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Stauffer SJ, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Potentially inappropriate medication use among older adults with lower-limb loss. Geriatr Nurs 2024; 56:218-224. [PMID: 38367544 DOI: 10.1016/j.gerinurse.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of, and explore factors related to, prescription of potentially inappropriate medications (PIMs) among older adults with lower-limb loss (LLL). METHODS This was a secondary analysis of a cross-sectional dataset collected through an interdisciplinary limb loss clinic between September 2013 and November 2022. Self-report medication lists were reviewed during in-clinic face-to-face interviews and compared to the American Geriatrics Society Beers Criteria corresponding to the patient's evaluation year. RESULTS Of 82 participants (72.9 ± 6.6 years-old; 78.0 % male), n = 41 (50.0 %) reported using one or more PIM. PIM prescription was significantly associated with presence of phantom limb pain, history of upper gastrointestinal issues, and a greater number of medications. DISCUSSION Polypharmacy and PIM use are common among older adults with LLL. Greater attention should be paid to medications post-amputation, especially pain management medications, to minimize potential adverse side-effects.
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Affiliation(s)
- Samantha Jeanne Stauffer
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA; Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 100 Discovery Blvd, Newark, DE, 19713 USA; University of Delaware, Epidemiology Program, STAR Tower, Suite 614, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA.
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Boyd CM, Shetterly SM, Powers JD, Weffald LA, Green AR, Sheehan OC, Reeve E, Drace ML, Norton JD, Maiyani M, Gleason KS, Sawyer JK, Maciejewski ML, Wolff JL, Kraus C, Bayliss EA. Evaluating the Safety of an Educational Deprescribing Intervention: Lessons from the Optimize Trial. Drugs Aging 2024; 41:45-54. [PMID: 37982982 PMCID: PMC11101016 DOI: 10.1007/s40266-023-01080-y] [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] [Accepted: 10/16/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Patients, family members, and clinicians express concerns about potential adverse drug withdrawal events (ADWEs) following medication discontinuation or fears of upsetting a stable medical equilibrium as key barriers to deprescribing. Currently, there are limited methods to pragmatically assess the safety of deprescribing and ascertain ADWEs. We report the methods and results of safety monitoring for the OPTIMIZE trial of deprescribing education for patients, family members, and clinicians. METHODS This was a pragmatic cluster randomized trial with multivariable Poisson regression comparing outcome rates between study arms. We conducted clinical record review and adjudication of sampled records to assess potential causal relationships between medication discontinuation and outcomes. This study included adults aged 65+ with dementia or mild cognitive impairment, one or more additional chronic conditions, and prescribed 5+ chronic medications. The intervention included an educational brochure on deprescribing that was mailed to patients prior to primary care visits, a clinician notification about individual brochure mailings, and an educational tip sheets was provided monthly to primary care clinicians. The outcomes of the safety monitoring were rates of hospitalizations and mortality during the 4 months following brochure mailings and results of record review and adjudication. The adjudication process was conducted throughout the trial and included classifications: likely, possibly, and unlikely. RESULTS There was a total of 3012 (1433 intervention and 1579 control) participants. There were 420 total hospitalizations involving 269 (18.8%) people in the intervention versus 517 total hospitalizations involving 317 (20.1%) people in the control groups. Adjusted risk ratios comparing intervention to control groups were 0.92 [95% confidence interval (CI) 0.72, 1.16] for hospitalization and 1.19 (95% CI 0.67, 2.11) for mortality. Both groups had zero deaths "likely" attributed to a medication change prior to the event. A total of 3 out of 30 (10%) intervention group hospitalizations and 7 out of 35 (20%) control group hospitalizations were considered "likely" due to a medication change. CONCLUSIONS Population-based deprescribing education is safe in the older adult population with cognitive impairment in our study. Pragmatic methods for safety monitoring are needed to further inform deprescribing interventions. TRIAL REGISTRATION NCT03984396. Registered on 13 June 2019.
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Affiliation(s)
- Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Medical Center, Durham, NC, USA.
| | - Susan M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - John D Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Linda A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ariel R Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily Reeve
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA, Australia
| | - Melanie L Drace
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jonathan D Norton
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahesh Maiyani
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Kathy S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jennifer K Sawyer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jennifer L Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Courtney Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Candeias C, Gama J, Rodrigues M, Falcão A, Alves G. Patients' Characterization, Pattern of Medication Use, and Factors Associated with Polypharmacy: A Cross-Sectional Study Focused on Eight Units of the Portuguese National Network for Long-Term Integrated Care. Healthcare (Basel) 2023; 12:57. [PMID: 38200961 PMCID: PMC10778689 DOI: 10.3390/healthcare12010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The Portuguese National Network for Long-term Integrated Care (RNCCI) comprises several Units for Integrated Continuous Care (UCCIs) that provide medical, nursing, and rehabilitation care. This study aimed to evaluate the demographic and medical characteristics of patients admitted to the RNCCI, their patterns of medication use, and factors associated with polypharmacy. An observational, retrospective, cross-sectional, multicenter study was performed. This study population consisted of 180 patients. Polypharmacy status was divided into two groups: non-polypharmacy (taking ≤ 4 drugs) and polypharmacy (taking ≥ 5 drugs). Bivariate analysis and multivariate logistic regression analysis were used to determine the influence of predictor factors such as demographic and medical characteristics on the polypharmacy status during the UCCI stays. This study population (mean age of 78.4 ± 12.3 years, range 23-102 years, 59% female) was prescribed a median of 8 medications. Approximately 89.4% of the patients were taking ≥ 5 drugs, demonstrating that polypharmacy is highly prevalent in Portuguese RNCCI residents of the eight UCCIs studied. A subsequent analysis with multivariate logistic regression found that polypharmacy status was significantly associated with the unit of internment (facility) when compared to facility E with H and with the Charlson Comorbidity Index (CCI). The high prevalence of polypharmacy and the associated factors show that it is urgent to improve pharmacotherapy regimens through periodic monitoring and review of patients' therapeutic lists, an area in which pharmacists play a very important role.
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Affiliation(s)
- Catarina Candeias
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
- UMP—Union of Portuguese Mercies, Rua Entrecampos 9, 1000-151 Lisboa, Portugal
| | - Jorge Gama
- CMA-UBI—Centre of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Rua Marquês D’Ávila e Bolama, 6201-001 Covilhã, Portugal;
| | - Márcio Rodrigues
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
- CPIRN-UDI-IPG—Center for Potential and Innovation of Natural Resources, Research Unit for Inland Development, Polytechnic Institute of Guarda, Av. Dr. Francisco de Sá Carneiro, 6300-559 Guarda, Portugal
| | - Amílcar Falcão
- CIBIT—Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI—Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
- ESALD-IPCB—Dr. Lopes Dias School of Health, Polytechnic Institute of Castelo Branco, Av. do Empresário, Campus da Talagueira, 6000-767 Castelo Branco, Portugal
- UFBI—Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
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Schönenberger N, Meyer-Massetti C. Risk factors for medication-related short-term readmissions in adults - a scoping review. BMC Health Serv Res 2023; 23:1037. [PMID: 37770912 PMCID: PMC10536731 DOI: 10.1186/s12913-023-10028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Hospital readmissions due to medication-related problems occur frequently, burdening patients and caregivers emotionally and straining health care systems economically. In times of limited health care resources, interventions to mitigate the risk of medication-related readmissions should be prioritized to patients most likely to benefit. Focusing on general internal medicine patients, this scoping review aims to identify risk factors associated with drug-related 30-day hospital readmissions. METHODS We began by searching the Medline, Embase, and CINAHL databases from their inception dates to May 17, 2022 for studies reporting risk factors for 30-day drug-related readmissions. We included all peer-reviewed studies, while excluding literature reviews, conference abstracts, proceeding papers, editorials, and expert opinions. We also conducted backward citation searches of the included articles. Within the final sample, we analyzed the types and frequencies of risk factors mentioned. RESULTS After deduplication of the initial search results, 1159 titles and abstracts were screened for full-text adjudication. We read 101 full articles, of which we included 37. Thirteen more were collected via backward citation searches, resulting in a final sample of 50 articles. We identified five risk factor categories: (1) patient characteristics, (2) medication groups, (3) medication therapy problems, (4) adverse drug reactions, and (5) readmission diagnoses. The most commonly mentioned risk factors were polypharmacy, prescribing problems-especially underprescribing and suboptimal drug selection-and adherence issues. Medication groups associated with the highest risk of 30-day readmissions (mostly following adverse drug reactions) were antithrombotic agents, insulin, opioid analgesics, and diuretics. Preventable medication-related readmissions most often reflected prescribing problems and/or adherence issues. CONCLUSIONS This study's findings will help care teams prioritize patients for interventions to reduce medication-related hospital readmissions, which should increase patient safety. Further research is needed to analyze surrogate social parameters for the most common drug-related factors and their predictive value regarding medication-related readmissions.
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Affiliation(s)
- N Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - C Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
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Involvement of Pharmacists in the Emergency Department to Correct Errors in the Medication History and the Impact on Adverse Drug Event Detection. J Clin Med 2023; 12:jcm12010376. [PMID: 36615176 PMCID: PMC9821377 DOI: 10.3390/jcm12010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists' interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians' medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians' medication histories.
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Evaluation of Factors Associated with Adverse Drug Events in South Korea Using a Population-Based Database. J Clin Med 2022; 11:jcm11216248. [PMID: 36362475 PMCID: PMC9657773 DOI: 10.3390/jcm11216248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
This retrospective study aims to investigate the factors associated with the occurrence of ADEs using nationally representative claims data. All patients with at least one claim with diagnosis codes denoting potential ADE between 1 July 2015 and 31 December 2015 were included. Potential ADE was defined as ADE identified in the claims data, because it was not verified. The index date was defined as the date of the first claim with potential ADEs. Demographic data were collected at the index date, while data on comorbidities and number of medications used were collected six months before the index date. Multivariate logistic regression was used to explore the association between potential ADEs and several factors, including sex, age group, insurance type, comorbidities, and number of prescribed medications. Patients with potential ADEs were older, had more chronic diseases, and used more medications than those without potential ADEs. In the multivariate analysis, occurrence of potential ADEs was associated with age (≥65 years, odds ratio [OR] 1.15, 95% confidence interval [CI] 1.08–1.21), Medical Aid program (OR 1.37, 95% CI 1.27–1.47), Charlson Comorbidity Index scores (≥5, OR 2.87, 95% CI 2.56–3.20), and use of six or more medications (6–10 medications, OR 1.89, 95% CI 1.79–1.99). Age, Medical Aid program, comorbidities, and number of medications were associated with occurrence of potential ADEs.
