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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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Reallon E, Yailian AL, Paillet C, Janoly-Dumenil A. Increasing the number of pharmacist-led medication order reviews using the available workforce: a retrospective study. Eur J Hosp Pharm 2023:ejhpharm-2023-003793. [PMID: 37580118 DOI: 10.1136/ejhpharm-2023-003793] [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: 04/05/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Due to staffing constraints, several hospitals have defined targeting strategies for pharmacist-led medication order review, leaving non-targeted patients exposed to potential harmful drug-related problems (DRPs). Using targeting criteria to stratify medication order review level (level 1 (L1): orders, basic patient characteristics; level 2 (L2) or comprehensive medication order review: orders, patient characteristics, medical records, laboratory results) could make it possible to save time and increase the overall number of medication order reviews. This study aims to define targeting criteria to stratify medication order review level and estimate the time saved for the performance of additional medication order reviews. METHOD This retrospective single-centre study included all medication order reviews performed in 2020; DRPs were collected to assess the medication order review level required to detect them. Logistic regressions were performed to define patient characteristics associated with L2. These targeting criteria were applied to the cohort to estimate the time saved and the number of additional medication order reviews which could have been performed using this approach. RESULTS 2478 DRPs were reported; 54.2% (1343/2748) could have been detected using an L1 medication order review (representing 48.2% of the patients (829/1721)). L2 medication order reviews were significantly associated with age ≥65 years, male, and renal clearance <60 mL/min (OR≥75yo=1.79; OR65-74yo=1.74; ORfemale=0.74; OR30-59mL/min=1.67; OR<30mL/min=2.62; p<0.05). Sex being a confounding factor, only age and renal clearance were used as targeting criteria. The time saved was estimated at 274 hours per year, leading to an additional 1720 medication order reviews (54 hospital beds). CONCLUSION The proposed approach would maintain a satisfying level of safety and quality for patients, by performing an L2 medication order review for targeted patients based on age and renal clearance, while improving medication order review coverage with an L1 medication order review for non-targeted patients, using the available workforce.
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Affiliation(s)
- Elsa Reallon
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Anne-Laure Yailian
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
- UR 4129 Parcours Santé Systémique, Université Claude Bernard Lyon 1, Lyon, Auvergne-Rhône-Alpes, France
| | - Carole Paillet
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Audrey Janoly-Dumenil
- Pharmacy Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
- UR 4129 Parcours Santé Systémique, Université Claude Bernard Lyon 1, Lyon, Auvergne-Rhône-Alpes, France
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3
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Sönnerstam E, Harlin F, Gustafsson M. Potentially inappropriate medications among elderly people with neurocognitive disorders - A nationwide register-based study using 3 different explicit criteria. Res Social Adm Pharm 2023; 19:758-763. [PMID: 36717339 DOI: 10.1016/j.sapharm.2023.01.010] [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: 11/10/2022] [Revised: 12/22/2022] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is a problem since it might contribute significantly to adverse drug reactions and hospital admissions among elderly with major neurocognitive disorder (NCD). To assess the appropriateness of drug treatment, different explicit criteria have been developed. OBJECTIVES To investigate and compare the prevalence of PIM users among elderly with major NCD on a nationwide basis using 3 different explicit criteria. Furthermore, the study aimed to investigate factors associated with the use of PIMs. METHODS This nationwide register-based study included 35,212 people, 65 years or older, diagnosed with major NCD and registered in the Swedish registry for cognitive/dementia disorders up to June 30, 2017 and alive December 31, 2017. PIMs were identified using 3 different explicit criteria; the Swedish quality indicators, the EU(7)-PIM list and the AGS Beers Criteria. PIM use was defined as having collected a minimum of one PIM at least once between July 01 - December 31, 2017. RESULTS The numbers of people using one or more PIMs were 7629 (21.7%) according to the Swedish quality indicators, 11,838 (33.6%) according to the EU(7)-PIM list, and 12,002 (34.1%) according to AGS Beers Criteria. Antipsychotics, antithrombotic agents and anxiolytics were the most frequently used PIM class according to the different assessment tools, respectively. The use of PIMs was positively associated with vascular dementia and Lewy body dementia/Parkinson's disease dementia, regardless of the assessment tool used. However, the association between using at least one PIM and age, sex, MMT-value and frontotemporal dementia, differed depending on the criteria used. CONCLUSIONS The different results and included PIMs indicate the different perspectives on PIMs between criteria, which make it difficult to compare the results. However, psychotropic drug use requires further highlighting, as well as the association between PIM use and different types of major NCD.
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Affiliation(s)
- Eva Sönnerstam
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Frida Harlin
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
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Thakkar S, Slikker W, Yiannas F, Silva P, Blais B, Chng KR, Liu Z, Adholeya A, Pappalardo F, Soares MDLC, Beeler P, Whelan M, Roberts R, Borlak J, Hugas M, Torrecilla-Salinas C, Girard P, Diamond MC, Verloo D, Panda B, Rose MC, Jornet JB, Furuhama A, Fang H, Kwegyir-Afful E, Heintz K, Arvidson K, Burgos JG, Horst A, Tong W. Artificial intelligence and real-world data for drug and food safety - A regulatory science perspective. Regul Toxicol Pharmacol 2023; 140:105388. [PMID: 37061083 DOI: 10.1016/j.yrtph.2023.105388] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/07/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
In 2013, the Global Coalition for Regulatory Science Research (GCRSR) was established with members from over ten countries (www.gcrsr.net). One of the main objectives of GCRSR is to facilitate communication among global regulators on the rise of new technologies with regulatory applications through the annual conference Global Summit on Regulatory Science (GSRS). The 11th annual GSRS conference (GSRS21) focused on "Regulatory Sciences for Food/Drug Safety with Real-World Data (RWD) and Artificial Intelligence (AI)." The conference discussed current advancements in both AI and RWD approaches with a specific emphasis on how they impact regulatory sciences and how regulatory agencies across the globe are pursuing the adaptation and oversight of these technologies. There were presentations from Brazil, Canada, India, Italy, Japan, Germany, Switzerland, Singapore, the United Kingdom, and the United States. These presentations highlighted how various agencies are moving forward with these technologies by either improving the agencies' operation and/or preparing regulatory mechanisms to approve the products containing these innovations. To increase the content and discussion, the GSRS21 hosted two debate sessions on the question of "Is Regulatory Science Ready for AI?" and a workshop to showcase the analytical data tools that global regulatory agencies have been using and/or plan to apply to regulatory science. Several key topics were highlighted and discussed during the conference, such as the capabilities of AI and RWD to assist regulatory science policies for drug and food safety, the readiness of AI and data science to provide solutions for regulatory science. Discussions highlighted the need for a constant effort to evaluate emerging technologies for fit-for-purpose regulatory applications. The annual GSRS conferences offer a unique platform to facilitate discussion and collaboration across regulatory agencies, modernizing regulatory approaches, and harmonizing efforts.
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Affiliation(s)
- Shraddha Thakkar
- Center for Drug Evaluations and Research (CDER), Food and Drug Administration (FDA), USA
| | - William Slikker
- National Center for Toxicological Research (NCTR), Food and Drug Administration (FDA), USA
| | | | | | | | - Kern Rei Chng
- National Centre for Food Science, Singapore Food Agency (SFA), Singapore
| | - Zhichao Liu
- National Center for Toxicological Research (NCTR), Food and Drug Administration (FDA), USA
| | - Alok Adholeya
- The Energy and Resources Institute (TERI), New Delhi, India
| | | | | | - Patrick Beeler
- Swissmedic, Bern, Switzerland; University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | - Matthew C Diamond
- Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), USA
| | | | - Binay Panda
- Jawaharlal Nehru University (JNU), New Delhi, India
| | | | | | | | - Hong Fang
- National Center for Toxicological Research (NCTR), Food and Drug Administration (FDA), USA
| | - Ernest Kwegyir-Afful
- Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA
| | - Kasey Heintz
- Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA
| | - Kirk Arvidson
- Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA
| | | | | | - Weida Tong
- National Center for Toxicological Research (NCTR), Food and Drug Administration (FDA), USA.
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Orenstein L, Chetrit A, Goldman A, Novikov I, Dankner R. Polypharmacy is differentially associated with 20-year mortality among community-dwelling elderly women and men: The Israel Glucose Intolerance, Obesity and Hypertension cohort study. Mech Ageing Dev 2023; 211:111788. [PMID: 36758642 DOI: 10.1016/j.mad.2023.111788] [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: 11/21/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Elderly individuals are characterized by multimorbidity and high medication intake, entailing risks for adverse events. We examined the overall and sex-specific association of polypharmacy (≥5 drugs concurrently) with 20-year mortality among community-dwelling older adults. METHODS Survivors of the longitudinal Israel Study of Glucose Intolerance, Obesity, and Hypertension underwent extensive evaluation during 1999-2004, and were followed-up for all-cause mortality until 2019. Cox regression examined association of polypharmacy with all-cause mortality. RESULTS Data included 1210 participants (mean baseline age 72.9 ± 7.4 years, 53% females), 50.7% of them died over a median follow-up of 12.8 years. Women received a higher mean number of drugs (4.3 vs 3.5; p < 0.0001), were twice more likely to take vitamins, and had higher comorbidity. Polypharmacy prevalence was 38.3%, and more frequent with age, female sex, European-American origin, sedentary lifestyle and poor self-rated health. Polypharmacy was independently associated with mortality in women only (HR=1.41, 95%CI:1.05-1.89). An interaction was found with sex (p = 0.045). CONCLUSIONS Polypharmacy was more prevalent in older women than men and associated with increased 20-year mortality in women only. Sex-specific adaptation of guidelines for appropriate drug use among community-dwelling older adults is warranted.
