Prevalence of hospitalisation caused by adverse drug reactions at an internal medicine ward of a single centre in Japan: a cross-sectional study

Prevalence of urgent hospitalizations caused by adverse drug reactions: a cross-sectional study

Adverse drug reactions account for a substantial portion of emergency hospital admissions. However, in the last decade, few studies have been conducted to determine the prevalence of hospitalization due to adverse drug reactions. Therefore, this cross-sectional study was conducted to determine the proportion of adverse drug reactions leading to emergency hospital admission and to evaluate the risk factors for these reactions. A total of 5707 consecutive patients aged > 18 years who were emergently hospitalized due to acute medical illnesses between June 2018 and May 2021 were included. Causality assessment for adverse drug reactions was performed by using the World Health Organization-Uppsala Monitoring Centre criteria. The median patient age was 78 years (IQR 63-87), and the proportion of women was 47.9%. Among all the hospitalizations, 287 (5.0%; 95% confidence interval (CI) 4.5-5.6%) were caused by 368 adverse drug reactions. The risk factors independently associated with hospitalization due to adverse drug reactions were polypharmacy (OR 2.66), age ≥ 65 years (OR 2.00), and ambulance use (OR 1.41). Given that the population is rapidly aging worldwide, further efforts are needed to minimize hospitalizations caused by adverse drug reactions.

A prospective intervention study to identify drug-related emergency department visits comparing a standard care group and a pharmaceutical care group

BACKGROUND AND IMPORTANCE

Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions.

OBJECTIVE

The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support.

DESIGN/SETTING/PARTICIPANTS

This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related.

OUTCOME MEASURES AND ANALYSIS

The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated.

MAIN RESULTS

A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25-Q75) 63.5-83.5] and took 7 [(Q25-Q75) 5-8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25-Q75) 66-83] and number of drugs taken was 9 [(Q25-Q75) 5.25-11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35-5.38). An intervention on the patient's pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group.

CONCLUSION

In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.

Validation of quality indicators for evaluating geriatric pharmacotherapy services in primary care: a mixed methods study

OBJECTIVE

To assess measurement properties of 121 face and content validated quality indicators (QIs) for medication safety in geriatric pharmacotherapy in primary care.

DESIGN

A mixed methods study: a 6-month observational study in primary care (July-December 2020) and in-depth semistructured online interviews with participants (February-March 2021).

SETTING

Sixty community pharmacies in Japan.

PARTICIPANTS

Patients aged 75 years and older who were regularly taking six or more prescription medicines for ˃4 weeks were eligible. The observational study included 457 patients. The interviews were undertaken with 26 community pharmacists, including pharmacy managers and owners.

PRIMARY AND SECONDARY OUTCOME MEASURES

Five measurement properties of QIs (applicability, improvement potential, acceptability, implementation issues and sensitivity to change) were evaluated. A web application was developed for data reporting and data visualisation.

RESULTS

This study showed that 53 QIs met the measurement properties of applicability, improvement potential, acceptability and implementation issues. Of 53 QIs, 17 also had a high sensitivity to change. Interviews identified eight themes (indicator characteristics, web application, policy, patient, time, competence, pharmacy administration and collaboration) in relation to the consequence of implementation of QIs.

CONCLUSIONS

A set of 121 QIs for geriatric pharmacotherapy was field tested for their five measurement properties. This QI set can be used to identify patients who may benefit from clinician reviews of their medicines. These QIs may be applied at different levels within the healthcare system: patient, pharmacy, regional and national levels. Further mechanisms to automatically collect and report data should be established to facilitate sustainable quality improvement initiatives.

Combining Machine Learning with a Rule-Based Algorithm to Detect and Identify Related Entities of Documented Adverse Drug Reactions on Hospital Discharge Summaries

INTRODUCTION

Discharge summaries contain valuable information about adverse drug reactions, but their unstructured nature makes them challenging to analyse and use as a signal source for pharmacovigilance. Machine learning has shown promise in identifying discharge summaries that contain related drug-adverse event pairs but has fared relatively poorer in entity extraction.

METHODS

A hybrid model is developed combining rule-based and machine learning algorithms using discharge summaries with the aim of maximising capture of related drug-adverse event pairs. The rule first identifies segments containing adverse event entities within a 100-character distance from a drug term; machine learning subsequently estimates the relatedness of the drug and adverse event entities contained. The approach is validated on four independent datasets that are temporally and geographically separated from model development data. The impact of restricted drug-adverse event pair detection on recall is evaluated by using two of the four validation datasets that do not impose rule-based restrictions to annotations.

RESULTS

The hybrid model achieves a recall of 0.80 (fivefold cross validation), 0.80 (temporal) and 0.76 (geographical) on validation using datasets containing only pre-identified target text segments that fulfil the rule-based algorithm criteria. When tested on datasets that additionally contained drug-adverse event pairs not restricted by the rule-based criteria, recall of the model declines to 0.68 and 0.62 on temporally and geographically separated datasets, respectively.

CONCLUSIONS

The proposed hybrid model demonstrates reasonable generalisability on external validation. Rule-based restriction of the detection space results in an approximately 12-14% reduction in recall but improves identification of the related drug and adverse event terms.

Development and consensus testing of quality indicators for geriatric pharmacotherapy in primary care using a modified Delphi study

Background Polypharmacy is associated with an increased risk of adverse drug events in older people. Although national guidance on geriatric pharmacotherapy exists in Japan, tools to routinely monitor the quality of care provided by community pharmacists are lacking. Aim To develop a set of quality indicators (QIs) to measure the quality of care provided by community pharmacists in improving geriatric pharmacotherapy in primary care in Japan, using a modified Delphi study. Method The development of QIs for the Japanese community pharmacy context followed a two-step process: national guidance review and consensus testing using a modified Delphi study. The latter involved two rounds of rating with a face-to-face meeting between the rounds. Ten experts in geriatric pharmacotherapy in primary care were recruited for the panel discussion. QIs were mapped to three key taxonomies and frameworks: the Anatomical Therapeutic Chemical (ATC) classification system, problems and causes of drug-related problems (DRPs) taxonomy and Donabedian's framework. Results A total of 134 QIs for geriatric pharmacotherapy were developed. This QI set included 111 medicine specific indicators, covering medicines in 243 third-level ATC classifications. QIs were classified into the problem of treatment safety (80%) and causes of drug selection (38%) based on validated classification for DRPs. In Donabedian's framework, most QIs (82%) were process indicators. There were no structure indicators. Conclusion A set of 134 QIs for geriatric pharmacotherapy was rigorously developed. Measurement properties of these QIs will be evaluated for feasibility, applicability, room for improvement, sensitivity to change, predictive validity, acceptability and implementation issues in a subsequent study.

Pharmacists can improve diagnosis and help prevent diagnostic errors

We present two cases that highlight the role of pharmacists in the diagnostic process and illustrate how a culture of safety and teamwork between pharmacists and physicians can help prevent diagnostic errors.