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Kang MG, Lee JY, Woo SI, Kim KS, Jung JW, Lim TH, Yoon HJ, Kim CW, Yoon HR, Park HK, Kim SH. Adverse drug events leading to emergency department visits: A multicenter observational study in Korea. PLoS One 2022; 17:e0272743. [PMID: 36121802 PMCID: PMC9484687 DOI: 10.1371/journal.pone.0272743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Adverse drug events are significant causes of emergency department visits. Systematic evaluation of adverse drug events leading to emergency department visits by age is lacking. This multicenter retrospective observational study evaluated the prevalence and features of adverse drug event-related emergency department visits across ages. We reviewed emergency department medical records obtained from three university hospitals between July 2014 and December 2014. The proportion of adverse drug events among total emergency department visits was calculated. The cause, severity, preventability, and causative drug(s) of each adverse drug event were analyzed and compared between age groups (children/adolescents [<18 years], adults [18–64 years], and the elderly [≥65 years]). Of 59,428 emergency department visits, 2,104 (3.5%) were adverse drug event-related. Adverse drug event-related emergency department visits were more likely to be female and older. Multivariate logistic regression analysis revealed that compared to non- adverse drug event-related cases, adverse drug event-related emergency department visitors were more likely to be female (60.6% vs. 53.6%, p<0.001, OR 1.285, 95% CI 1.025–1.603) and older (50.8 ± 24.6 years vs. 37.7 ± 24.4 years, p<0.001, OR 1.892, 95% CI: 1.397–2.297). Comorbidities such as diabetes, chronic kidney disease, chronic liver disease, and malignancies were also significantly associated with adverse drug event-related emergency department visits. Side effects were the most common type of adverse drug events across age groups, although main types differed substantially depending on age. Serious adverse drug events, hospitalizations, and adverse drug event-related deaths occurred more frequently in the elderly than in adults or children/adolescents. The proportion of adverse drug event-related emergency department visits that were preventable was 15.3%. Causative drugs of adverse drug events varied considerably depending on age group. Adverse drug event features differ substantially according to age group. The findings suggest that an age-specific approach should be adopted in the preventive strategies to reduce adverse drug events.
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Affiliation(s)
- Min-Gyu Kang
- Department of Internal Medicine, Subdivision of Allergy, Chungbuk National University Hospital, Cheongju, Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Subdivision of Allergy, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Sook Kim
- Department of Pharmacy, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- * E-mail: (SHK); (JWJ)
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye-Ran Yoon
- College of Pharmacy, Duksung Women’s University, Seoul, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail: (SHK); (JWJ)
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Fernández Bosch A, del Campo Giménez M, Hermida Lazcano I, Rodríguez Marín Y, Camarena Navarro L, Párraga Martínez I. Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/150206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario.
Diseño: estudio observacional retrospectivo de casos y controles.
Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete.
Participantes: Se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos).
Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos.
Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17).
Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.
Palabras clave: multimorbilidad, comorbilidad, hospitalización, utilización de servicios de salud.
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Affiliation(s)
- Alba Fernández Bosch
- Especialista en Medicina Familiar y Comunitaria. CS Plaza Segovia. Gerencia de Atención Primaria Hospital Dr. Peset. Valencia (España)
| | - María del Campo Giménez
- Especialista en Medicina Familiar y Comunitaria. Consultorio de Ledaña. CS de Iniesta. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ignacio Hermida Lazcano
- Médica internista. Servicio de Medicina Interna. Unidad de Continuidad Asistencial Primaria-Interna (UCAPI). Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Yulema Rodríguez Marín
- Especialista en Medicina Interna. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
| | - Lucía Camarena Navarro
- Medicina Interna. Hospital de Villarrobledo. Gerencia de Atención Integrada de Villarrobledo. Albacete (España)
| | - Ignacio Párraga Martínez
- Especialista en Medicina Familiar y Comunitaria. CS Zona VIII de Albacete. Gerencia de Atención Integrada de Albacete. Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha. Albacete (España)
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Fernández Bosch A, del Campo-Giménez M, Hermida-Lazcano I, Rodríguez-Marín Y, Camarena Navarro L, Párraga-Martínez I. Influencia de la pluripatología y comorbilidad en el ingreso hospitalario en una cohorte de pacientes de una unidad de continuidad asistencial Primaria-Interna. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2022. [DOI: 10.55783/rcmf.150206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objetivo: estimar la frecuencia de pluripatología y comorbilidad en pacientes seguidos en una unidad de continuidad asistencial Primaria-Interna, así como conocer sus características clínicas y la relación entre pluripatología y comorbilidad con el ingreso hospitalario.
Diseño: estudio observacional retrospectivo de casos y controles.
Emplazamiento: Unidad de Continuidad Asistencial de Atención Primaria y Medicina Interna (UCAPI) del Complejo Hospitalario Universitario de Albacete.
Participantes: Se analizaron 1.591 pacientes atendidos en una unidad de continuidad asistencial Primaria-Interna (292 con algún ingreso hospitalario en el último año y 1.299 sin ingresos).
Mediciones principales: edad, sexo, problemas de salud, índice de Charlson, consumo de medicamentos y utilización de servicios sanitarios los 3 años previos.
Resultados: del total de la muestra, un 18,4% (IC 95%:16,4-20,3) eran casos con algún ingreso. Presentaba pluripatología un 23,3% (IC 95%: 21,1-25,4) y comorbilidad (índice de Charlson ≥ 2) un 32,6% (IC 95%: 30,2-34,9). Fueron variables asociadas de forma independiente a ingreso hospitalario la pluripatología (OR: 2,51; IC 95%: 1,64-3,83; p < 0,001), comorbilidad (índice de Charlson ≥ 2) (OR: 1,81; IC 95%:1,18-2,78; p = 0,006), tener más de tres problemas de salud (OR: 1,49; IC 95%: 1,07-2,07; p = 0,017), contar con mayor número de consultas de Atención Primaria (AP) (OR: 1,01; IC 95%: 1,00-1,02; p = 0,005), de hospital (1,03; IC 95%: 1,01-1,05), p < 0,001) y realizar más visitas a urgencias hospitalarias (OR: 1,12, IC 95%: 1,07-1,17).
Conclusiones: casi una cuarta parte de los pacientes seguidos en una unidad de continuidad asistencial entre Medicina interna y de Familia presenta pluripatología y un tercio, comorbilidad. La presencia de pluripatología y comorbilidad son características relacionadas con el ingreso hospitalario, junto con la mayor utilización de servicios sanitarios.
Palabras clave: multimorbilidad, comorbilidad, hospitalización, utilización de servicios de salud.
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Affiliation(s)
- Alba Fernández Bosch
- Especialista en Medicina Familiar y Comunitaria. CS Plaza Segovia. Gerencia de Atención Primaria Hospital Dr. Peset. Valencia (España)
| | - María del Campo-Giménez
- Especialista en Medicina Familiar y Comunitaria. Consultorio de Ledaña. CS de Iniesta. Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Ignacio Hermida-Lazcano
- Médica internista. Servicio de Medicina Interna. Unidad de Continuidad Asistencial Primaria-Interna (UCAPI). Gerencia de Atención Integrada de Albacete. Albacete (España)
| | - Yulema Rodríguez-Marín
- Especialista en Medicina Interna. Hospital de Hellín. Gerencia de Atención Integrada de Hellín. Albacete (España)
| | - Lucía Camarena Navarro
- Medicina Interna. Hospital de Villarrobledo. Gerencia de Atención Integrada de Villarrobledo. Albacete (España)
| | - Ignacio Párraga-Martínez
- Especialista en Medicina Familiar y Comunitaria. CS Zona VIII de Albacete. Gerencia de Atención Integrada de Albacete. Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha. Albacete (España)
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10
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Ali S, Curtain CM, Bereznicki LR, Salahudeen MS. Actual drug-related harms in residential aged care facilities: a narrative review. Expert Opin Drug Saf 2022; 21:1047-1060. [PMID: 35634890 DOI: 10.1080/14740338.2022.2084071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Older people in residential aged care facilities (RACFs) have a high risk of safety issues and concerns about the potential quality of care received. This narrative review investigates the types of actual drug-related harms, their prevalence, reporting of any standard definitions for these harms, and their identification methods. AREAS COVERED The authors conducted a systematic search on Ovid Embase, Ovid Medline, and PubMed from March 2001 to March 2021. This narrative review included all types of studies targeting aged care residents aged 65 years and above with actual drug-related harms. EXPERT OPINION The prevalence of actual drug-related harms in residents ranged from 0.07% to 63.0%. Falls, drug-drug interactions, neuropsychiatric symptoms, anaphylaxis, urinary tract infection, hypoglycemia, hypokalaemia, and acute kidney injury are the most common drug-related harms in older residents. Psychotropic drugs are the most common drug class implicated in these harms. Evidence related to the association between individual psychotropic drugs and injury, or harm is also lacking. Due to the variation in study duration, reported prevalence, identification methods, and absence of a definition for actual drug-related harms in most studies, further research is mandated to understand the prevalence and clinical implications of drug-related harms in older residents.
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Affiliation(s)
- Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Luke Re Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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11
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Schmid O, Bereznicki B, Peterson GM, Stankovich J, Bereznicki L. Persistence of Adverse Drug Reaction-Related Hospitalization Risk Following Discharge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095585. [PMID: 35564982 PMCID: PMC9101512 DOI: 10.3390/ijerph19095585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/28/2022]
Abstract
This retrospective cohort study analyzed the administrative hospital records of 91,500 patients with the aim of assessing adverse drug reaction (ADR)-related hospital admission risk after discharge from ADR and non-ADR-related admission. Patients aged ≥18 years with an acute admission to public hospitals in Tasmania, Australia between 2011 and 2015 were followed until May 2017. The index admissions (n = 91,550) were stratified based on whether they were ADR-related (n = 2843, 3.1%) or non-ADR-related (n = 88,707, 96.9%). Survival analysis assessed the post-index ADR-related admission risk using (1) the full dataset, and (2) a matched subset of patients using a propensity score analysis. Logistic regression was used to identify the risk factors for ADR-related admissions within 90 days of post-index discharge. The patients with an ADR-related index admission were almost five times more likely to experience another ADR-related admission within 90 days (p < 0.001). An increased risk persisted for at least 5 years (p < 0.001), which was substantially longer than previously reported. From the matched subset of patients, the risk of ADR-related admission within 90 and 365 days more than doubled in the patients with an ADR-related index admission (p < 0.0001). These admissions were often attributed to the same drug class as the patients’ index ADR-related admission. Cancer was a major risk factor for ADR-related re-hospitalization within 90 days; other factors included heart failure and increasing age.
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Affiliation(s)
- Olive Schmid
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
- Correspondence:
| | - Bonnie Bereznicki
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia;
| | - Gregory Mark Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
| | - Jim Stankovich
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
| | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS 7001, Australia; (G.M.P.); (J.S.); (L.B.)
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12
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Drug-Related Hospital Admissions and Associated Factors among Adults Admitted to Felege Hiwot Comprehensive and Specialized Hospital, North West Ethiopia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:6767488. [PMID: 35391834 PMCID: PMC8983245 DOI: 10.1155/2022/6767488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 01/13/2023]
Abstract
Background A drug-related problem (DRP) is an event involving drug therapy that actually or potentially interferes with the desired therapeutic outcome. Drug-related hospital admission (DRHA) is hospitalization due to one or more DRPs. Objective This study was aimed at assessing the prevalence of DRHA and factors associated with it among adults admitted to the internal medicine wards of Felege Hiwot Comprehensive Specialized Hospital. Methods A prospective cross-sectional study was conducted using a previously validated tool, AT-HARM 10. Data were collected by two clinical pharmacists from July 1 to September 15, 2020. The data were entered into EpiData software (version 4.2.0.0) and then transported to Statistical Package for Social Sciences (SPSS®) software (version 24) (IBM Corporation) for analysis. Descriptive statistics were presented using frequency and proportion. Binary logistic regression was applied to identify factors associated with DRHAs with a 95% confidence level, and significance was declared at a p value <0.05. Results The prevalence of DRHAs was 31.9% (95% CI = 27.7%–36.4%). From this, noncompliance (37.8%) (95% CI = 29.6–45.9), untreated indication (31.9%) (95% CI = 23.7–40), and adverse drug reaction (15.6%) (95% CI = 9.6–21.5) cause the majority of DRHAs. More than a quarter (28.8%) of all admissions were preventable. Most DRHAs were moderate (76.3) and preventable (80.7%). Lower to medium Charlson comorbidity index scores, longer duration of therapy, and not having health insurance were significantly associated with DRHAs. Conclusion The prevalence of DRHAs was considerably high. Noncompliance, untreated indications, and adverse drug reactions were the commonest DRPs that caused DRHAs. Lower to medium Charlson comorbidity index scores, longer duration of therapy, and not having health insurance were significantly contributing factors of DRHAs. Therefore, all healthcare providers should prevent, identify, and resolve DRPs to decrease DRHAs in the hospital.