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Affiliation(s)
- Liat Orenstein
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel.
| | - Adam Goldman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; Department of Internal Medicine, Sheba Medical Center, Ramat-Gan 52621, Israel.
| | - Ilya Novikov
- Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel.
| | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan 52621, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
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Silva LT, Modesto ACF, de Oliveira RA, Amaral RG, Lopes FM. Hospitalizations and adverse drug events in the Brazilian unified health system: a ten-year retrospective analysis of routine data. Rev Saude Publica 2022; 56:86. [PMID: 36228231 PMCID: PMC9529208 DOI: 10.11606/s1518-8787.2022056003913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 12/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the frequency and characteristics of hospitalizations for/with adverse drug events in the Brazilian unified health system routine data. METHODS Nationwide retrospective study using data obtained from a period of ten years from the Brazil Hospital Information System (SIH-SUS), an administrative database that registers hospitalizations in the unified health system. We selected hospitalizations with primary and/or secondary diagnosis related to adverse drug events according to a list of validated International Classification Disease 10th edition (ICD-10) codes. These events were described according to year, age group, sex, length of hospital stay, mortality, hospital costs, Brazilian geographical region, and category of ICD-10 codes. Crude hospitalization rates of adverse drug events per 100,000 inhabitants were obtained and Joinpoint Regression was used to analyze temporal changes in these rates along the years. The most frequent ICD-10 codes were also identified. RESULTS Over ten years, 603,663 hospitalizations in Brazil were found in the database, out of which 2.5% of the patients died. Though 2009 had the highest prevalence of hospitalization per 100,000 inhabitants (32.57), no significant annual change in rates was found for the entire period. All age groups and sexes presented a jointpoint in temporal series; however, only women had a significative increase trend. The most frequent codes were from the chapter of mental and behavioral disorders (F19.2, F19.0, and F19.5 codes). CONCLUSIONS The database methodology can be useful to estimate frequencies of adverse drug events and perform characterization nationwide and to help monitor morbidity along the years.
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Affiliation(s)
- Lunara Teles Silva
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasil Universidade Federal de Goiás. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Goiânia, GO, Brasil
| | - Ana Carolina Figueiredo Modesto
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilUniversidade Federal de Goiás. Hospital das Clínicas. Goiânia, GO, Brasil
| | - Rodrigo Alves de Oliveira
- Universidade Federal de GoiásHospital das ClínicasGoiâniaGOBrasilUniversidade Federal de Goiás. Hospital das Clínicas. Goiânia, GO, Brasil
| | - Rita Goreti Amaral
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasil Universidade Federal de Goiás. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Goiânia, GO, Brasil,Universidade Federal de GoiásFaculdade de FarmáciaGoiâniaGOBrasilUniversidade Federal de Goiás. Faculdade de Farmácia. Goiânia, GO, Brasil
| | - Flavio Marques Lopes
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasil Universidade Federal de Goiás. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Saúde. Goiânia, GO, Brasil,Universidade Federal de GoiásFaculdade de FarmáciaGoiâniaGOBrasilUniversidade Federal de Goiás. Faculdade de Farmácia. Goiânia, GO, Brasil
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Schulze C, Toni I, Moritz K, Eberl S, Rascher W, Neubert A. Development and Adjustment of an Algorithm for Identifying Drug-Related Hospital Admissions in Pediatrics. J Patient Saf 2022; 18:421-429. [PMID: 35113507 DOI: 10.1097/pts.0000000000000951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adverse drug events (ADEs) in the outpatient pediatric pharmacotherapy can be serious and lead to inpatient admissions. Recent research only focused on ADE identification during hospitalization. The aim of the present study was to develop an algorithm to identify drug-related hospital admissions in pediatrics. METHODS A systematic literature research was performed, and a pediatric trigger tool for identifying drug-related inpatient admissions was built. The initial version was tested in a sample of 292 patients admitted to a German university children's hospital. Subsequently, the tool was further improved by combining different modules as a novel approach. RESULTS The obtained algorithm with 39 triggers in 5 modules identified drug-related inpatient admissions at a sensitivity of 95.5% (95% confidence interval [CI], 89.3%-100%) and a specificity of 16.5% (95% CI, 11.9%-21.2%), respectively. After modifications including trigger activation requiring a combination of different modules, specificity increased to 56.9% (95% CI, 50.7%-63.0%). Identifying 36 of 44 ADEs leading to admission, sensitivity remained high (81.8% [95% CI, 70.4%-93.2%]). The overall positive predictive value was 25.2% (95% CI, 18.1%-32.3%). CONCLUSIONS The algorithm is the first trigger tool to identify ambulant acquired ADEs leading to hospital admission in pediatrics. However, the underlying patient sample is small.Using a larger population for refinement will allow further specifications and reduction in the total amount of triggers and thus signals.
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Affiliation(s)
- Christopher Schulze
- From the Department of Paediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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8
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Silva LT, Modesto ACF, Amaral RG, Lopes FM. Hospitalizations and deaths related to adverse drug events worldwide: Systematic review of studies with national coverage. Eur J Clin Pharmacol 2021; 78:435-466. [PMID: 34716774 DOI: 10.1007/s00228-021-03238-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Adverse drug events are related to negative outcomes in healthcare, including hospitalization, increased duration of hospital stay and death. The aim of this study was to conduct a systematic review to evaluate hospitalizations and deaths related to adverse drug events worldwide, reported in studies with national coverage. METHODS The protocol was registered in PROSPERO (CRD42020157008). We performed a systematic search on Medline, Embase, CINAHL, LILACS, and the Cochrane Library (until March 2020) using pre-specified terms. We included published studies that reported data on hospitalizations and/or deaths related to adverse drug events from a national perspective and the use of secondary data as a source of information. Two reviewers independently extracted and synthesized data. The quality of the studies was assessed using an adapted version of the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Narrative summaries of findings were undertaken. RESULTS Among 59,336 citations, 62 studies were included for data extraction and synthesis. Among these studies, 41 studies included the outcome of hospitalization, 16 included the death outcome, and five included both outcomes. Administrative databases regarding discharges and registries of vital statistics were the most common sources of information. The relative frequency of hospitalizations ranged from 0.03% to 7.3%, and from 9.7 to 383.0/100,000 population, whereas mortality rate ranged from 0.1 to 7.88/100,000 population. CONCLUSION Our study highlights information about adverse drug events using large administrative databases in a national scenario and provides an overview of databases and methods implemented to detect adverse drug events.
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Affiliation(s)
- Lunara Teles Silva
- Postgraduate Program On Health Sciences, School of Medicine, Universidade Federal de Goiás - UFG, Goiânia, Goiás, Brazil
| | | | - Rita Goreti Amaral
- School of Pharmacy, Universidade Federal de Goiás - UFG, Goiânia, Goiás, Brazil
| | - Flavio Marques Lopes
- School of Pharmacy, Universidade Federal de Goiás - UFG, Goiânia, Goiás, Brazil.
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9
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Madla CM, Gavins FKH, Merchant HA, Orlu M, Murdan S, Basit AW. Let's talk about sex: Differences in drug therapy in males and females. Adv Drug Deliv Rev 2021; 175:113804. [PMID: 34015416 DOI: 10.1016/j.addr.2021.05.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/04/2021] [Accepted: 05/15/2021] [Indexed: 12/13/2022]
Abstract
Professor Henry Higgins in My Fair Lady said, 'Why can't a woman be more like a man?' Perhaps unintended, such narration extends to the reality of current drug development. A clear sex-gap exists in pharmaceutical research spanning from preclinical studies, clinical trials to post-marketing surveillance with a bias towards males. Consequently, women experience adverse drug reactions from approved drug products more often than men. Distinct differences in pharmaceutical response across drug classes and the lack of understanding of disease pathophysiology also exists between the sexes, often leading to suboptimal drug therapy in women. This review explores the influence of sex as a biological variable in drug delivery, pharmacokinetic response and overall efficacy in the context of pharmaceutical research and practice in the clinic. Prospective recommendations are provided to guide researchers towards the consideration of sex differences in methodologies and analyses. The promotion of disaggregating data according to sex to strengthen scientific rigour, encouraging innovation through the personalisation of medicines and adopting machine learning algorithms is vital for optimised drug development in the sexes and population health equity.
