to deprescribe antihypertensive medication using the deprescribing protocol. After 12 months antihypertensive drug use was lowered in 11 patients (79%). These patients had a mean systolic blood pressure increase of 16 mmHg and a mean diastolic blood pressure increase of 8 mmHg. Nine patients (64%) reported experiencing no ADEs anymore after twelve months. The mean number of deprescribed antihypertensives was 1.1 in all patients and 1.4 (range: 0.5 to 3.5) in patients who successfully lowered their medication. At baseline, being able to use less medication was the most frequently mentioned enabler to participate in this study. The most frequently mentioned positive experience at the end of the study was using less medication, which was in line with the most mentioned enabler to participate in this study. CONCLUSION A protocol for deprescribing antihypertensives in older patients was considered feasible, as it resulted in a substantial degree of safe deprescribing in this pilot study. Larger studies are needed to demonstrate the effect and safety of deprescribing antihypertensives in older patients.
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Affiliation(s)
- Dimokrat Hassan
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jorie Versmissen
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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Detectability of Medication Errors With a STOPP/START-Based Medication Review in Older People Prior to a Potentially Preventable Drug-Related Hospital Admission. Drug Saf 2022; 45:1501-1516. [DOI: 10.1007/s40264-022-01237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
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Dijkstra NE, Vervloet M, Sino CGM, Heerdink ER, Nelissen-Vrancken M, Bleijenberg N, de Bruin M, Schoonhoven L. Home Care Patients' Experiences with Home Care Nurses' Support in Medication Adherence. Patient Prefer Adherence 2021; 15:1929-1940. [PMID: 34511888 PMCID: PMC8420798 DOI: 10.2147/ppa.s302818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To describe nurses' support interventions for medication adherence, and patients' experiences and desired improvements with this care. PATIENTS AND METHODS A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The questionnaire assessed 14 types of interventions, satisfaction (score 0-10) with received interventions, needs, experiences, and desired improvements in nurses' support. Interviews further explored experiences and improvements. Data were analyzed using descriptive statistics and a thematic analysis approach. RESULTS Fifty-nine participants completed the questionnaire, and 14 of the 59 participants were interviewed. The satisfaction score for interventions was 7.9 (IQR 7-9). The most common interventions were: "noticing when I don't take medication as prescribed" (n = 35), "helping me to find solutions to overcome problems with using medications" (n = 32), "helping me with taking medication" (n = 32), and "explaining the importance of taking medication at the right moment" (n = 32). Fifteen participants missed ≥1 of the 14 interventions. Most mentioned the following: "regularly asking about potential problems with medication use" (33%), "regularly discussing whether using medication is going well" (29%), and "explaining the importance of taking medication at the right moment" (27%). Twenty-two participants experienced the following as positive: improved self-management of adequate medication taking, a professional patient-nurse relationship to discuss adherence problems, and nurses' proactive attitude to arrange practical support for medication use. Thirteen patients experienced the following as negative: insufficient timing of home visits, rushed appearance of nurses, and insufficient expertise about side effects and taking medication. Suggested improvements included performing home visits on time, more time for providing support in medication use, and more expertise about side effects and administering medication. CONCLUSION Overall, participants were satisfied, and few participants wanted more interventions. Nurses' support improved participants' self-management of medication taking and enabled patients to discuss their adherence problems. Adequately timed home visits, more time for support, and accurate medication-related knowledge are desired.
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Affiliation(s)
- Nienke E Dijkstra
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Correspondence: Nienke E Dijkstra, Research Group Proactive Care for Elderly People Living at Home, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, the NetherlandsTel +31 641620681 Email
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Carolien G M Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Eibert R Heerdink
- Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Nienke Bleijenberg
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marijn de Bruin
- IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southhampton, UK
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Lghoul-Oulad Saïd F, Hek K, Flinterman LE, Herings RM, Warlé-van Herwaarden MF, de Bie S, Valkhoff VE, Alsma J, Mosseveld M, Vanrolleghem AM, Stricker BH, Sturkenboom MC, De Smet PA, van den Bemt PM. Prevalence and incidence rate of hospital admissions related to medication between 2008 and 2013 in The Netherlands. Pharmacoepidemiol Drug Saf 2020; 29:1659-1668. [PMID: 33051958 PMCID: PMC7756305 DOI: 10.1002/pds.5122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/27/2020] [Accepted: 08/27/2020] [Indexed: 11/08/2022]
Abstract
Purpose In 2009 a Dutch guideline was published containing recommendations to reduce Hospital Admissions Related to Medications (HARMs). This study aims to examine time‐trends of HARMs and their potential preventability between 2008 and 2013 in The Netherlands. Methods A retrospective prevalence study was conducted using the Dutch PHARMO Database Network. A semi‐automated pre‐selection was used to make a crude identification of possible HARMs of which four samples were selected. These were independently assessed with respect to causality and potential preventability by a physician and pharmacist. The results were stratified by age into 18‐64 years and 65 years and older. For these groups the net prevalences and incidence rates of HARMs and potentially preventable HARMs were calculated for the years 2008, 2009, 2011 and 2013. Results Four samples of 467 (2008), 447 (2009), 446 (2011) and 408 (2013) admissions were assessed. The net prevalence of HARMs in the 18‐64 years group was approximately four times smaller compared to the older group with a mean prevalence of 2.7% (95% confidence interval [CI]:2.4%‐3.0%) and 10.2% (95%CI: 9.7%‐10.7%) respectively. The potential preventability was 25.1% (18.4%‐31.8%) and 48.3% (95%CI: 44.8%‐51.8%), respectively. The prevalence of HARMs in both groups did not change significantly between 2008 and 2013 with 2.4% (95%CI: 1.9%‐3.0%) and 10.0% (95%CI: 9.0%‐11.0%) in 2008 and 3.1% (2.7%‐3.5%) and 10.4% (95%CI: 9.4%‐11.4%) in 2013, respectively. Conclusion Despite efforts to reduce HARMs, the prevalence did not decrease over time. Additional measures are therefore necessary, especially in the elderly population.
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Affiliation(s)
- Fouzia Lghoul-Oulad Saïd
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Gorlaeus Laboratories, Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Linda E Flinterman
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Ron Mc Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | - Sandra de Bie
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vera E Valkhoff
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jelmer Alsma
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mees Mosseveld
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ann M Vanrolleghem
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruno Hch Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Peter Agm De Smet
- Departments of IQ healthcare and of clinical pharmacy, Radboud university medical centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Patricia Mla van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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