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13
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Won SH, Suh SY, Yim E, Ahn HY. Risk Factors Related to Serious Adverse Drug Reactions Reported through Electronic Submission during Hospitalization in Elderly Patients. Korean J Fam Med 2022; 43:125-131. [PMID: 35320898 PMCID: PMC8943238 DOI: 10.4082/kjfm.21.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Many studies have assessed the risk factors for adverse drug reactions (ADRs) in elderly patients. However, most of these studies have focused on risk factors for ADRs, not serious ADRs (s-ADRs). s-ADRs are commonly found in hospitalized patients. s-ADRs warrant imminent but thorough investigations, given their critical impact on patient health. Therefore, this retrospective study aimed to assess the associated risk factors for s-ADRs in elderly hospitalized patients. Methods In-patients aged >65 years having ADRs during hospitalization at a university hospital in Korea between 2010 and 2012 were included. Medical professionals spontaneously reported ADRs using an electronic submission system at the study hospital. Further, all descriptions of ADRs were characterized and categorized through the screening of electronic medical records. We compared the characteristics of patients having s-ADRs with those of patients not having s-ADRs. Results There were 353 cases of ADRs, 67 of which were s-ADRs. Patients taking more than eight concomitant drugs showed the highest odds ratio (OR, 11.99; 95% confidence interval [CI], 3.42–42.03). The ratio of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was also significantly related to s-ADRs (OR, 2.78; 95% CI, 1.33–5.81). The use of antibiotics (OR, 2.39; 95% CI, 1.13–5.02) and antineoplastics (OR, 4.17; 95% CI, 1.09–15.94) were significant risk factors. Conclusion Our findings highlight the importance of polypharmacy. Liver function tests (AST/ALT ratio) must be monitored carefully within high-risk groups for ADRs.
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Affiliation(s)
- Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Department of Medicine, Dongguk University, Seoul, Korea
- Corresponding Author: Sang-Yeon Suh https://orcid.org/0000-0002-6145-1150 Tel: +82-31-961-7490, Fax: +82-31-961-7969, E-mail:
| | - Eunji Yim
- Department of Neurology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, Korea
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14
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Lee J. Severe Adverse Drug Reactions in Korean Elderly Patients. Korean J Fam Med 2022; 43:91-92. [PMID: 35320893 PMCID: PMC8943233 DOI: 10.4082/kjfm.43.2e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jungun Lee
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
- Corresponding Author: Jungun Lee https://orcid.org/0000-0001-8580-1445 Tel: +82-31-390-2416, Fax: +82-31-390-2266, E-mail:
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15
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Linkens AEMJH, Milosevic V, van Nie N, Zwietering A, de Leeuw PW, van den Akker M, Schols JMGA, Evers SMAA, Gonzalvo CM, Winkens B, van de Loo BPA, de Wolf L, Peeters L, de Ree M, Spaetgens B, Hurkens KPGM, van der Kuy HM. Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study. BMC Geriatr 2022; 22:36. [PMID: 35012478 PMCID: PMC8744034 DOI: 10.1186/s12877-021-02723-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. Methods The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. Discussion This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. Trial registration The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02723-8.
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Affiliation(s)
- Aimée E M J H Linkens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands. .,Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015, GD, Rotterdam, The Netherlands.
| | - Vanja Milosevic
- Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - Noémi van Nie
- Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | - Anne Zwietering
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Institute of General Practice, Goethe University, Frankfurt am Main, Germany.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jos M G A Schols
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Carlota Mestres Gonzalvo
- Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | | | | | | | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.,Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kim P G M Hurkens
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Hugo M van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015, GD, Rotterdam, The Netherlands
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16
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Putriana NA, Rusdiana T, Rostinawati T, Akbar MR, Destiani DP. Evaluation of adverse drug reaction in patients warfarin therapy. J Adv Pharm Technol Res 2022; 13:291-295. [PMID: 36568047 PMCID: PMC9784044 DOI: 10.4103/japtr.japtr_439_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/09/2022] [Accepted: 08/01/2022] [Indexed: 12/27/2022] Open
Abstract
This research aimed to understand the adverse drug reaction (ADR) in heart disease outpatients who were administered warfarin at a hospital in Bandung city. The research was conducted using a cross-sectional design with an observational approach. Subsequently, data were collected from 74 patients who met the inclusion criteria. The causality assessment was made by the Naranjo Algorithm and the incidence of bleeding was classified based on the Bleedscore™. The result showed that the most common ADR were nausea, dizziness, stomach ache, ecchymosis, petechiae, bleeding in the mouth, melena, etc. Furthermore, the INR value was the most significant factor in the incidence of ADR. It was 6.445 using a value of P = 0.001 or a confidence interval of 95%. The most common side effect of warfarin in cardiac outpatients was superficial bleeding, followed by internal bleeding (melena). The INR value is the most significant factor in measuring the incidence of ADR.
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Affiliation(s)
- Norisca Aliza Putriana
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Taofik Rusdiana
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia,Address for correspondence: Prot. apt. Taofik Rusdiana, Raya Bandung Sumedang Road Km. 21, Hegarmanah, West Java 45363 Bandung, Indonesia. E-mail:
| | - Tina Rostinawati
- Department of Biology Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiovascular, Faculty of Medicine, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Dika Pramita Destiani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Indonesia
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17
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Blumenthal KG, Wolfson AR, Li Y, Seguin CM, Phadke NA, Banerji A, Mort E. Allergic Reactions Captured by Voluntary Reporting. J Patient Saf 2021; 17:e1595-e1604. [PMID: 30720546 PMCID: PMC6669104 DOI: 10.1097/pts.0000000000000568] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities for allergy safety in healthcare, we identified and described safety reports of allergic reactions. METHODS We searched the safety report database of a large academic medical center from April 2006 to March 2016 using 101 complete, truncated, and/or misspelled key words related to allergic symptoms, treatments, and culprits (e.g., medications, foods). Patient and event data were summarized for ARs and two types of ARs, HSRs and side effects/toxicities. RESULTS Among 9111 key word search-identified events, 876 (10%) were ARs, of which 436 (5%) were HSRs and the remaining 440 (5%) were side effect reactions or toxicities. Whereas the most common HSRs were simple cutaneous reactions (83%), the following severe immediate HSRs were also identified: shortness of breath (16%), anaphylaxis (14%), and angioedema (12%). Most HSRs were caused by drugs (81%), with antibiotics (26%), particularly β-lactams (11%), and vancomycin (8%), commonly implicated. Other causes of drug HSRs included contrast agents (24%), chemotherapeutics (7%), and opioids (6%). Nondrug HSRs were from blood products (8%), latex (3%), and devices (3%). Food reactions were rarely identified (1%). CONCLUSIONS We identified ARs, HSRs, and side effects/toxicities, contained in a decade of safety reports at an academic medical center. Allergy safety in the healthcare setting should target approaches to common and severe reactions, with a focus on the safe administration of β-lactams, vancomycin, contrast agents, chemotherapeutics, and opioids. Priority nondrug HSR culprits include blood products, latex, and devices.
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Affiliation(s)
- Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anna R. Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yu Li
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Claire M. Seguin
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization, Boston, MA, USA
| | - Neelam A Phadke
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth Mort
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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18
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Candeias C, Gama J, Rodrigues M, Falcão A, Alves G. Potentially Inappropriate Medications and Potential Prescribing Omissions in Elderly Patients Receiving Post-Acute and Long-Term Care: Application of Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment Criteria. Front Pharmacol 2021; 12:747523. [PMID: 34737705 PMCID: PMC8560892 DOI: 10.3389/fphar.2021.747523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Screening Tool of Older People's Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria have been used to detect potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). These criteria were applied to geriatric Portuguese patients receiving post-acute and long-term care to assess the prevalence and predictors of PIMs and PPOs. Methods: An observational, retrospective, cross-sectional and multicenter study was performed in 161 patients (aged ≥65 years) from eight Units for Integrated Continuous Care. Results: In these studied patients (mean age: 81.6, 64% female, median number of medications: 9) PIMs were detected in 85.1% and PPOs in 81.4% of patients. While PIMs mainly involved the central nervous system and psychotropic drugs (66.5%), PPOs were mostly related to musculoskeletal system (55.3%) and cardiovascular (39.8%) system. A subsequent analysis with logistic regression found the female gender, the hospital provenience, and the number of medications as predictors of PIMs. Predictors of PPOs were the Charlson Comorbidity Index and history of recent fractures. Conclusion: PIMs and PPOs were highly prevalent in the studied patients receiving post-acute and long-term care in Units for Integrated Continuous Care. Therefore, STOPP/START criteria might be an effective tool for improving prescribing quality and clinical outcomes in these frail elderly patients.
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Affiliation(s)
- Catarina Candeias
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,UMP-Union of Portuguese Mercies, Lisboa, Portugal
| | - Jorge Gama
- CMA-UBI-Centre of Mathematics and Applications, University of Beira Interior, Covilhã, Portugal
| | - Márcio Rodrigues
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,ESALD-IPCB-Dr. Lopes Dias School of Health, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,UDI-IPG-Research Unit for Inland Development, Polytechnic Institute of Guarda, Guarda, Portugal
| | - Amílcar Falcão
- CIBIT-Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal.,Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,ESALD-IPCB-Dr. Lopes Dias School of Health, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal.,UFBI-Pharmacovigilance Unit of Beira Interior, University of Beira Interior, Covilhã, Portugal
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19
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Breuker C, Faucanié M, Laureau M, Perier D, Pinzani V, Marin G, Sebbane M, Villiet M. Impact of a medico-pharmaceutical follow-up and an optimized communication between hospital and community on the readmission to the emergency department for an adverse drug event: URGEIM, study protocol for a randomized controlled trial. Trials 2021; 22:521. [PMID: 34362410 PMCID: PMC8349018 DOI: 10.1186/s13063-021-05501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Adverse drug events (ADE) represent one of the main causes of admission to emergency department (ED). Their detection, documentation, and reporting are essential to avoid readmission. We hypothesize that a pharmacist-initiated multidisciplinary transition of care program combining ED pharmacist contribution and medications’ data transfer between inpatient and outpatient caregivers will reduce emergency visits related to ADE Method/design This is a prospective, open-label, randomized controlled trial. The primary aim of the study is 6-month ED readmission related to the same ADE. Three hundred forty-six adult patients with an ADE detected by a binomial pharmacist-physician will be recruited from the ED of an University Hospital and will be randomized in two groups: [1] experimental group (multidisciplinary transition of care program and medications’ data transfer between inpatient and outpatient caregivers) and [2] control group (usual care). Patients will be followed up over a period of 6 months. Endpoints will be carried out blindly of the randomization arm. The primary endpoint is the rate of patients who had at least one readmission in the ED for the same reason at 6 months (data collected during a phone call with the patient and the general practitioner). Trials registered NCT03725046. Discussion The trial results will have implications for the role of the clinical pharmacist in an emergency department. If successful, the intervention could be considered for implementation across other hospitals. Trial registration ClinicalTrials.govNCT03725046. Registered on 30 October 2018
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Affiliation(s)
- Cyril Breuker
- CHU Montpellier, Clinical Pharmacy Departement, Univ. Montpellier, 34 295, Montpellier Cedex 5, France. .,PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France.