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Affiliation(s)
- Christine M Madla
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Francesca K H Gavins
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Hamid A Merchant
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom
| | - Mine Orlu
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Abdul W Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom.
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10
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Insani WN, Whittlesea C, Alwafi H, Man KKC, Chapman S, Wei L. Prevalence of adverse drug reactions in the primary care setting: A systematic review and meta-analysis. PLoS One 2021; 16:e0252161. [PMID: 34038474 PMCID: PMC8153435 DOI: 10.1371/journal.pone.0252161] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) represent a major cause of iatrogenic morbidity and mortality in patient care. While a substantial body of work has been undertaken to characterise ADRs in the hospital setting, the overall burden of ADRs in the primary care remains unclear. OBJECTIVES To investigate the prevalence of ADRs in the primary care setting and factors affecting the heterogeneity of the estimates. METHODS Studies were identified through searching of Medline, Embase, CINAHL and IPA databases. We included observational studies that reported information on the prevalence of ADRs in patients receiving primary care. Disease and treatment specific studies were excluded. Quality of the included studies were assessed using Smyth ADRs adapted scale. A random-effects model was used to calculate the pooled estimate. Potential source of heterogeneity, including age groups, ADRs definitions, ADRs detection methods, study setting, quality of the studies, and sample size, were investigated using sub-group analysis and meta-regression. RESULTS Thirty-three studies with a total study population of 1,568,164 individuals were included. The pooled prevalence of ADRs in the primary care setting was 8.32% (95% CI, 7.82, 8.83). The percentage of preventable ADRs ranged from 12.35-37.96%, with the pooled estimate of 22.96% (95% CI, 7.82, 38.09). Cardiovascular system drugs were the most commonly implicated medication class. Methods of ADRs detection, age group, setting, and sample size contributed significantly to the heterogeneity of the estimates. CONCLUSION ADRs constitute a significant health problem in the primary care setting. Further research should focus on examining whether ADRs affect subsequent clinical outcomes, particularly in high-risk therapeutic areas. This information may better inform strategies to reduce the burden of ADRs in the primary care setting.
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Affiliation(s)
- Widya N. Insani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Department of Pharmacology and Clinical Pharmacy, Center of Excellence for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Hassan Alwafi
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, Hong Kong
| | - Sarah Chapman
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
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11
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Khalili M, Mesgarpour B, Sharifi H, Golozar A, Haghdoost AA. Estimation of adverse drug reaction reporting in Iran: Correction for underreporting. Pharmacoepidemiol Drug Saf 2021; 30:1101-1114. [PMID: 33772938 DOI: 10.1002/pds.5235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
PROPOSE Underreporting of Adverse Drug Reactions (ADRs) reduces the sensitivity of pharmacovigilance systems. We described ADR reporting and its trend from 1999 to 2017 and estimated the ADR underreporting in the Iranian Pharmacovigilance Center. METHODS We expressed the number of ADR reporting per inhabitants and admissions and their possible trends. Finally, ADR underreporting percentages were estimated by three approaches: prospective studies, literature review, stratification of the country; and the trend of the proportion of ADR per inhabitants was corrected. RESULTS The proportion of ADR reporting was 15.3 per 100 000 inhabitants (95% CI: 15.2, 15.8) and 10.0 per 100 000 admissions (95% CI: 9.8, 10.2) in 2017, and its trend was increasing with 16.3% average change per annum during 19 years. The median of estimated percentages of underreporting was 76.0% (IQR: 64.32-81.35). After the correction, the mean proportion of ADR reporting for 19 years reached from 5.87 to 10.33 per 100 000 inhabitants. CONCLUSIONS The trend of ADRs reporting has been increasing over the 19 years but is still low. This study showed a considerable underreporting of ADR, and about one of four detected ADRs were reported to the pharmacovigilance center from 1999 to 2017.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Mesgarpour
- Department of Public and International Affairs, National Institute for Medical Research Development, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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12
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Mota DM, Vigo Á, Kuchenbecker RDS. [Adverse drug reaction notification forms of the pharmacovigilance systems in Brazil and twelve other Latin-American countries: a comparative analysis]. CIENCIA & SAUDE COLETIVA 2021; 26:1245-1257. [PMID: 33886754 DOI: 10.1590/1413-81232021264.06202019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/05/2019] [Indexed: 11/21/2022] Open
Abstract
The scope of this study was to assess the forms used to report suspected adverse drug reactions (ADR) to the pharmacovigilance system in Brazil and twelve other Latin-American countries. The study comprised three stages. In the first stage, the forms were attributed a score relating to the presence of critical items to generate ADR notification. In the second stage, the variables of the forms were quantified and classified regarding feasibility to contribute to an appropriate assessment of causality. In the last stage, hierarchical clustering was used to identify similar forms. The Venezuelan form achieved the highest score (18 points). The median number of variables in the forms of each country was 41 [26 (Guatemala) to 95 (Brazil)]. Most of the variables of the form were classified as life-critical and the majority contribute as an alternative explanation to causality assessment. Four clusters were identified (1, 2, 3 and 4). The forms of Brazil and Bolivia formed two distinct groups, 1 and 3 respectively. The results of this study indicate the need to change the forms of the different countries studied or even delete some variables, making them more appropriate for the process of assessment of ADR causality.
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Affiliation(s)
- Daniel Marques Mota
- Agência Nacional de Vigilância Sanitária. SIA Trecho 05, Guará. 71205-050 Brasília DF Brasil.
| | - Álvaro Vigo
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul. Porto Alegre RS Brasil
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13
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Population-Based Observational Study of Adverse Drug Event-Related Mortality in the Super-Aged Society of Japan. Drug Saf 2021; 44:531-539. [PMID: 33826081 DOI: 10.1007/s40264-020-01037-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Adverse drug events (ADEs) are a major cause of mortality. OBJECTIVE We examined long-term trends for ADE-related deaths in Japan. METHODS This observational study was conducted using the Japanese Vital Statistics from 1999 to 2016. Data for all ADE-related deaths were extracted using International Classification of Diseases, Tenth Revision codes. We analysed ADE-related deaths by age and sex and calculated crude and age-standardised mortality rates (ASMR) per 100,000 people. We used Joinpoint regression analysis to identify significant changing points in mortality trends and to estimate annual percentage change (APC). RESULTS In total, 16,417 ADE-related deaths were identified. The crude mortality rate for individuals aged ≥ 65 years was higher than that of young individuals. The ASMR per 100,000 people increased from 0.44 in 1999 to 0.64 in 2016. The crude mortality rate increased from 0.44 in 1999 to 1.01 in 2016. The APC of ASMR increased at a rate of 2.8% (95% confidence interval [CI] 1.4-4.2) throughout the study period. In addition, crude mortality increased at a rate of 5.7% (95% CI 4.2-7.3) annually from 1999 to 2016. The ADE-related mortality rate was higher for men than for women during the study period. CONCLUSIONS The number of and trend in ADE-related deaths increased in Japan from 1999 to 2016, particularly in the older population.
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14
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Chiou BL, Ho CC, Yang CC. Hematologic adverse drug reactions leading to hospitalization among cancer patients: A retrospective case-control study. J Chin Med Assoc 2020; 83:784-790. [PMID: 32168075 DOI: 10.1097/jcma.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cancer is one of the leading causes of death worldwide. Despite the rapid evolution of cancer treatment, chemotherapy remains the mainstay in the management of cancer. Chemotherapy can result in various adverse drug reactions (ADRs), which may lead to hospitalization and even life-threatening side-effects. Hematologic ADRs are among the most severe forms of ADR following chemotherapy, as they generally lead to hospitalization. It is important to realize the predictors and outcome of hematologic ADRs in cancer patients. METHODS We conducted a hospital-based case-control study to include all the cancer patients who were hospitalized to receive chemotherapy in Taipei Veterans General Hospital during 2013. Among them the patients rehospitalized after chemotherapy due to neutropenia, leucopenia, or pancytopenia were identified as the study group. Control subjects consisted of hospitalized cancer patients who did not display the aforementioned ADRs. The study and control groups were numbered in the ratio of 1:4 and were age- and gender-matched. Their demographic and clinical characteristics were collected through chart review. Determinants of hematologic ADRs were then analyzed. RESULTS During the study period, we collected a total of 64 patients into the study group and 256 as control subjects. The mean length of hospitalization was 11 days in the study group of patients, which was 5 days longer than that in the control group (p < 0.001). Predictors of hematologic ADR-related hospitalization included history of hematologic ADRs, hypertension, cisplatin treatment, and a Charlson comorbidity score of 2 to 3. CONCLUSION Severe outcomes of hematologic ADRs may increase healthcare costs and decrease patient productivity. Therefore, the determinants of ADR-related hospitalization identified in this study may help improve the quality of healthcare for cancer patients.