| | - Marie Faucanié
- CHU Montpellier, Clinical Reasearch and Epidemiology Unit (Departement Information Médicale), Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Marion Laureau
- CHU Montpellier, Clinical Pharmacy Departement, Univ. Montpellier, 34 295, Montpellier Cedex 5, France.,CHU Montpellier, Emergency Medicine Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Damien Perier
- CHU Montpellier, Emergency Medicine Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Véronique Pinzani
- CHU Montpellier, Medical Pharmacology and Toxicology Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Grégory Marin
- CHU Montpellier, Clinical Reasearch and Epidemiology Unit (Departement Information Médicale), Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - Mustapha Sebbane
- CHU Montpellier, Emergency Medicine Department, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
| | - M Villiet
- CHU Montpellier, Clinical Pharmacy Departement, Univ. Montpellier, 34 295, Montpellier Cedex 5, France
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20
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Pereira F, Verloo H, Zhivko T, Di Giovanni S, Meyer-Massetti C, von Gunten A, Martins MM, Wernli B. Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study. BMJ Open 2021; 11:e052755. [PMID: 34261693 PMCID: PMC8281082 DOI: 10.1136/bmjopen-2021-052755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The present study analysed 4 years of a hospital register (2015-2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home. DESIGN Registry-based cohort study. SETTING Valais Hospital-a public general hospital centre in the French-speaking part of Switzerland. PARTICIPANTS We explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital's patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old. OUTCOME MEASURES Sociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge. RESULTS The overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788). CONCLUSIONS Thirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug-drug interactions.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Taushanov Zhivko
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Saviana Di Giovanni
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
- Pharmacy Benu Tavil-Chatton, Morges, Switzerland
| | | | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Maria Manuela Martins
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Porto Higher School of Nursing, Porto, Portugal
| | - Boris Wernli
- FORS, Swiss Centre of Expertise in the Social Sciences, University of Lausanne, Lausanne, Switzerland
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21
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Micaglio E, Locati ET, Monasky MM, Romani F, Heilbron F, Pappone C. Role of Pharmacogenetics in Adverse Drug Reactions: An Update towards Personalized Medicine. Front Pharmacol 2021; 12:651720. [PMID: 33995067 PMCID: PMC8120428 DOI: 10.3389/fphar.2021.651720] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Adverse drug reactions (ADRs) are an important and frequent cause of morbidity and mortality. ADR can be related to a variety of drugs, including anticonvulsants, anaesthetics, antibiotics, antiretroviral, anticancer, and antiarrhythmics, and can involve every organ or apparatus. The causes of ADRs are still poorly understood due to their clinical heterogeneity and complexity. In this scenario, genetic predisposition toward ADRs is an emerging issue, not only in anticancer chemotherapy, but also in many other fields of medicine, including hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency, aplastic anemia, porphyria, malignant hyperthermia, epidermal tissue necrosis (Lyell's Syndrome and Stevens-Johnson Syndrome), epilepsy, thyroid diseases, diabetes, Long QT and Brugada Syndromes. The role of genetic mutations in the ADRs pathogenesis has been shown either for dose-dependent or for dose-independent reactions. In this review, we present an update of the genetic background of ADRs, with phenotypic manifestations involving blood, muscles, heart, thyroid, liver, and skin disorders. This review aims to illustrate the growing usefulness of genetics both to prevent ADRs and to optimize the safe therapeutic use of many common drugs. In this prospective, ADRs could become an untoward "stress test," leading to new diagnosis of genetic-determined diseases. Thus, the wider use of pharmacogenetic testing in the work-up of ADRs will lead to new clinical diagnosis of previously unsuspected diseases and to improved safety and efficacy of therapies. Improving the genotype-phenotype correlation through new lab techniques and implementation of artificial intelligence in the future may lead to personalized medicine, able to predict ADR and consequently to choose the appropriate compound and dosage for each patient.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Romani
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
| | | | - Carlo Pappone
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
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22
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Akindele MO, Useh U. Multimorbidity of chronic diseases of lifestyle among South African adults. Pan Afr Med J 2021; 38:332. [PMID: 34285755 PMCID: PMC8265261 DOI: 10.11604/pamj.2021.38.332.15109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 02/22/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the prevalence of non-communicable and chronic diseases has been on the increase globally and has been a major factor responsible for high morbidity and mortality. Multimorbidity of the chronic diseases in low/medium income countries should be a major concern for public health practitioners because of the communicable diseases they also battle with. This study was carried out to determine the prevalence of multi-morbidity of chronic diseases of lifestyle (CDL) among adult South Africans. METHODS we employed General House Survey (GHS) data released by Statistics South Africa (Stats SA) in December 2015 with a response rate was 90.5%. Data on diabetes mellitus, high cholesterol, stroke, heart attack/myocardial infarction, hypertension were analysed using descriptive and inferential statistics. RESULTS the outcome of this secondary data analysis showed that about 16.3% of South Africans respondents aged 18 years and above had a single/or multiple CDL. The majority of the respondents with CDL were females (10.9%), older adults (9.4%), married (8.5%), of the black racial extract (11.9%), and reside in urban areas (3.4%). Also, high blood pressure (13.7%) was the most reported prevalent chronic disease while heart attack (1.1%) was the least reported chronic disease. The outcome of regression analysis after adjustment showed that gender (OR=0.56, CI=0.53-0.60, p<0.001), age [middle-aged adult (R=0.003, CI=0.003-0.004, p=0.001), older adult (R=0.25, CI=0.23-0.26, p=0.001)] and marital status [divorced (OR=1.55, CI=1.44-1.67, p<0.001), separated (OR=1.71, CI=1.46-2.00, p=0.001), single (R=1.88, CI=1.71-2.07, p=0.001)] were among the correlates of chronic diseases of lifestyle for the 1st step of the adjustment. However, White population group (OR=1.17, CI=0.96-1.41, p=0.113), residing in farm settlement (OR=0.99, CI=0.84-1.16, p=0.910) and all the sub-scales of educational status were not correlates of the CDLs for the 2nd adjustment of regression analysis. CONCLUSION the findings of the study suggest that CDL is endemic among the South African population and that the most susceptible groups are the older adults, females, the married, the uneducated and the coloured individuals.
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Affiliation(s)
- Mukadas Oyeniran Akindele
- Diseases of Lifestyle Niche Area, Faculty of Health Sciences, North West University, Mafikeng Campus, Mahikeng, South Africa
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano State, Kano, Nigeria
| | - Ushotanefe Useh
- Diseases of Lifestyle Niche Area, Faculty of Health Sciences, North West University, Mafikeng Campus, Mahikeng, South Africa
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23
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Yang J, Wang L, Phadke NA, Wickner PG, Mancini CM, Blumenthal KG, Zhou L. Development and Validation of a Deep Learning Model for Detection of Allergic Reactions Using Safety Event Reports Across Hospitals. JAMA Netw Open 2020; 3:e2022836. [PMID: 33196805 PMCID: PMC7670315 DOI: 10.1001/jamanetworkopen.2020.22836] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Although critical to patient safety, health care-related allergic reactions are challenging to identify and monitor. OBJECTIVE To develop a deep learning model to identify allergic reactions in the free-text narrative of hospital safety reports and evaluate its generalizability, efficiency, productivity, and interpretability. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed hospital safety reports filed between May 2004 and January 2019 at Brigham and Women's Hospital and between April 2006 and June 2018 at Massachusetts General Hospital in Boston. Training and validating a deep learning model involved extracting safety reports using 101 expert-curated keywords from Massachusetts General Hospital (data set I). The model was then evaluated on 3 data sets: reports without keywords (data set II), reports from a different time frame (data set III), and reports from a different hospital (Brigham and Women's Hospital; data set IV). Statistical analyses were performed between March 1, 2019, and July 18, 2020. MAIN OUTCOMES AND MEASURES The area under the receiver operating characteristic curve and area under the precision-recall curve were used on data set I. The precision at top-k was used on data sets II to IV. RESULTS A total of 299 028 safety reports with 172 854 patients were included. Of these patients, 86 544 were women (50.1%) and the median (interquartile range [IQR]) age was 59.7 (43.8-71.6) years. The deep learning model achieved an area under the receiver operating characteristic curve of 0.979 (95% CI, 0.973-0.985) and an area under the precision-recall curve of 0.809 (95% CI, 0.773-0.845). The model achieved precisions at the top 100 model-identified cases of 0.930 in data set II, 0.960 in data set III, and 0.990 in data set IV. Compared with the keyword-search approach, the deep learning model reduced the number of cases for manual review by 63.8% and identified 24.2% more cases of confirmed allergic reactions. The model highlighted important words (eg, rash, hives, and Benadryl) in prediction and extended the list of expert-curated keywords through an attention layer. CONCLUSIONS AND RELEVANCE This study showed that a deep learning model can accurately and efficiently identify allergic reactions using free-text narratives written by a variety of health care professionals. This model could be used to improve allergy care, potentially enabling real-time event surveillance and guidance for medical errors and system improvement.
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Affiliation(s)
- Jie Yang
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Liqin Wang
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Neelam A. Phadke
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Paige G. Wickner
- Harvard Medical School, Boston, Massachusetts
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christian M. Mancini
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Kimberly G. Blumenthal
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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24
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Lee EJ, Ahn YC, Kim YI, Oh MS, Park YC, Son CG. Incidence Rate of Hypersensitivity Reactions to Bee-Venom Acupuncture. Front Pharmacol 2020; 11:545555. [PMID: 33117156 PMCID: PMC7577189 DOI: 10.3389/fphar.2020.545555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Bee-venom acupuncture (BVA) has been widely applied to various disorders including pain-related diseases; however, patients are often warned of adverse reactions such as anaphylaxis. This study aimed to estimate the risk of hypersensitivity reactions to BVA and to determine their clinical features. METHODS We retrospectively surveyed the medical records of patients treated by BVA between January 2010 and April 2019 in Dunsan Hospital of Daejeon University, and all cases of allergic reactions and their clinical symptoms were analyzed. RESULTS A total of 8,580 patients (males 4,081 and females 4,499) were treated with BVA which amounts to a total of 60,654 treatments (average 7.1 ± 14.8 times). A total of fifteen patients (7 males and 8 females) reported an allergic reaction (0.175%, 95% CI, 0.086-0.263) of type 1 hypersensitivity, indicating a rate of allergic reaction in 0.025% (95% CI, 0.012-0.037) of the total BVA treatments. The average number of BVA treatments in those patients was 6.9 ± 6.5 (males: 4.1 ± 3.4 and females: 9.3 ± 7.9). Among the cases of hypersensitivity reactions, 4 involved anaphylactic shock; therefore, the incidence rate of anaphylaxis was 0.047% (95% CI, 0.001-0.092) for the 8,580 subjects and 0.007% (95% CI, 0.000-0.013) for the 60,654 treatments. All grade 1 cases were recovered within 1 day, whereas others took up to 30 days for complete recovery. CONCLUSION Our results may emphasize paying attention to unforeseeable risks of anaphylaxis after bee-venom acupuncture. This study could be essential reference data for the guidelines of appropriate use of bee-venom acupuncture and bee-venom-derived interventions in clinical applications.
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Affiliation(s)
- Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, Daejeon, South Korea
| | - Young-Il Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Min-Seok Oh
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Yang-Chun Park
- Division of Respiratory System, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Chang-Gue Son
- Department of Gastrobilliary System, Dunsan Hospital of Daejeon University, Daejeon, South Korea
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25
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Medication-related risk factors and its association with repeated hospital admissions in frail elderly: A case control study. Res Social Adm Pharm 2020; 16:1318-1322. [DOI: 10.1016/j.sapharm.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/13/2018] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
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26
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Zhang H, Kang E, Ham YE, Chang JW. Disability and self-reported adverse drug events among patients with chronic diseases. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Linkens AEMJH, Milosevic V, van der Kuy PHM, Damen-Hendriks VH, Mestres Gonzalvo C, Hurkens KPGM. Medication-related hospital admissions and readmissions in older patients: an overview of literature. Int J Clin Pharm 2020; 42:1243-1251. [PMID: 32472324 PMCID: PMC7522062 DOI: 10.1007/s11096-020-01040-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 04/16/2020] [Indexed: 01/26/2023]
Abstract
Background The number of medication related hospital admissions and readmissions are increasing over the years due to the ageing population. Medication related hospital admissions and readmissions lead to decreased quality of life and high healthcare costs. Aim of the review To assess what is currently known about medication related hospital admissions, medication related hospital readmissions, their risk factors, and possible interventions which reduce medication related hospital readmissions. Method We searched PubMed for articles about the topic medication related hospital admissions and readmissions. Overall 54 studies were selected for the overview of literature. Results Between the different selected studies there was much heterogeneity in definitions for medication related admission and readmissions, in study population and the way studies were performed. Multiple risk factors are found in the studies for example: polypharmacy, comorbidities, therapy non adherence, cognitive impairment, depending living situation, high risk medications and higher age. Different interventions are studied to reduce the number of medication related readmission, some of these interventions may reduce the readmissions like the participation of a pharmacist, education programmes and transition-of-care interventions and the use of digital assistance in the form of Clinical Decision Support Systems. However the methods and the results of these interventions show heterogeneity in the different researches. Conclusion There is much heterogeneity in incidence and definitions for both medication related hospital admissions and readmissions. Some risk factors are known for medication related admissions and readmissions such as polypharmacy, older age and additional diseases. Known interventions that could possibly lead to a decrease in medication related hospital readmissions are spare being the involvement of a pharmacist, education programs and transition-care interventions the most mentioned ones although controversial results have been reported. More research is needed to gather more information on this topic.
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Affiliation(s)
- A E M J H Linkens
- Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - V Milosevic
- Department of Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, The Netherlands
| | - P H M van der Kuy
- Department of Clinical Pharmacy, Erasmus Medical Centre, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - V H Damen-Hendriks
- Department of Internal Medicine, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, Geleen, The Netherlands
| | - C Mestres Gonzalvo
- Department of Clinical Pharmacy, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - K P G M Hurkens
- Department of Internal Medicine, Zuyderland Medical Centre, PO box 5500, 6130 MB, Sittard, Geleen, The Netherlands
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Coetzee R, Johnson Y, van Niekerk J, Namane M. Amitriptyline prescribing in public sector healthcare facilities in the Western Cape, South Africa. PLoS One 2020; 15:e0231675. [PMID: 32311002 PMCID: PMC7170249 DOI: 10.1371/journal.pone.0231675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Inappropriate medication use is a major patient safety concern, especially for the elderly population. Amitriptyline is widely used in primary care in South Africa and a cross-sectional study found that amitriptyline was prescribed potentially inappropriately in 6.5% of elderly patients. An analysis of prescriptions from the Chronic Dispensing Unit in the Western Cape revealed that amitriptyline was one of the most common medicines prescribed without a suitable diagnosis listed on the prescription. OBJECTIVE The main objective of the medicine use evaluation (MUE) was to determine whether amitriptyline was prescribed in accordance with recommendations from standard treatment guidelines (STG) and essential medicines lists (EML) endorsed by the National Department of Health, South Africa. METHODS A retrospective, cross-sectional, multicentre review of patients' clinical notes was conducted. The study population was selected by systematic random sampling from adult outpatients who were prescribed amitriptyline for longer than three months. Criteria for evaluation included amitriptyline indication and total daily dose prescribed. RESULTS Of the sample of 2237 patient medical records reviewed, 1732 (77.4%) included amitriptyline prescriptions that were according to the approved STG indications. For the approved STG indications, amitriptyline was prescribed mainly for osteoarthritis (25.8%), neuropathies (18.5%) and chronic non-cancer pain (17.9%). Major depressive disorders constituted only 8.6% of the patient records reviewed; however, doses were atypically low. The main inappropriate indication for amitriptyline was sleep disorders (16%). CONCLUSION This MUE has highlighted the need to improve the use of amitriptyline in specific patient populations, e.g. the elderly and patients with sleeping disorders.
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Affiliation(s)
- Renier Coetzee
- School of Pharmacy, University of the Western Cape, Cape Town, South Africa
| | | | - Johan van Niekerk
- Khayelitsha Eastern Sub-structure, Metro Health Services, Department of Health, Western Cape Government, Cape Town, South Africa
| | - Mosedi Namane
- Vanguard Community Health Centre and School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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29
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Asscher VER, van der Vliet Q, van der Aalst K, van der Aalst A, Brand EC, van der Meulen-de Jong AE, Oldenburg B, Pierik MJ, van Tuyl B, Mahmmod N, Maljaars PWJ, Fidder HH. Anti-tumor necrosis factor therapy in patients with inflammatory bowel disease; comorbidity, not patient age, is a predictor of severe adverse events. Int J Colorectal Dis 2020; 35:2331-2338. [PMID: 32860081 PMCID: PMC7648742 DOI: 10.1007/s00384-020-03716-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess safety and effectiveness of anti-tumor necrosis factor (anti-TNF) therapy in IBD patients ≥ 60 years. METHODS Ninety IBD patients ≥ 60 years at initiation of anti-TNF therapy, 145 IBD patients ≥ 60 years without anti-TNF therapy and 257 IBD patients < 60 years at initiation of anti-TNF therapy were retrospectively included in this multicentre study. Primary outcome was the occurrence of severe adverse events (SAEs), serious infections and malignancies. Secondary outcome was effectiveness of therapy. Cox regression analyses were used to assess differences in safety and effectiveness. In safety analyses, first older patients with and without anti-TNF therapy and then older and younger patients with anti-TNF therapy were assessed. RESULTS In older IBD patients, the use of anti-TNF therapy was associated with serious infections (aHR 3.920, 95% CI 1.185-12.973, p = .025). In anti-TNF-exposed patients, cardiovascular disease associated with serious infections (aHR 3.279, 95% CI 1.098-9.790, p = .033) and the presence of multiple comorbidities (aHR 9.138 (1.248-66.935), p = .029) with malignancies, while patient age did not associate with safety outcomes. Effectiveness of therapy was not affected by age or comorbidity. CONCLUSION Older patients receiving anti-TNF therapy have a higher risk of serious infections compared with older IBD patients without anti-TNF therapy, but not compared with younger patients receiving anti-TNF therapy. However, in anti-TNF-exposed patients, comorbidity was found to be an indicator with regards to SAEs. Effectiveness was comparable between older and younger patients.
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Affiliation(s)
- Vera E. R. Asscher
- grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Quirine van der Vliet
- grid.7692.a0000000090126352Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Karen van der Aalst
- grid.7692.a0000000090126352Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anniek van der Aalst
- grid.412966.e0000 0004 0480 1382Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Eelco C. Brand
- grid.7692.a0000000090126352Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Andrea E. van der Meulen-de Jong
- grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Bas Oldenburg
- grid.7692.a0000000090126352Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marieke J. Pierik
- grid.412966.e0000 0004 0480 1382Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bas van Tuyl
- grid.413681.90000 0004 0631 9258Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Nofel Mahmmod
- grid.415960.f0000 0004 0622 1269Department of Gastroenterology and Hepatology, Sint Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands
| | - P. W. Jeroen Maljaars
- grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Herma H. Fidder
- grid.7692.a0000000090126352Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Processes and determinants of integration of eGFR in physicians' drug prescriptions: a qualitative study of semi-structured interviews. Prim Health Care Res Dev 2019; 20:e143. [PMID: 31640822 PMCID: PMC6842646 DOI: 10.1017/s1463423619000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM Our objective was to explore the processes and determinants leading physicians to integrate estimated glomerular filtration rate (eGFR) in their drug prescriptions. BACKGROUND Access to patients' eGFR would allow primary care pharmacists to optimise their role in the procedure of safe prescribing. Some rare physicians actively integrate eGFR in their prescriptions, in a sporadically and uncoordinated manner. METHODS Qualitative study using semi-directed interviews conducted among 12 French physicians who integrated eGFR in their drug prescriptions, (February 2016-April 2017). These voluntary participants were recruited through different means: Twitter®, forums, direct contact and snowball sampling. Data analysis was based on the grounded theory approach, underpinned by a comprehensive perspective of interactionist orientation. FINDINGS Residency and training, professional experience - including experiences of adverse drug reactions - and the membership in various communities of professionals were key drivers for the integration of eGFR in prescriptions. The theoretical aim was above all safe prescribing in order to reduce adverse drug reactions, with the control by a dispensing pharmacist and/or other healthcare professionals. Nevertheless, none of the physicians had received any feedback from any healthcare professionals. Despite their disappointment, the physicians remained convinced of the interest of integrating eGFR in their prescriptions and would continue to do so. Characteristics associated with integration of eGFR in drug prescriptions belong partly to Roger's theory of innovations. If a widespread diffusion of this habit takes place, it will be necessary to evaluate its adoption by both physicians and pharmacists.
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Margolis SA, Sears MZ, Daiello LA, Solon C, Nakhutina L, Hoogendoorn CJ, Gonzalez JS. Anticholinergic/sedative drug burden predicts worse memory acquisition in older racially/ethnically diverse patients with type 2 diabetes mellitus. Int J Geriatr Psychiatry 2019; 34:1545-1554. [PMID: 31313847 PMCID: PMC8807032 DOI: 10.1002/gps.5173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), is linked to cognitive impairment in older adults. Yet, studies on the DBI's association with neuropsychological functioning are lacking, especially in underserved groups at increased risk of cognitive impairment. We examined cross-sectional relationships between total DBI (DBIT ) and an age-adjusted analogue (Adj DBIT ) with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in diverse adults with type 2 diabetes mellitus (T2DM). Based on results of a prior study, we anticipated higher DBIs would be associated with worse memory at older ages. METHODS One hundred five adults with T2DM (age = 57 ± 9 years, 65% female, 62% Black, 27% Hispanic/Latino, HbA1c = 7.8 ± 1.8) participated. Although memory outcomes were normally distributed, DBIT values were positively skewed. Spearman correlations assessed their bivariate relationships with RBANS. Adjusting for comorbidities, polypharmacy, HbA1c , and education, we tested the moderating effect of age on DBI-RBANS associations at mean ±1 standard deviations of age. RESULTS One third of the participants endorsed current sedative/anticholinergic use. Mean DBIT was 0.385, and mean Adj DBIT was 0.393 (ranges = 0.00-4.22). Drug burden negatively correlated with RBANS Immediate Memory (DBIT rs = -0.237, P = .013; Adj DBIT rs = -0.239, P = .014) but no other indices. There was a significant DBI*Age interaction; the negative effect of drug burden on Immediate Memory was significant for ages greater than or equal to 55 years old. CONCLUSIONS Sedative/anticholinergic drug exposure was prevalent in these diverse T2DM patients. Adjusting for covariates, greater drug burden was associated with worse memory acquisition among older adults only. Prospective studies should examine these relationships over time and assess whether dementia biomarkers affect the interaction.