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Affiliation(s)
- Be-Ling Chiou
- International Health Program, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chin-Chin Ho
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chen-Chang Yang
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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15
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Thomas G, West MA, Browning M, Minto G, Swart M, Richardson K, McGarrity L, Jack S, Grocott MPW, Levett DZH. Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing. Perioper Med (Lond) 2020; 9:18. [PMID: 32518637 PMCID: PMC7271469 DOI: 10.1186/s13741-020-00148-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023] Open
Abstract
Background The use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative care and enhances shared decision-making. Sex-related differences in physical fitness are reported in non-perioperative literature. However, little attention has been paid to sex-related differences in the context of perioperative CPET. Aim We explored differences in the physical fitness variables reported in a recently published multi-centre study investigating CPET before colorectal surgery. We also report the inclusion rate of females in published perioperative CPET cohorts that are shaping guidelines and clinical practice. Methods We performed a post hoc analysis of the trial data of 703 patients who underwent CPET prior to major elective colorectal surgery. We also summarised the female inclusion rate in peer-reviewed published reports of perioperative CPET. Results Fitness assessed using commonly used perioperative CPET variables—oxygen consumption at anaerobic threshold (AT) and peak exercise—was significantly higher in males than in females both before and after correction for body weight. In studies contributing to the development of perioperative CPET, 68.5% of the participants were male. Conclusion To our knowledge, this is the first study to describe differences between males and females in CPET variables used in a perioperative setting. Furthermore, there is a substantial difference between the inclusion rates of males and females in this field. These findings require validation in larger cohorts and may have significant implications for both sexes in the application of CPET in the perioperative setting.
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Affiliation(s)
- G Thomas
- Department of Intensive Care, Spaarne Hospital, Haarlem, The Netherlands
| | - M A West
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Anaesthesia Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK
| | - M Browning
- Department of Anaesthesia, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone, Kent, UK
| | - G Minto
- Directorate of Anaesthesia, Derriford Hospital, 9th Floor Terence Lewis Building, Plymouth, UK.,Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - M Swart
- Department of Anaesthesia and Critical Care Medicine, Torbay Hospital, Torquay, UK
| | - K Richardson
- STRAPH Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, UK.,Anaesthesia and Intensive Care Medicine, Medway Maritime Hospital, Gillingham, UK
| | - L McGarrity
- Department of Anaesthesia, University Hospital Crosshouse, Kilmarnock, East Ayrshire, Scotland, UK
| | - S Jack
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Mailpoint 810, Tremona Road, Southampton, SO16 6YD UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Mailpoint 27, D Level, Centre Block, Tremona Road, Southampton, SO16 6YD UK
| | - M P W Grocott
- Anaesthesia Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Mailpoint 810, Tremona Road, Southampton, SO16 6YD UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Mailpoint 27, D Level, Centre Block, Tremona Road, Southampton, SO16 6YD UK
| | - D Z H Levett
- Anaesthesia Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Mailpoint 810, Tremona Road, Southampton, SO16 6YD UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Mailpoint 27, D Level, Centre Block, Tremona Road, Southampton, SO16 6YD UK
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16
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Kindstedt J, Svahn S, Sjölander M, Glader EL, Lövheim H, Gustafsson M. Investigating the effect of clinical pharmacist intervention in transitions of care on drug-related hospital readmissions among the elderly: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e036650. [PMID: 32345700 PMCID: PMC7213854 DOI: 10.1136/bmjopen-2019-036650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Drug-related problems (DRPs) are a major cause of unplanned hospital admissions among elderly people, and transitions of care have been emphasised as a key area for improving patient safety. We have designed a complex clinical pharmacist intervention that targets people ≥75 years of age undergoing transitions of care from hospital to home and primary care. The main objective is to investigate if the intervention can reduce the risk of unplanned drug-related readmission within the first 180 days after the person is discharged from hospital. METHODS AND ANALYSIS This is a randomised, controlled, superiority trial with two parallel arms. A total of 700 people ≥75 years will be assigned to either intervention or routine care (control). The intervention, which aims to find and manage DRPs, is initiated within a week of the person being discharged from hospital and combines repeated medical chart reviews, phone interviews and in some cases medication reviews. People in both study arms may have been the subject of a medication review during their ward stay. As the primary outcome, we will measure time until unplanned drug-related readmission within 180 days of leaving hospital and use log rank tests and Cox proportional hazard models to analyse differences between the groups. Further investigations of subgroup effects and adjustments of the regression models will be based on heart failure and cognitive impairment as prognostic factors. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethical Review Board in Umeå (registration numbers 2017-69-31M, 2018-83-32M and 2018-254-32M). We intend to publish the results with open access in international peer-reviewed journals and present our findings at international conferences. The trial is expected to result in more than one published article and form part of two PhD theses. TRIAL REGISTRATION NUMBER NCT03671629.
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Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Sofia Svahn
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Maria Sjölander
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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17
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Kitchen SA, McGrail K, Wickham ME, Law MR, Hohl CM. Emergency department-based medication review on outpatient health services utilization: interrupted time series. BMC Health Serv Res 2020; 20:254. [PMID: 32216791 PMCID: PMC7098150 DOI: 10.1186/s12913-020-05108-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background One in nine emergency department (ED) visits in Canada are caused by adverse drug events, the unintended and harmful effects of medication use. Medication reviews by clinical pharmacists are interventions designed to optimize medications and address adverse drug events to impact patient outcomes. However, the effect of medication reviews on long-term outpatient health services utilization is not well understood. This research studied the effect of medication review performed by clinical pharmacists on long-term outpatient health services utilization. Methods Data included information from 10,783 patients who were part of a prospective, multi-centre quality improvement evaluation from 2011 to 2013. Outpatient health services utilization was defined as total ED visits and physician contacts, aggregated to four physician specialty groups: general and family practitioners (GP); medical specialists; surgical specialists; and imaging and laboratory specialists. During triage, patients deemed high-risk based on their medical history, were systematically allocated to receive either a medication review (n = 6403) or the standard of care (n = 4380). Medication review involved a critical examination of a patient’s medications to identify and resolve medication-related problems and communicate these results to community care providers. Interrupted time series analysis compared the effect of the intervention on health services utilization relative to the standard of care controlling for pre-intervention differences in utilization. Results ED-based pharmacist-led medication review did not result in a significant level or trend change in the primary outcome of total outpatient health services utilization. There were also no differences in the secondary outcomes of primary care physician visits or ED visits relative to the standard of care in the 12 months following the intervention. Our findings were consistent when stratified by age, hospital site, and whether patients were discharged on their index visit. Conclusion This was the first study to measure long-term trends of physician visits following an ED-based medication review. The lack of differences in level and trend of GP and ED visits suggest that pharmacist recommendations may not have been adequately communicated to community-based providers, and/or recommendations may not have affected health care delivery. Future studies should evaluate physician acceptance of pharmacist recommendations and should encourage patient follow-up to community providers.
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Affiliation(s)
- Sophie A Kitchen
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.,Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, BC, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, BC, Canada
| | - Maeve E Wickham
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z9, Canada.,Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, BC, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, BC, Canada
| | - Corinne M Hohl
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 900 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada. .,Department of Emergency Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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18
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Almubark RA, Aljadani RH, Alqahtani AS, Alshammari TM, BinDhim NF. National Cross-Sectional Study of Community-Based Adverse Drug Reactions in Saudi Arabia. Drugs Real World Outcomes 2020; 7:161-170. [PMID: 32215839 PMCID: PMC7221044 DOI: 10.1007/s40801-020-00186-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background An adverse drug reaction (ADR) is a response to a medicine that is not intended and is harmful, and which occurs at normal dose levels for humans. Currently, there are no estimates of the population-based prevalence of ADRs in the Kingdom of Saudi Arabia (KSA). Objective The aims of this study were to (1) estimate the population-based prevalence of ADRs in KSA, (2) describe the ADRs experienced by survey respondents, and (3) investigate the level of awareness of the ADR reporting system. Patients and Methods This was a cross-sectional survey using stratified, population-based sampling conducted at a chain of community pharmacies. Results Analysis was conducted on 5228 surveys; 50.17% of respondents were males, and the mean age was 39 ± 15 years (min = 18, max = 98). The sample prevalence of ADRs was 23.45% (95% CI 22.30–24.60%, P < 0.001). The estimated population prevalence (after weighting) was 28.00% (26.10–30.00%). Gastrointestinal disorders were the most commonly reported ADRs (58.73%), followed by general disorders and administration site conditions (19.74%). The largest drug class that was reported to lead to ADRs was nonsteroidal anti-inflammatory drugs (NSAIDs) (11%). Over 19% of the respondents who experienced an ADR required medical intervention to control the suffering induced by the ADR. Of the respondents who experienced an ADR, 371 (30.26%) were aware of the ADR reporting system but only 53 (14.29%) said that they had filed a report in the system. Conclusions Our study estimated that 28% of the population experienced an ADR over a 1-year period in KSA. Risk factors for ADR included certain chronic disease groups and the use of certain classes of medications. Regulatory authorities in KSA intend to conduct more research and deploy educational interventions to reduce ADR rates in KSA. This will hopefully occur in an international context that promotes the standardized measurement of ADRs in the community. A subset of findings from this report was presented in an oral presentation at the Saudi Food and Drug Authority (SFDA) Annual Conference, September 27, 2018. In addition, a subset of findings from this report were presented on a poster at the International Conference of Pharmacoepidemiology and Therapeutic Risk Management (ICPE), August 27, 2019. Electronic supplementary material The online version of this article (10.1007/s40801-020-00186-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rasha A Almubark
- Saudi Food and Drug Authority, 6336 Northern Ring Branch Rd, 3372, Riyadh, 13312 6336, Saudi Arabia.
| | - Rawabi H Aljadani
- Saudi Food and Drug Authority, 6336 Northern Ring Branch Rd, 3372, Riyadh, 13312 6336, Saudi Arabia
| | - Amani S Alqahtani
- Saudi Food and Drug Authority, 6336 Northern Ring Branch Rd, 3372, Riyadh, 13312 6336, Saudi Arabia
| | - Thamir M Alshammari
- Saudi Food and Drug Authority, 6336 Northern Ring Branch Rd, 3372, Riyadh, 13312 6336, Saudi Arabia.,Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Nasser F BinDhim
- Saudi Food and Drug Authority, 6336 Northern Ring Branch Rd, 3372, Riyadh, 13312 6336, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Abstract
The use of pharmacogenetic information is becoming mainstream with insurance companies and others starting to pay for widescale implementation of this new technology starting with patients who have anxiety and depression. It has been introduced in response to the unpredictability of medication, the high number of adverse drug events, and lack of drug effectiveness. Greater than one-third of patients are identified as having one or more pharmacogenetic variants. Each pharmacogenetic variant may affect the metabolism of several medications used in primary care, in addition to the antidepressant and anti-anxiolytic medications. Pharmacogenetic information is evolving with major international working groups providing continuous updates. It is challenging to incorporate this new information along with all the other variables needed to identify safe and effective drug options within a normal consultation. Medication decision support software is one solution that can help address this.
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Affiliation(s)
- Martin Dawes
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
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20
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Just KS, Dormann H, Böhme M, Schurig M, Schneider KL, Steffens M, Dunow S, Plank-Kiegele B, Ettrich K, Seufferlein T, Gräff I, Igel S, Schricker S, Jaeger SU, Schwab M, Stingl JC. Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED). Eur J Clin Pharmacol 2019; 76:439-448. [DOI: 10.1007/s00228-019-02797-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
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21
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Laurent C, Aho Glele LS, Lazzarotti A, Petit JM, Vergès B, Bouillet B. [Who is at risk for drug-drug interactions in type 2 diabetic patients?]. Presse Med 2019; 48:1576-1578. [PMID: 31761604 DOI: 10.1016/j.lpm.2019.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Claire Laurent
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France
| | - Ludwig Serge Aho Glele
- Centre hospitalier universitaire, service d'épidémiologie et d'hygiène hospitalière, Dijon, France
| | - Aline Lazzarotti
- Centre hospitalier universitaire, service de pharmacie, Dijon, France
| | - Jean Michel Petit
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France; Université de Bourgogne, unité inserm LNC-UMR 1231, Dijon, France
| | - Bruno Vergès
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France; Université de Bourgogne, unité inserm LNC-UMR 1231, Dijon, France
| | - Benjamin Bouillet
- Centre hospitalier universitaire, service d'endocrinologie, diabétologie et maladies métaboliques, Dijon, France; Université de Bourgogne, unité inserm LNC-UMR 1231, Dijon, France.
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22
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Schultheiss JPD, Brand EC, Lamers E, van den Berg WCM, van Schaik FDM, Oldenburg B, Fidder HH. Earlier discontinuation of TNF-α inhibitor therapy in female patients with inflammatory bowel disease is related to a greater risk of side effects. Aliment Pharmacol Ther 2019; 50:386-396. [PMID: 31310690 DOI: 10.1111/apt.15380] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/31/2019] [Accepted: 05/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND In rheumatoid arthritis and psoriasis female sex has been shown to be associated with discontinuation of anti-tumour necrosis factor-α (TNF-α) therapy. AIM To retrospectively assess the association between sex and TNF-α drug persistence in patients with inflammatory bowel disease (IBD). METHODS All IBD patients on anti-TNF-α therapy with a minimum follow-up of 12 months in a single tertiary centre were identified. Patient and treatment characteristics and reasons for anti-TNF-α discontinuation were recorded. Overall and cause-specific drug persistence was analysed with Kaplan-Meier followed by Cox proportional hazards regression models. RESULTS We included 529 patients (49.9% male) with 631 treatment episodes (2280 anti-TNF-α treatment years) and 289 discontinuations of therapy. Female sex (adjusted hazard ratio [aHR] 1.42, 95% confidence interval [CI] 1.16-1.74), greater age at start of therapy per decade (aHR 1.15, 95% CI 1.04-1.27] and dose escalation (aHR 3.74, 95% CI 2.78-5.02) were associated with TNF-α inhibitor discontinuation. Total cohort cause-specific analysis identified female sex to be associated with side effects (aHR 4.05, 95% CI 2.36-6.98) but not to other discontinuation reasons. Adalimumab (aHR 1.70, 95% CI 1.11-2.60) and golimumab (aHR 4.97, 95% CI 2.30-10.74) use and dose-escalation (aHR 7.71, 95% CI 5.28-11.26) were associated with secondary loss of response. CONCLUSION Drug persistence of anti-TNF-α therapy is lower in females as compared to males, mainly because of higher rates of side effects in females. Understanding the sex specific differences in effectiveness and safety of anti-TNF-α compounds can aid physicians in clinical decision-making.
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Affiliation(s)
- Johannes P D Schultheiss
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Eelco C Brand
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Evert Lamers
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Willemijn C M van den Berg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fiona D M van Schaik
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Herma H Fidder
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Aldryhim AY, Alomair A, Alqhtani M, Mahmoud MA, Alshammari TM, Pont LG, Kamal KM, Aljadhey H, Mekonnen AB, Alwhaibi M, Balkhi B, Alhawassi TM. Factors that facilitate reporting of adverse drug reactions by pharmacists in Saudi Arabia. Expert Opin Drug Saf 2019; 18:745-752. [PMID: 31232612 DOI: 10.1080/14740338.2019.1632287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Adverse drug reactions (ADRs) are a pervasive global problem, and its management is integral to patient safety and healthcare quality. Pharmacists play a pivotal role in monitoring and reporting ADRs, which has a direct impact on patient care. The aim of this study was to identify potential factors that facilitate pharmacists in community and hospital settings to report ADRs. Methods: A cross-sectional, online survey using a validated questionnaire was administered to pharmacists working in community and hospital pharmacies in Saudi Arabia. Results: 1,717 community and 153 hospital pharmacists participated in this study. Only 10.2% and 26.8% of community and hospital pharmacists, respectively, admitted ever reporting an ADR. The most reported factors that may facilitate ADRs reporting have included ongoing improvements in therapeutic knowledge about ADRs, attending educational programs with continuous medical education credits, the seriousness of the experienced ADRs and accessibility to patients' medical profile. The impact of peers by seeing colleagues reporting ADRs and ADRs due to herbal or traditional medicine were the least important factors reported by pharmacists. Conclusion: The study identified factors that can effectively address the under-reporting of ADRs by pharmacists. A multi-stakeholder, multi-pronged approach of ADR reporting is needed to develop greater awareness of this issue among pharmacists.