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Affiliation(s)
- Seth A. Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI,The Miriam Hospital, Providence, RI
| | | | - Lori A. Daiello
- Rhode Island Hospital, Providence, RI,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Carly Solon
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY
| | | | | | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY,Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY,New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, New York, NY,The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, New York, NY
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Lea M, Mowe M, Mathiesen L, Kvernrød K, Skovlund E, Molden E. Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward. PLoS One 2019; 14:e0220071. [PMID: 31329634 PMCID: PMC6645516 DOI: 10.1371/journal.pone.0220071] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background Knowledge of risk factors for drug-related hospitalizations (DRHs) is limited. Aim To examine the prevalence of DRHs and the relationships between DRHs and various variables in multimorbid patients admitted to an internal medicine ward. Methods Multimorbid patients ≥ 18 years, using minimum of four regular drugs from minimum two therapeutic classes, were included from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016. Clinical pharmacists prospectively conducted medicines reconciliations and reviews to reveal drug-related problems (DRPs). Blinded for identified DRPs, an interdisciplinary group retrospectively made comprehensive, clinical assessments of each patient case to classify hospitalizations as drug-related (DRH) or non-drug-related (non-DRH). Age, sex distribution, Charlson Comorbidity Index (CCI), renal function, aberrant genotype frequencies, body-mass index, number of drugs, proportion of patients which received assistance for drug administration from the home care service, and/or through multidose-dispensed drugs, and occurrence of specific DRP subgroups, were compared separately between patients with DRHs versus non-DRHs, followed by multiple logistic regression analysis. Results Hospitalizations were classified as drug-related in 155 of the 404 included patients (38%). Factors significantly associated with DRHs were occurrence of adverse effect DRPs (adjusted odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4–8.0), adherence issues (OR 2.9, 1.1–7.2), home care (OR 1.9, 1.1–3.5), drug monitoring DRPs (OR 1.9, 1.2–3.0), and CCI score ≥6 (OR 0.33, 0.14–0.77). Frequencies of aberrant genotypes did not differ between the patient groups, but in 41 patients with DRHs (26.5%), gene-drug interactions influenced the assessments of DRHs. Conclusion DRHs are prevalent in multimorbid patients with adverse effect DRPs and adherence issues as the most important risk factors.
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Affiliation(s)
- Marianne Lea
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
- * E-mail:
| | - Morten Mowe
- General Internal Medicine Ward, the Medical Clinic, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Liv Mathiesen
- Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - Kristin Kvernrød
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Espen Molden
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
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Lin YW, Zhou Y, Faghri F, Shaw MJ, Campbell RH. Analysis and prediction of unplanned intensive care unit readmission using recurrent neural networks with long short-term memory. PLoS One 2019; 14:e0218942. [PMID: 31283759 PMCID: PMC6613707 DOI: 10.1371/journal.pone.0218942] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unplanned readmission of a hospitalized patient is an indicator of patients' exposure to risk and an avoidable waste of medical resources. In addition to hospital readmission, intensive care unit (ICU) readmission brings further financial risk, along with morbidity and mortality risks. Identification of high-risk patients who are likely to be readmitted can provide significant benefits for both patients and medical providers. The emergence of machine learning solutions to detect hidden patterns in complex, multi-dimensional datasets provides unparalleled opportunities for developing an efficient discharge decision-making support system for physicians and ICU specialists. METHODS AND FINDINGS We used supervised machine learning approaches for ICU readmission prediction. We used machine learning methods on comprehensive, longitudinal clinical data from the MIMIC-III to predict the ICU readmission of patients within 30 days of their discharge. We incorporate multiple types of features including chart events, demographic, and ICD-9 embeddings. We have utilized recent machine learning techniques such as Recurrent Neural Networks (RNN) with Long Short-Term Memory (LSTM), by this we have been able to incorporate the multivariate features of EHRs and capture sudden fluctuations in chart event features (e.g. glucose and heart rate). We show that our LSTM-based solution can better capture high volatility and unstable status in ICU patients, an important factor in ICU readmission. Our machine learning models identify ICU readmissions at a higher sensitivity rate of 0.742 (95% CI, 0.718-0.766) and an improved Area Under the Curve of 0.791 (95% CI, 0.782-0.800) compared with traditional methods. We perform in-depth deep learning performance analysis, as well as the analysis of each feature contribution to the predictive model. CONCLUSION Our manuscript highlights the ability of machine learning models to improve our ICU decision-making accuracy and is a real-world example of precision medicine in hospitals. These data-driven solutions hold the potential for substantial clinical impact by augmenting clinical decision-making for physicians and ICU specialists. We anticipate that machine learning models will improve patient counseling, hospital administration, allocation of healthcare resources and ultimately individualized clinical care.
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Affiliation(s)
- Yu-Wei Lin
- Department of Business Administration, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Yuqian Zhou
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Faraz Faghri
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michael J. Shaw
- Department of Business Administration, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Roy H. Campbell
- Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
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Liao PJ, Mao CT, Chen TL, Deng ST, Hsu KH. Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case-control study. BMJ Open 2019; 9:e026771. [PMID: 31079084 PMCID: PMC6530431 DOI: 10.1136/bmjopen-2018-026771] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients. DESIGN A nested case-control study. SETTING A medical centre located in north Taiwan. PARTICIPANTS 539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected. EXPOSURE Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses. PRIMARY AND SECONDARY OUTCOME MEASURES ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes. RESULTS The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively. CONCLUSIONS The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient's safety improvement in geriatric care.
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Affiliation(s)
- Pei-Ju Liao
- Department of Health Care Administration, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Chien-Tai Mao
- Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tun-Liang Chen
- Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Tarng Deng
- Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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Sumida CA, Vo TT, Van Etten EJ, Schmitter-Edgecombe M. Medication Management Performance and Associated Cognitive Correlates in Healthy Older Adults and Older Adults with aMCI. Arch Clin Neuropsychol 2019; 34:290-300. [PMID: 29912269 PMCID: PMC6454840 DOI: 10.1093/arclin/acy038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/19/2018] [Accepted: 04/08/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Difficulties managing medications, particularly among older adults experiencing cognitive deficits, is an important contributing factor to medication nonadherence that may have significant negative financial and health outcomes. The current study examined the performance of healthy older adults' (HOA) and individuals with amnestic mild cognitive impairment (aMCI) on the medication management abilities assessment's (MMAA, a performance-based measure of medication management) original scoring criteria and derived error process measures, assessing medication overtaking and undertaking magnitude. Exploratory correlations between performances on the MMAA and self-reported confidence in medication management skills and cognitive abilities were also examined. METHOD A sample of 25 HOAs with aMCI and 25 age- and education-matched HOAs completed the MMAA, a self-reported medication management confidence rating and a battery of neuropsychological tests. RESULTS HOAs performed significantly better on the MMAA score and committed significantly less process errors than individuals with aMCI. Despite these differences in MMAA performance, the HOA and aMCI groups rated similar high levels of confidence in their ability to manage a new medication routine. Notably, while the HOA group's performance on all of the MMAA measures did not relate to cognitive measures, the aMCI group's performance on the MMAA score was significantly related to memory and executive functioning and a new process error score for overtaking was related to processing speed. CONCLUSIONS Although these results present promising potential for the MMAA as a measure of medication management in a clinical setting, further studies need to examine the validity of the MMAA against real-world adherence measures.
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Affiliation(s)
| | - Thao T Vo
- Department of Psychology, Washington State University, Pullman, WA, USA
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36
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Monteiro Mantovani V, Moorhead S, de Abreu Almeida M, Rabelo-Silva ER. Adverse Reactions to Medications: Concept Analysis and Development of a New Risk Nursing Diagnosis. Int J Nurs Knowl 2019; 31:87-93. [PMID: 30900386 DOI: 10.1111/2047-3095.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the concept of adverse reaction to medications and to develop the new nursing diagnosis Risk for Adverse Reactions to Medications. METHODS Concept analysis using Walker and Avant's eight step method. FINDINGS Thirty-three articles indexed in four databases were included. The components of the new nursing diagnosis were determined, including possible nursing outcomes and interventions. CONCLUSIONS The concept analysis supported the development of the new nursing diagnosis Risk for Adverse Reactions to Medications, which may help nurses to evaluate and identify patients susceptible to adverse reactions. IMPLICATIONS FOR NURSING PRACTICE The establishment of this nursing diagnosis will provide nurses an opportunity to implement interventions to anticipate and effectively intervene with patients at risk for this condition.
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Affiliation(s)
- Vanessa Monteiro Mantovani
- Vanessa Monteiro Mantovani, RN, MSc, is a PhD Student at the Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Brazil, is a Visiting Scholar at the College of Nursing, University of Iowa, Iowa, is a Member of the Nursing Research Group on the Care of Adults and the Elderly (GEPECADI-CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Sue Moorhead
- Sue Moorhead, RN, PhD, FAAN, is an Associate Professor at the College of Nursing, University of Iowa, Iowa, is the Director of the Center for Nursing Classification and Clinical Effectiveness, Iowa
| | - Miriam de Abreu Almeida
- Miriam de Abreu Almeida, RN, PhD, is an Associate Professor at the School of Nursing, is the Coordinator of the Graduate Program in Nursing, Universidade Federal do Rio Grande do Sul, Brazil, is a Researcher at the GEPECADI, Porto Alegre, Rio Grande do Sul, Brazil, is a Researcher of CNPq, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida Rejane Rabelo-Silva
- Eneida Rejane Rabelo-Silva, RN, MSc, ScD, is an Associate Professor at the School of Nursing, Universidade Federal do Rio Grande do Sul, Nurse Coordinator of the PICC TEAM, Hospital de Clínicas de Porto Alegre, Brazil, is a Researcher at the GEPECADI, Porto Alegre, Rio Grande do Sul, Brazil, is a Researcher at CNPq, Porto Alegre, Rio Grande do Sul, Brazil
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Zikos D, Ogunneye Y, Delellis N, Ivanitskaya L. Association Between the Rate of Diabetes and Quality of Patient Care in Home Health Agencies. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318813100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The multitude of comorbidities and disabilities that are prevalent among diabetic patients make their care very challenging for providers. This, in turn, may have a negative effect on measures of patient satisfaction, quality, and outcomes. This study examines the correlation between diabetes ratio as a primary diagnosis in home health agencies (HHAs) with the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey and the Outcome and Assessment Information Set (OASIS) star ratings. Our result indicates that HHAs with a higher proportion of patients with diabetes have lower ratings in health outcomes (bathing, breathing, moving from the bed, moving around, and controlling pain). The association was stronger in the case of diabetic cases with complications.