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Affiliation(s)
- Ahmed Y Aldryhim
- a Department of Clinical Pharmacy, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia.,b Department of Pharmaceutics, College of Pharmacy, King Abdulaziz University , Jeddah , Saudi Arabia
| | - Abdulrahman Alomair
- a Department of Clinical Pharmacy, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia.,c National pharmacovigilance Center, Saudi Food and Drug Authority , Riyadh , Saudi Arabia
| | - Meshari Alqhtani
- a Department of Clinical Pharmacy, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia
| | - Mansour A Mahmoud
- d Medication Safety Research Chair, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia.,e Department of Clinical Pharmacy, College of Pharmacy, Taibah University , Medina , Saudi Arabia
| | - Thamir M Alshammari
- c National pharmacovigilance Center, Saudi Food and Drug Authority , Riyadh , Saudi Arabia.,d Medication Safety Research Chair, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia.,f College of Pharmacy, Hail University , Hail , Saudi Arabia
| | - Lisa G Pont
- g Graduate School of Health, University of Technology Sydney , Broadway , Australia
| | - Khalid M Kamal
- h Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy , Pittsburgh , PA , USA
| | - Hisham Aljadhey
- c National pharmacovigilance Center, Saudi Food and Drug Authority , Riyadh , Saudi Arabia.,d Medication Safety Research Chair, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia
| | - Alemayehu B Mekonnen
- d Medication Safety Research Chair, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia
| | - Monira Alwhaibi
- a Department of Clinical Pharmacy, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia.,d Medication Safety Research Chair, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia
| | - Bander Balkhi
- a Department of Clinical Pharmacy, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia
| | - Tariq M Alhawassi
- a Department of Clinical Pharmacy, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia.,d Medication Safety Research Chair, College of Pharmacy, King Saud University , Riyadh , Saudi Arabia
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Moore VR, Glassman PA, Au A, Good CB, Leadholm TC, Cunningham FE. Adverse drug reactions in the Veterans Affairs healthcare system: Frequency, severity, and causative medications analyzed by patient age. Am J Health Syst Pharm 2019; 76:312-319. [PMID: 30753290 DOI: 10.1093/ajhp/zxy059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose Adverse drug events (ADEs) in the U.S. Department of Veterans Affairs (VA) were evaluated, and differences in age group report rates and reported medications in different age groups were assessed. Methods We utilized the VA Adverse Drug Event Reporting System (ADERS) to assess 10-year age groups regarding ADE reporting rates, event severity, and associated reported medications. Data were derived from 484,351 ADE reports from 395,703 patients included in VA ADERS from 2009 through 2016. Results Reported rates of ADEs per 10,000 unique users demonstrated a nonlinear relationship with age, peaking in the group aged 60-69 years (148.6 reports/10,000 unique users) and declining thereafter. However, the percentage of adverse events reported as severe consistently rose with age group (3% in patients age 20-29 years versus 6% in patients older than 90 years). The types of medications reported as causative agents shifted over time from predominantly mental health and pain medications in younger veterans (e.g., age 20-29 years) to medications for chronic diseases in older cohorts (e.g., age 60-69 years). Conclusion An analysis of VA ADE reports revealed a nonlinear relationship between age and events, with events peaking at age 60-69 years. Rates of severe ADEs increased in older age groups. Drugs commonly associated with ADEs tended to be those primarily used for mental health and pain treatment in younger patients and those used to address chronic disease states in older patients.
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Affiliation(s)
- Von R Moore
- Veterans Affairs Center for Medication Safety/Pharmacy Benefits Management Services, Hines, IL
| | - Peter A Glassman
- Veterans Affairs Center for Medication Safety/Pharmacy Benefits Management Services, Hines, IL.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Anthony Au
- Veterans Affairs Center for Medication Safety/Pharmacy Benefits Management Services, Hines, IL
| | - Chester B Good
- Veterans Affairs Center for Medication Safety/Pharmacy Benefits Management Services, Hines, IL.,Veterans Affairs Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Thomas C Leadholm
- Veterans Affairs Pharmacy Benefits Management Services and Consolidated Mail Outpatient Pharmacy, Tucson, AZ
| | - Francesca E Cunningham
- Veterans Affairs Center for Medication Safety/Pharmacy Benefits Management Services, Hines, IL
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25
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Waldman L, Shuman C, Cohn I, Kaiser A, Chitayat D, Wasim S, Hazell A. Perplexed by PGx? Exploring the impact of pharmacogenomic results on medical management, disclosures and patient behavior. Pharmacogenomics 2019; 20:319-329. [DOI: 10.2217/pgs-2018-0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pharmacogenomic (PGx) tests represent significant advances in precision medicine. Our aim was to explore perceptions following the return of PGx results, medication management, and disclosure to providers. We surveyed clients who had PGx testing and conducted a chart review of PGx results. Respectively, 84% and 94% of participants found pre- and post-test genetic counseling helpful. There was a significant difference in disclosure, while 6% disclosed results to a pharmacist, 50% disclosed to a physician. Qualitative analysis identified three themes: 1) psychological response; 2) perceived utility; 3) experiences with disclosure. Our study supports the provision of genetic counseling for a non-disease related genetic test. Benefits of PGx testing can be optimized by the collaboration of physicians, pharmacists, genetic counselors and patients.
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Affiliation(s)
- Larissa Waldman
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Shuman
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Iris Cohn
- Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amy Kaiser
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Genetic Counselling, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Prenatal Diagnosis & Medical Genetics Program, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Syed Wasim
- Fred A Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allison Hazell
- Medcan Health Management, Inc., Toronto, Ontario, Canada
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26
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Hernández MH, Mestres C, Modamio P, Junyent J, Costa-Tutusaus L, Lastra CF, Mariño EL. Adverse Drug Events in Patients with Dementia and Neuropsychiatric/Behavioral, and Psychological Symptoms, a One-Year Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E934. [PMID: 30875907 PMCID: PMC6466294 DOI: 10.3390/ijerph16060934] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 01/19/2023]
Abstract
Older people usually present with adverse drug events (ADEs) with nonspecific symptoms such as cognitive decline, recurrent falls, reduced mobility, and/or major deterioration. The aims of this study were to assess the ADEs of patients with dementia and presenting neuropsychiatric/behavioral, and psychological symptoms in dementia (BPSD) and to categorize and identify the principal factors that allow to prevent ADEs, and separately ADEs that result in falls. To that end, a one-year prospective study in a psychogeriatric ward (July 2015 to July 2016) was performed. All patients admitted to this ward were eligible for enrolment. Patients who met any of the following criteria were excluded from the study: Patients without cognitive impairment, a length of stay under 7 days, and palliative or previous psychiatric pathology. We included 65 patients (60% women, 84.9 years ± 6.7) with mild to moderate cognitive impairment, moderate to severe functional dependence, and a high prevalence of geriatric syndromes and comorbidity. A total of 87.7% were taking five or more drugs (mean 9.0 ± 3.1). ADEs were identified during the interdisciplinary meeting and the follow up by clinical record. Sixty-eight ADEs (81.5% patients) were identified, of which 73.5% were not related to falls. From these, 80% were related to drugs of the nervous system. The Naranjo algorithm determined that 90% of ADEs were probable. The severity of the ADEs was Category E in 34 patients (68%). The number of preventable ADE according to the Schumork⁻Thornton test was 58%. The main ADE was drowsiness/somnolence (27.7%). ADEs related to falls represented a 26.5%. The balance between effective treatment and safety is complex in these patients. A medication review in interdisciplinary teams is an essential component to optimize safety prevention.
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Affiliation(s)
- Marta H Hernández
- Pharmacy Department, Grup Mutuam, 08024 Barcelona, Spain.
- School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain.
| | - Conxita Mestres
- School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain.
| | - Pilar Modamio
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
| | | | - Lluís Costa-Tutusaus
- School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain.
| | - Cecilia F Lastra
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.
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Greil W, Zhang X, Stassen H, Grohmann R, Bridler R, Hasler G, Toto S, Bleich S, Kasper S. Cutaneous adverse drug reactions to psychotropic drugs and their risk factors - a case-control study. Eur Neuropsychopharmacol 2019; 29:111-121. [PMID: 30424913 DOI: 10.1016/j.euroneuro.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/11/2018] [Accepted: 10/23/2018] [Indexed: 01/01/2023]
Abstract
Cutaneous adverse drug reactions (CADRs) in patients with psychotropic drugs are common. Large studies on the relevant drugs and other risk factors are still scarce. 594 cases of severe CADRs ("cases") were compared with 8085 cases of other adverse drug reactions ("non-cases") documented in a pharmacovigilance program in psychiatry (AMSP) from 1993 to 2014. Logistic regression was carried out to determine risk factors and between-drug differences. CADRs were relatively more prevalent in patients treated with clomipramine, maprotiline, carbamazepine, lamotrigine, acamprosate, clomethiazole and disulfiram as well as with antidepressants and anticonvulsants as drug classes (p < 0.01). For these drugs, significantly more women were found in patients using maprotiline, lamotrigine (not carbamazepine) and in the groups of antidepressants, tricyclics and anticonvulsants (p < 0.01). Women were more vulnerable to CADRs (67% in cases and 56% in non-cases, p < 0.01). The significantly higher rate of CADRs in women was mainly observed under age of 50 years, i.e. during female reproductive years. In a multivariate logistic regression, female sex, the diagnostic group ICD F1 (substance abuse), maprotiline, carbamazepine, lamotrigine and clomethiazole were identified as risk factors of CADRs. The case/non-case approach allowed to identify risk factors based on empirical data rather than experts' evaluations. The new findings of substance abuse and clomethiazole as risk factors for CADRs have to be confirmed in further studies. Since CADRs can be life-threatening, it is important to be aware of risk factors, especially women during their reproductive period and with lamotrigine treatment.