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Mota DM, Vigo Á, Kuchenbecker RDS. [Recommendation of ICD-10 codes for surveillance of adverse drug reactions and drug intoxication]. CIENCIA & SAUDE COLETIVA 2018; 23:3041-3054. [PMID: 30281741 DOI: 10.1590/1413-81232018239.20692016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/03/2016] [Indexed: 11/22/2022] Open
Abstract
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization. It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Associations between variables were evaluated using Pearson's chi-squared test and multiple correspondence analysis. Six hundred and ninety-one (691) codes were identified related to adverse drug reactions (52.1%) and drug poisoning (47.9%). A total of 687 (99.4%) and 511 (73.9%) codes were validated in 1st and 2nd validation, respectively. There were statistically significant differences (p <0.05) between adverse reactions and drug poisoning in the variables used to characterize the reference list. The association between drug and hospital admission and death was statistically significant when stratified by type of adverse event (p <0.001). Three groupings of codes were identified in multiple correspondence analysis where there are associations between categories of response assessed. The reference list can be a useful tool in pharmacovigilance actions in Brazil.
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Affiliation(s)
- Daniel Marques Mota
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
| | - Álvaro Vigo
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
| | - Ricardo de Souza Kuchenbecker
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2.400/2º, Rio Branco. 90035-003 Porto Alegre RS Brasil.
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Kwok CS, Martinez SC, Pancholy S, Ahmed W, Al-Shaibi K, Potts J, Mohamed M, Kontopantelis E, Curzen N, Mamas MA. Effect of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database). Sci Rep 2018; 8:11156. [PMID: 30042466 PMCID: PMC6057975 DOI: 10.1038/s41598-018-29303-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022] Open
Abstract
It is unclear how comorbidity influences rates and causes of unplanned readmissions following percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database who were admitted to hospital between 2010 and 2014. The comorbidity burden as defined by the Charlson Comorbidity Index (CCI). Primary outcomes were 30-day readmission rates and causes of readmission according to comorbidity burden. A total of 2,294,346 PCI procedures were included the analysis. The patients in CCI = 0, 1, 2 and ≥3 were 842,272(36.7%), 701,476(30.6%), 347,537(15.1%) and 403,061(17.6%), respectively. 219,227(9.6%) had an unplanned readmission within 30 days and rates by CCI group were 6.6%, 8.6%, 11.4% and 15.9% for CCI groups 0, 1, 2 and ≥3, respectively. The CCI score was also associated with greater cost (cost of index PCI for not readmitted vs readmitted was CCI = 0 $21,257 vs $19,764 and CCI ≥ 3 $26,736 vs $27,723). Compared to patients with CCI = 0, greater CCI score was associated with greater independent odds of readmission (CCI = 1 OR 1.25(1.22–1.28), p < 0.001, CCI ≥ 3 OR 2.08(2.03–2.14), p < 0.001). Rates of non-cardiac causes for readmissions increased with increasing CCI group from 49.4% in CCI = 0 to 57.1% in CCI ≥ 3. Rates of early unplanned readmission increase with greater comorbidity burden and non-cardiac readmissions are higher among more comorbid patients.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK. .,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | - Sara C Martinez
- Division of Cardiology, Providence St. Peter Hospital, Olympia, Washington, USA
| | - Samir Pancholy
- The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, PA, USA
| | - Waqar Ahmed
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khaled Al-Shaibi
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Jessica Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Nick Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Lenssen R, Schmitz K, Griesel C, Heidenreich A, Schulz JB, Trautwein C, Marx N, Fitzner C, Jaehde U, Eisert A. Comprehensive pharmaceutical care to prevent drug-related readmissions of dependent-living elderly patients: a randomized controlled trial. BMC Geriatr 2018; 18:135. [PMID: 29898670 PMCID: PMC6000946 DOI: 10.1186/s12877-018-0814-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. METHODS A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis. RESULTS Sixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors 'age' or 'length of stay on the ward' were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward). CONCLUSIONS Our findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01578525 , prospectively registered April 13, 2012.
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Affiliation(s)
- R Lenssen
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany.,Present address: Hospital Pharmacy, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - K Schmitz
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.,Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - C Griesel
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany
| | - A Heidenreich
- Department of Urology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Present address: Department of Urology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - J B Schulz
- Department of Neurology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - C Trautwein
- Department of Internal Medicine III, Gastroenterology, Metabolic Disorders and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - N Marx
- Department of Internal Medicine I, Cardiology, Pneumology, Angiology and Internal Intensive Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - C Fitzner
- Department of Medical Statistics, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - U Jaehde
- Institute of Pharmacy, Clinical Pharmacy, University of Bonn, An der Immenburg 4, 53121, Bonn, Germany
| | - A Eisert
- Hospital Pharmacy, University Hospital RWTH Aachen, Steinbergweg 20, 52074, Aachen, Germany.
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Parameswaran Nair N, Chalmers L, Bereznicki BJ, Curtain CM, Bereznicki LR. Repeat Adverse Drug Reaction-Related Hospital Admissions in Elderly Australians: A Retrospective Study at the Royal Hobart Hospital. Drugs Aging 2018; 34:777-783. [PMID: 28952130 DOI: 10.1007/s40266-017-0490-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adverse drug reactions are a major cause of hospital admissions in older individuals, with the majority potentially preventable. Despite the apparent magnitude of this problem, little is known about rates of repeat admission to hospital as a result of adverse drug reactions. OBJECTIVES The objectives of this study were to investigate the occurrence of repeat adverse drug reaction-related hospital admissions in elderly patients within 12 months of an adverse drug reaction-related admission to a medical ward and whether a validated adverse drug reaction score could be useful in identifying patients at higher risk of a repeat adverse drug reaction-related hospitalisation. METHODS This retrospective study followed elderly participants who were hospitalised with an adverse drug reaction from our earlier study [the PADR-EC (Prediction of Hospitalization due to Adverse Drug Reactions in Elderly Community-Dwelling Patients) study] to identify repeat adverse drug reaction-related hospital admissions within 12 months of discharge. The PADR-EC score is the sum of points assigned to five significant predictors of adverse drug reaction-related hospitalisation: antihypertensive use, renal failure, dementia, inappropriate anticholinergic use and drug changes in the preceding 3 months. The causality, preventability and severity of each adverse drug reaction-related repeat admission within the 12-month follow-up were assessed. RESULTS Adverse drug reaction-related repeat admissions occurred after 13.4% (n = 15) of 112 adverse drug reaction-related index admissions. Patients with a repeat adverse drug reaction-related admission had significantly higher PADR-EC scores at discharge of their index admission (median PADR-EC score 7, interquartile range 7-9) than patients who were not readmitted (median PADR-EC score 7, interquartile range 5-7, p = 0.034). Most (73.3%) adverse drug reaction-related repeat admissions were considered 'preventable'. Adverse drug reaction severity was 'moderate' in all cases. Renal disorders (44.4%) represented the most common adverse drug reactions and the most frequently implicated drug classes were diuretics (44.8%). All adverse drug reaction-related repeat admissions were found to be 'probable'. CONCLUSIONS One in eight elderly patients hospitalised because of an adverse drug reaction had a repeat admission for an adverse drug reaction within 12 months of discharge. The PADR-EC score could potentially be used at hospital discharge to prioritise patients for interventions to prevent subsequent adverse drug reaction-related hospital admissions.
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Affiliation(s)
- Nibu Parameswaran Nair
- Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia.
| | - Leanne Chalmers
- Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
| | - Bonnie J Bereznicki
- Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
| | - Colin M Curtain
- Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
| | - Luke R Bereznicki
- Unit for Medication Outcomes Research and Education, Division of Pharmacy, Faculty of Health, School of Medicine, University of Tasmania, Private Bag 26, Hobart, TAS, 7001, Australia
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El Morabet N, Uitvlugt EB, van den Bemt BJ, van den Bemt PM, Janssen MJ, Karapinar-Çarkit F. Prevalence and Preventability of Drug-Related Hospital Readmissions: A Systematic Review. J Am Geriatr Soc 2018; 66:602-608. [DOI: 10.1111/jgs.15244] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Najla El Morabet
- Department of Hospital Pharmacy; OLVG; Amsterdam The Netherlands
| | | | - Bart J.F. van den Bemt
- Department of Pharmacy; SintMaartenskliniek; Nijmegen The Netherlands
- Department of Pharmacy; Radboud University Medical Centre; Nijmegen The Netherlands
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O’Mahony D, O’Connor MN, Eustace J, Byrne S, Petrovic M, Gallagher P. The adverse drug reaction risk in older persons (ADRROP) prediction scale: derivation and prospective validation of an ADR risk assessment tool in older multi-morbid patients. Eur Geriatr Med 2018; 9:191-199. [DOI: 10.1007/s41999-018-0030-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/15/2018] [Indexed: 01/02/2023]
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Angamo MT, Curtain CM, Chalmers L, Yilma D, Bereznicki L. Predictors of adverse drug reaction-related hospitalisation in Southwest Ethiopia: A prospective cross-sectional study. PLoS One 2017; 12:e0186631. [PMID: 29036230 PMCID: PMC5643118 DOI: 10.1371/journal.pone.0186631] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are important causes of morbidity and mortality in the healthcare system; however, there are no studies reporting on the magnitude and risk factors associated with ADR-related hospitalisation in Ethiopia. OBJECTIVES To characterise the reaction types and the drugs implicated in admission to Jimma University Specialized Hospital, Southwest Ethiopia, and to identify risk factors associated with ADR-related hospitalisation. METHODS A prospective cross-sectional study was conducted from May 2015 to August 2016 among consenting patients aged ≥18 years consecutively admitted to medical wards taking at least one medication prior to admission. ADR-related hospitalisations were determined through expert review of medical records, laboratory tests, patient interviews and physical observation. ADR causality was assessed by the Naranjo algorithm followed by consensus review with internal medicine specialist. ADR preventability was assessed using Schumock and Thornton's criteria. Only definite and probable ADRs that provoked hospitalisation were considered. Binary logistic regression was used to identify independent predictors of ADR-related hospitalisation. RESULTS Of 1,001 patients, 103 (10.3%) had ADR-related admissions. Common ADRs responsible for hospitalisation were hepatotoxicity (35, 29.4%) and acute kidney injury (27, 22.7%). The drug classes most frequently implicated were antitubercular agents (45, 25.0%) followed by antivirals (22, 12.2%) and diuretics (19, 10.6%). Independent predictors of ADR-related hospitalisation were body mass index (BMI) <18.5 kg/m2 (adjusted odd ratio [AOR] = 1.69; 95% confidence interval [CI] = 1.10-2.62; p = 0.047), pre-existing renal disease (AOR = 2.84; 95%CI = 1.38-5.85, p = 0.004), pre-existing liver disease (AOR = 2.61; 95%CI = 1.38-4.96; p = 0.003), number of comorbidities ≥4 (AOR = 2.09; 95%CI = 1.27-3.44; p = 0.004), number of drugs ≥6 (AOR = 2.02; 95%CI = 1.26-3.25; p = 0.004) and history of previous ADRs (AOR = 24.27; 95%CI = 11.29-52.17; p<0.001). Most ADRs (106, 89.1%) were preventable. CONCLUSIONS ADRs were a common cause of hospitalisation. The majority of ADRs were preventable, highlighting the need for monitoring and review of patients with lower BMI, ADR history, renal and liver diseases, multiple comorbidities and medications. ADR predictors should be integrated into clinical pathways and pharmacovigilance systems.