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Affiliation(s)
- Waldemar Greil
- Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr. 7, Munich D-80331, Germany; Psychiatric Hospital, Kilchberg, Zurich, Switzerland.
| | - Xueqiong Zhang
- Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr. 7, Munich D-80331, Germany; Psychiatric Hospital, Kilchberg, Zurich, Switzerland
| | - Hans Stassen
- Psychiatric Hospital, Kilchberg, Zurich, Switzerland; Institute for Response-Genetics, Psychiatric University Hospital (KPPP), Zurich, Switzerland
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilian University, Nussbaumstr. 7, Munich D-80331, Germany
| | - René Bridler
- Psychiatric Hospital, Kilchberg, Zurich, Switzerland
| | - Gregor Hasler
- Division of Molecular Psychiatry, University Psychiatry Department (UPD), University of Bern, Bern, Switzerland
| | - Sermin Toto
- Department of Psychiatry, Socialpsychiatry & Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Socialpsychiatry & Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Muriel J, Margarit C, Barrachina J, Ballester P, Flor A, Morales D, Horga JF, Fernández E, Peiró A. Pharmacogenetics and prediction of adverse events in prescription opioid use disorder patients. Basic Clin Pharmacol Toxicol 2018; 124:439-448. [DOI: 10.1111/bcpt.13155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/11/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Javier Muriel
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Occupational Observatory Miguel Hernández University of Elche Elche Spain
| | - César Margarit
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Pain Unit Department of Health of Alicante‐General Hospital Alicante Spain
| | - Jordi Barrachina
- Occupational Observatory Miguel Hernández University of Elche Elche Spain
| | - Pura Ballester
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Occupational Observatory Miguel Hernández University of Elche Elche Spain
| | - Andrea Flor
- Pain Unit Department of Health of Alicante‐General Hospital Alicante Spain
| | - Domingo Morales
- Operations Research Centre Miguel Hernández University of Elche Elche Spain
| | - José F. Horga
- Clinical Pharmacology Unit Department of Health of Alicante‐General Hospital Alicante Spain
| | - Eduardo Fernández
- Biomedical Neuroengineering Research Group (nBio) Systems Engineering and Automation Department of Miguel Hernandez University Elche Spain
| | - Ana M. Peiró
- Neuropharmacology on Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
- Pain Unit Department of Health of Alicante‐General Hospital Alicante Spain
- Clinical Pharmacology Unit Department of Health of Alicante‐General Hospital Alicante Spain
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Martins AC, Giordani F, Guaraldo L, Tognoni G, Rozenfeld S. Adverse drug events identified in hospitalized patients in Brazil by International Classification of Diseases (ICD-10) code listings. CAD SAUDE PUBLICA 2018; 34:e00222417. [DOI: 10.1590/0102-311x00222417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022] Open
Abstract
Studies of adverse drug events (ADEs) are important in order not to jeopardize the positive impact of pharmacotherapy. These events have substantial impact on the population morbidity profiles, and increasing health system operating costs. Administrative databases are an important source of information for public health purposes and for identifying ADEs. In order to contribute to learning about ADE in hospitalized patients, this study examined the potential of applying ICD-10 (10th revision of the International Classification of Diseases) codes to a national database of the public health care system (SIH-SUS). The study comprised retrospective assessment of ADEs in the SIH-SUS administrative database, from 2008 to 2012. For this, a list of ICD-10 codes relating to ADEs was built. This list was built up by examining lists drawn up by other authors identified by bibliographic search in the MEDLINE and LILACS and consultations with experts. In Brazil, 55,604,537 hospital admissions were recorded in the SIH-SUS, between 2008 and 2012, of which 273,440 (0.49%) were related to at least one ADE. The proportions and rates seem to hold constant over the study period. Fourteen out of 20 most frequent ADEs were identified in codes relating to mental disorders. Intoxications figure as the second most frequently recorded group of ADEs in the SIH-SUS, comprising 76,866 hospitalizations. Monitoring of ADEs in administrative databases using ICD-10 codes is feasible, even in countries with information systems under construction, and can be an innovative tool to complement drug surveillance strategies in place in Brazil, as well as in others countries.
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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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31
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Ock M, Kim HJ, Jeon B, Kim YJ, Ryu HM, Lee MS. Identifying Adverse Events Using International Classification of Diseases, Tenth Revision Y Codes in Korea: A Cross-sectional Study. J Prev Med Public Health 2018; 51:15-22. [PMID: 29397642 PMCID: PMC5797717 DOI: 10.3961/jpmph.17.118] [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: 08/11/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives The use of administrative data is an affordable alternative to conducting a difficult large-scale medical-record review to estimate the scale of adverse events. We identified adverse events from 2002 to 2013 on the national level in Korea, using International Classification of Diseases, tenth revision (ICD-10) Y codes. Methods We used data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We relied on medical treatment databases to extract information on ICD-10 Y codes from each participant in the NHIS-NSC. We classified adverse events in the ICD-10 Y codes into 6 types: those related to drugs, transfusions, and fluids; those related to vaccines and immunoglobulin; those related to surgery and procedures; those related to infections; those related to devices; and others. Results Over 12 years, a total of 20 817 adverse events were identified using ICD-10 Y codes, and the estimated total adverse event rate was 0.20%. Between 2002 and 2013, the total number of such events increased by 131.3%, from 1366 in 2002 to 3159 in 2013. The total rate increased by 103.9%, from 0.17% in 2002 to 0.35% in 2013. Events related to drugs, transfusions, and fluids were the most common (19 446, 93.4%), followed by those related to surgery and procedures (1209, 5.8%) and those related to vaccines and immunoglobulin (72, 0.3%). Conclusions Based on a comparison with the results of other studies, the total adverse event rate in this study was significantly underestimated. Improving coding practices for ICD-10 Y codes is necessary to precisely monitor the scale of adverse events in Korea.
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Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Bomin Jeon
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ye-Jee Kim
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyun Mi Ryu
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Moo-Song Lee
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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32
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El-Metwally A. Current status, and future prospects of pharmaco-epidemiology and post-marketing surveillance in Saudi Arabia: A review of literature. Saudi Pharm J 2018; 26:629-633. [PMID: 29989016 PMCID: PMC6035327 DOI: 10.1016/j.jsps.2018.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 02/26/2018] [Indexed: 11/28/2022] Open
Abstract
Background Pharmacoepidemiology is the concept used for evaluating the impact of drugs among a large number of people in the post-marketing phase. The use of this concept makes it increasingly necessary to detect the recurrence of drug-related anomalies that mostly occur through health care professionals or patients themselves. Pharmacoepidemiology is important since it helps to provide the right balance of benefits versus risks of the drug products while remaining an excellent tool to prepare the risk/benefit balance profile. Aim The objective of this study is to review and explore the current status and future prospects of pharmacoepidemiology and post-marketing surveillance in Saudi Arabia. Methods A literature review has been conducted using keywords such as pharmacoepidemiology’; ‘post-marketing’; ‘surveillance’; ‘Saudi Arabia’; ‘ADRs’; and ‘pharmacovigilance’. The study refines its focus on 13 pharmacoepidemiology and post-marketing surveillance research studies conducted in Saudi Arabia using the databases; Embase, PubMed, EBSCOhost, MEDLINE, and AMED. Results Pharmacoepidemiology and post-marketing surveillance creates a body of research in Saudi Arabia, but within a restricted scope. The studies that were reviewed assessed the challenge from various perspectives. Lack of knowledge, post-marketing surveillance, ADR reporting, and increased use of generic products were reported. Conclusion The current level of research may be widened and increased through improving the process of ADRs reporting system. More research needs to be conducted based on nation-wide observational studies. Collaboration among medical professionals, academics and industries should continue to establish a more efficient and consistent post-marketing surveillance system.
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Affiliation(s)
- Ashraf El-Metwally
- Epidemiology & Biostatistics Department, College of Public Health & Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Dimitrow M, Puustinen J, Viikari P, Puumalainen E, Vahlberg T, Airaksinen MSA, Kivelä SL. Can Practical Nurses Identify Older Home Care Clients at Risk of Drug-Related Problems-Geriatricians' Appraisal of Their Risk Screenings: A Pilot Study. J Pharm Technol 2018; 34:99-108. [PMID: 34861022 PMCID: PMC6580731 DOI: 10.1177/8755122518756332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). Objective: Establish the sensitivity of practical nurse (PN) administered DRP risk assessment tool (DRP-RAT) compared with geriatrician's assessment of the medical record. Identify the clinically most significant DRPs needing action. Methods: Twenty-six PNs working in HC of Härkätie Health Center in Lieto, Finland, 46 HC clients (≥65 years), and a geriatrician participated in this pilot study. The geriatrician reviewed HC clients' medications using 3 different methods. The reviews were based on the following: (1) the PN's risk screening (ie, PN-completed DRP-RAT) and medication list, (2) health center's medical records, and (3) methods 1 and 2 together. The main outcome was the number of "at-risk patients" (ie, the patient is at risk of clinically significant DRPs) by using each review method. Secondary outcomes were clinically most significant DRP-risk predicting factors identified by the geriatrician. Results: The geriatrician reviewed 45 clients' medications using all 3 methods. Based on PN-completed DRP-RAT and medication list, 93% (42/45) of the clients were classified as "at-risk patients." Two other review methods resulted in 45/45 (100%) "at-risk patients." Symptoms suggestive of adverse drug reactions were the most significant risk predicting factors. Small sample size limits the generalizability of the results. Conclusions: The PN-completed DRP-RAT was able to provide clinically important timely patient information for clinical decision making. DRP-RAT could make it possible to more effectively involve PNs in medication risk management among older HC clients.