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Affiliation(s)
- Mulugeta Tarekegn Angamo
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- * E-mail:
| | - Colin Michael Curtain
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leanne Chalmers
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Daniel Yilma
- Department of Internal Medicine, School of Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Luke Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Jeffrey AW, Huang Y, de Boer WB, Adams LA, MacQuillan G, Speers D, Joseph J, Jeffrey GP. Improved Hepascore in hepatitis C predicts reversal in risk of adverse outcome. World J Hepatol 2017; 9:850-856. [PMID: 28740596 PMCID: PMC5504360 DOI: 10.4254/wjh.v9.i19.850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/30/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To establish if serial Hepascore tests (referred to as delta Hepascore) in those with chronic hepatitis C (CHC) correlate with the increase and/or decrease in risk of liver related complications.
METHODS Three hundred and forty-six CHC patients who had two Hepascore tests performed were studied. During 1944 patient years follow-up 28 (8.1%) reached an endpoint. The Hepascore is a serum test that provides clinically useful data regarding the stage of liver fibrosis and subsequent clinical outcomes in chronic liver disease.
RESULTS Patients with a baseline Hepascore > 0.75 had a significantly increased rate of reaching a composite endpoint consisting of hepatocellular carcinoma, liver death, and/or decompensation (P < 0.001). In those with an initial Hepascore > 0.75, a subsequent improved Hepascore showed a significantly decreased risk for the composite endpoint (P = 0.004). There were no negative outcomes in those with a stable or improved delta Hepascore. The minimum time between tests that was found to give a statically significant result was in those greater than one year (P = 0.03).
CONCLUSION In conclusion, Hepascore is an accurate predictor of liver related mortality and liver related morbidity in CHC patients. Of note, we have found that there is a decreased risk of mortality and morbidity in CHC patients when the patient has an improving delta Hepascore. Repeat Hepascore tests, when performed at a minimum one-year interval, may be of value in routine clinical practice to predict liver related clinical outcomes and to guide patient management.
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Yu YM, Lee JY, Lee E. Access to Anti-osteoporosis Medication after Hip Fracture in Korean Elderly Patients. Maturitas 2017; 103:54-59. [PMID: 28778333 DOI: 10.1016/j.maturitas.2017.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/05/2017] [Accepted: 06/09/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE This study aims to evaluate access to anti-osteoporosis medication (AOM) and the factors affecting their prescription for Korean elderly patients with a hip fracture. METHODS A cross-sectional study was conducted on hip fracture patients aged 65 years or more using national-level data from 2013 to 2014. The prescription rates of AOM within 3 months after hip fracture were determined and the factors affecting AOM prescriptions were identified through multivariate logistic regression. RESULTS A total of 6307 elderly patients were selected from a national medical insurance database, giving an estimated 15,768 patients nationally in a nine-month period. One-third of the patients (33.5%) received an AOM prescription and only 9.4% of the patients were prescribed an AOM with calcium and vitamin D supplements. Being 80 years and older (adjusted OR, 0.78; 95% CI, 0.70-0.88) and having three or more comorbid diseases (adjusted OR, 0.66; 95% CI, 0.55-0.78) were associated with a lower likelihood of an AOM prescription. Female sex (adjusted OR, 2.54; 95% CI, 2.17-2.98), an osteoporosis diagnosis (adjusted OR, 2.50; 95% CI, 2.15-2.91), concurrent thiazolidinedione therapy (adjusted OR, 2.11; 95% CI, 1.29-3.45) and a dual-energy X-ray absorptiometry (DXA) examination after hip fracture (adjusted OR 4.11; 95% CI, 3.67-4.62) were all significant predictive factors for AOM prescription. Bisphosphonates were the most frequently prescribed AOMs (92.2%). CONCLUSIONS The AOM prescription rate for elderly patients with hip fractures was suboptimal in Korea. Factors affecting an AOM prescription were age, sex, clinical comorbidity, osteoporosis status, concurrent thiazolidinedione therapy, and receiving a DXA examination after hip fracture.
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Affiliation(s)
- Yun Mi Yu
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea.
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55, Hanyangdaehak-ro, Sangrok-gu, Ansan, 15588, Republic of Korea.
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Bassi PU, Osakwe AI, Ogar CK, Elagbaje C, Nwankwo BB, Balogun ST, Ntadom GN, Isah AO. Impact of comorbidity on adverse drug reaction profile in a cohort of patients treated with Artemisinin combination therapies for uncomplicated malaria in Nigeria. Pharmacol Res Perspect 2017; 5:e00302. [PMID: 28357128 PMCID: PMC5368966 DOI: 10.1002/prp2.302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022] Open
Abstract
Artemisinin‐based combination antimalarial therapy (ACTs), is still highly effective in uncomplicated falciparum malaria, however, there remain some concerns in relation to its safety and tolerability. Comorbid disease conditions may influence susceptibility to adverse drug reactions (ADRs) as the presence of multiple disease conditions may predisposes patients to ADRs due to the use of many medicines. There is therefore need to assess the impact of comorbidities on the ADR profile of malaria patients treated with ACTs. The study was carried out in health care facilities spread across Nigeria. From the database of over 10,000 patients recruited into an initial cohort, data for 1000 patients with comorbidities was extracted and matched with a control group of 1000 randomly selected patients with no comorbidity. There were 1105 adverse drug reactions in all, of which 66.2% were recorded in patients with comorbidity, and 34% are patients without comorbidity. The mean age of patients with comorbidities was 38.3 ± 17.5 years and 23.8 ± 17.2 for those without comorbidity. Out of the 979 patients with comorbidity, 36% were hypertensive, 2.2% hypertensive‐diabetes, 16.4% peptic ulcer disease, 10.4% HIV/AIDS, 4.4% diabetes and 4.3% were asthmatic. Patients with comorbidity were three times more likely to have adverse drug reaction than those without comorbidity (Odds ration = 2.96; 95% CI = 2.23–3.93). HIV/AIDS and osteoarthritis were significantly associated with development of adverse drug reactions. Probability was <0.0001. Age, weight, and height of patients were also found to be risk factor for development of adverse drug reactions.
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Affiliation(s)
- Peter U Bassi
- Department of Pharmacology & Therapeutics College of Health Sciences University of Abuja FCT Abuja Nigeria
| | | | - Comfort K Ogar
- National Pharmacovigilance centre NAFDAC Nigeria Abuja Nigeria
| | | | - Biyaya B Nwankwo
- Department of Community Medicine College of Health Sciences University of Abuja FCT Abuja Nigeria
| | - Sulayman T Balogun
- Department of Clinical Pharmacology & Therapeutics College of Medical Sciences University of Maiduguri Borno State Nigeria
| | | | - Ambrose O Isah
- University of Benin Teaching Hospital Benin City Nigeria
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Casalini F, Salvetti S, Memmini S, Lucaccini E, Massimetti G, Lopalco PL, Privitera GP. Unplanned readmissions within 30 days after discharge: improving quality through easy prediction. Int J Qual Health Care 2017; 29:256-261. [DOI: 10.1093/intqhc/mzx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/18/2017] [Indexed: 11/14/2022] Open
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Parihar HS, Yin H, Gooch JL, Allen S, John S, Xuan J. Trends in hospital admissions due to antidepressant-related adverse drug events from 2001 to 2011 in the U.S. BMC Health Serv Res 2017; 17:51. [PMID: 28103930 PMCID: PMC5244566 DOI: 10.1186/s12913-017-1993-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background Depression is a prevalent mental health disorder and the fourth leading cause of disability in the world as per the World Health Organization. Use of antidepressants can lead to adverse drug events (ADEs), defined as any injury resulting from medication use. This study aimed to examine changes in hospital admissions due to antidepressant-related ADEs (ArADEs) among different socio-demographic groups and changes in lengths of stay (LOS) and hospital charges in ArADE admissions from 2001 to 2011. Methods The Healthcare Cost and Utilization Project database was used. ArADE admissions in different socio-demographic groups were examined including characteristics such as age, gender, rural/urban, and income. LOS and hospital charges for ArADE cases were compared between 2001 and 2011. Chi-square test and t test were used for statistical analyses. Results There were 17,375 and 20,588 ArADE related admissions in 2001 and 2011, respectively. There was a 17.6% increase among the group of 18 to 64 years old and a 64.8% increase among the group of 65 years or older while the other age groups experienced decreased admission rates. Males and females had similar increases. Patients from the lower income areas experienced a two-fold increase while those from the higher income areas experienced a decrease. The mean LOS for all ArADE related admissions increased from 2.18 to 2.81 days and mean hospital charges increased from $8,456.2 to $21,572.5. Conclusions There was an increase in ArADE hospital admissions. The greater increase in ArADE admissions among elderly, urban or low-income patients should be noted and addressed by practitioners and policy makers. The large increase in hospital charges needs further research.
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Affiliation(s)
- Harish S Parihar
- School of Pharmacy, Philadelphia College of Osteopathic Medicine School of Pharmacy-Georgia campus, 625 Old Peachtree Rd NW, Suwanee, GA, 30024, USA.
| | - Hongjun Yin
- School of Pharmacy, Philadelphia College of Osteopathic Medicine School of Pharmacy-Georgia campus, 625 Old Peachtree Rd NW, Suwanee, GA, 30024, USA
| | - Jennifer L Gooch
- School of Pharmacy, Philadelphia College of Osteopathic Medicine School of Pharmacy-Georgia campus, 625 Old Peachtree Rd NW, Suwanee, GA, 30024, USA
| | - Shari Allen
- School of Pharmacy, Philadelphia College of Osteopathic Medicine School of Pharmacy-Georgia campus, 625 Old Peachtree Rd NW, Suwanee, GA, 30024, USA
| | - Samuel John
- School of Pharmacy, Philadelphia College of Osteopathic Medicine School of Pharmacy-Georgia campus, 625 Old Peachtree Rd NW, Suwanee, GA, 30024, USA
| | - Jianwei Xuan
- Health Economic Research Institute, Sun Yat-sen University, Guangzhou, China
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Ofori-Asenso R, Agyeman AA. Irrational Use of Medicines-A Summary of Key Concepts. PHARMACY 2016; 4:E35. [PMID: 28970408 PMCID: PMC5419375 DOI: 10.3390/pharmacy4040035] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/09/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
Medicines play an integral part of healthcare delivery. However, they are expensive commodities and account for a significant proportion of overall health expenditure in most countries. Irrational use of medicines is a major challenge facing many health systems across the world. Such practices are likely to lead to poor health delivery that may put patients at risk and result in wastage of scarce resources that could have been used to tackle other pressing health needs. The concept of "rational use of medicine" can at times be confusing and not easily appreciated by patients, healthcare providers, policy makers, or the public, all of whom need to collaborate effectively to address this challenge. In this article, we summarize basic concepts such as rational medicine use, good prescribing and dispensing, and explore some of the factors that contribute to irrational use of medicines as well as potential impacts of such practices. This article has been written with the intention of offering a clear, concise, and easy to understand explanation of basic medicine use concepts for health professionals, patients, policy makers, and the public.
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