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Affiliation(s)
| | - Juha Puustinen
- University of Helsinki, Helsinki,
Finland
- Satakunta Central Hospital, Pori,
Finland
| | | | | | | | | | - Sirkka-Liisa Kivelä
- University of Helsinki, Helsinki,
Finland
- University of Turku, Turku,
Finland
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Rydberg DM, Mejyr S, Loikas D, Schenck-Gustafsson K, von Euler M, Malmström RE. Sex differences in spontaneous reports on adverse drug events for common antihypertensive drugs. Eur J Clin Pharmacol 2018; 74:1165-1173. [PMID: 29804162 PMCID: PMC6096710 DOI: 10.1007/s00228-018-2480-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/10/2018] [Indexed: 12/21/2022]
Abstract
Purpose To explore sex differences in spontaneously reported adverse drug events (ADEs) for antihypertensives in routine care. Methods A cross sectional analysis combining number of reports from the national pharmacovigilance database with data from the Swedish Prescribed Drug Register, from 2005 to 2012 for ACE inhibitors (ACE-I) and angiotensin receptor blockers (ARB), with or without thiazide, diuretics (thiazides, potassium-sparing agents, sulfonamides, aldosterone antagonists), selective betablockers, and dihydropyridine calcium-channel-blockers (DHPs). The total number of reports was adjusted to exposed patients and dispensed DDDs among women and men. Dose exposures, co-medications, and co-prescriptions were also analyzed. Results In women, a higher prevalence of ADE-reports was seen in ACE-I (odds ratio, OR 1.21; 95% CI 1.09–1.35), ACE-I-combinations (OR 1.61; 1.44–1.79), ARB-combinations (OR 2.12; 1.47–3.06), thiazides (OR 1.78; 1.33–2.39), diuretics and potassium-sparing agents (OR 1.62; 1.22–2.17), and DHPs (OR 1.40; 1.17–1.67), with a potential linkage to dose exposure. For aldosterone antagonists, we observed a higher prevalence of ADE reports in men (OR 0.75; 0.59–0.97) but without any sex difference in dose exposure. Conclusions This ecological study of reported ADEs showed a higher prevalence of reports in women in six out of ten groups of antihypertensive drugs, and this may potentially be linked to dose exposure. Aldosterone antagonists was the only group with a higher prevalence of ADE-reports in men with a similar dose exposure between women and men. Electronic supplementary material The online version of this article (10.1007/s00228-018-2480-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana M Rydberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. .,Clinical Pharmacology, Drug Evaluation Unit, L7:03, Karolinska University Hospital Solna, 17176, Stockholm, Sweden.
| | - Stefan Mejyr
- Clinical Pharmacology, Drug Evaluation Unit, L7:03, Karolinska University Hospital Solna, 17176, Stockholm, Sweden
| | - Desirée Loikas
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
| | | | - Mia von Euler
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Clinical Pharmacology, Drug Evaluation Unit, L7:03, Karolinska University Hospital Solna, 17176, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Rickard E Malmström
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Clinical Pharmacology, Drug Evaluation Unit, L7:03, Karolinska University Hospital Solna, 17176, Stockholm, Sweden
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Lee J, Noh Y, Lee S. Evaluation of preventable adverse drug reactions by implementation of the nationwide network of prospective drug utilization review program in Korea. PLoS One 2018; 13:e0195434. [PMID: 29641617 PMCID: PMC5895028 DOI: 10.1371/journal.pone.0195434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A prospective Drug Utilization Review (DUR) program has been implemented in Korea to improve the quality and safety of medication use. OBJECTIVE To evaluate the influence of the DUR program in reducing incidence of preventable adverse drug reactions (pADRs). METHODS This study was performed using administrative data from the Health Insurance Review and Assessment Service (HIRA). The claims data for all adult patients with adverse drug events (ADE)-related diagnoses from 2009 to 2014 were obtained. Incidence rates of first-time and repeat pADRs prior to and after DUR program implementation were evaluated. Quarterly trends in incidence rates of overall ADE, allergic reactions, and ADRs were analyzed. RESULTS Data extraction covering the period from 2009 to 2014 led to the identification of 3,927,662 records. First-time pADR rates decreased gradually after implementation of the DUR program (change in slope: -0.016, p = 0.02). The program had a similar influence on repeat pADR rates (change in slope: -0.006, p≤0.01). The program did not decrease rates of first-time or repeat allergic reactions (change in slope: 0.018, p = 0.07 and 0.003, p = 0.04, respectively). In the cohort aged ≤65 years, first-time pADR rate reduction was significant (28.2% [27.1-29.3] in ≤18 years, and 19.8% [18.1-21.5] in 19-64 years). In contrast, first-time pADR rate was increased by 0.6% [-0.7-1.9] in patients ≥65 years. CONCLUSION Implementation of the prospective DUR program effectively reduced the number of pADRs. In the future, to reduce non-preventable ADRs such as allergic reactions, provision of clinical information including allergy history should be added to the DUR program.
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Affiliation(s)
- Jimin Lee
- College of Pharmacy, Ajou University, Suwon, South Korea
| | - Yoojin Noh
- College of Pharmacy, Ajou University, Suwon, South Korea
| | - Sukhyang Lee
- College of Pharmacy, Ajou University, Suwon, South Korea
- * E-mail:
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Costa MJ, Herdeiro MT, Polónia JJ, Ribeiro-Vaz I, Botelho C, Castro E, Cernadas J. Type B adverse drug reactions reported by an immunoallergology department. Pharm Pract (Granada) 2018; 16:1070. [PMID: 29619134 PMCID: PMC5881478 DOI: 10.18549/pharmpract.2018.01.1070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/27/2018] [Indexed: 11/14/2022] Open
Abstract
Objective: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC). Methods: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed. Results: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%). Conclusions: Reported ADR to NPC by the Drug Alert Unit were mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategies to prevent the clinical and economic consequences of ADR.
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Affiliation(s)
- Maria J Costa
- Department of Community Medicine, Information and Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Maria T Herdeiro
- Institute for Research in Biomedicine - iBiMED, Department of Medical Sciences, University of Aveiro. Aveiro (Portugal).
| | - Jorge J Polónia
- Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Inês Ribeiro-Vaz
- Center for Health Technology and Services Research; & Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto. Porto (Portugal).
| | - Cármen Botelho
- Immunoallergology Department, Hospital São João. Porto (Portugal).
| | - Eunice Castro
- Immunoallergology Department, Hospital São João. Porto (Portugal).
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Mortality among patients due to adverse drug reactions that lead to hospitalization: a meta-analysis. Eur J Clin Pharmacol 2018; 74:819-832. [PMID: 29556685 DOI: 10.1007/s00228-018-2441-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of mortality among patients due to adverse drug reactions that lead to hospitalisation (fatal ADRAd), to explore the heterogeneity in its estimation through subgroup analysis of study characteristics, and to identify system-organ classes involved and causative drugs for fatal ADRAd. METHODS We identified prospective ADRAd-related studies via screening of the PubMed and Google Scholar databases with appropriate key terms. We estimated the prevalence of fatal ADRAd using a double arcsine method and explored heterogeneity using the following study characteristics: age groups, wards, study region, ADR definitions, ADR identification methods, study duration and sample size. We examined patterns of fatal ADRAd and causative drugs. RESULTS Among 312 full-text articles assessed, 49 studies satisfied the selection criteria and were included in the analysis. The mean prevalence of fatal ADRAd was 0.20% (95% CI: 0.13-0.27%; I2 = 93%). The age groups and study wards were the important heterogeneity modifiers. The mean fatal ADRAd prevalence varied from 0.01% in paediatric patients to 0.44% in the elderly. Subgroup analysis showed a higher prevalence of fatal ADRAd in intensive care units, emergency departments, multispecialty wards and whole hospitals. Computer-based monitoring systems in combination with other methods detected higher mortality. Intracranial haemorrhage, renal failure and gastrointestinal bleeding accounted for more than 50% of fatal ADRAdcases. Warfarin, aspirin, renin-angiotensin system (RAS) inhibitors and digoxin accounted for 60% of fatal ADRAd. CONCLUSIONS ADRAd is an important cause of mortality. Strategies targeting the safer use of warfarin, aspirin, RAS inhibitors and digoxin could reduce the large number of fatal ADRAdcases.
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Angamo MT, Chalmers L, Curtain CM, Bereznicki LRE. Adverse-Drug-Reaction-Related Hospitalisations in Developed and Developing Countries: A Review of Prevalence and Contributing Factors. Drug Saf 2017; 39:847-57. [PMID: 27449638 DOI: 10.1007/s40264-016-0444-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adverse drug reactions (ADRs) are one of the leading causes of hospital admissions and morbidity in developed countries and represent a substantial burden on healthcare delivery systems. However, there is little data available from low- and middle-income countries. This review compares the prevalence and characteristics of ADR-related hospitalisations in adults in developed and developing countries, including the mortality, severity and preventability associated with these events, commonly implicated drugs and contributing factors. A literature search was conducted via PubMed, Scopus, Web of Science, Embase, ProQuest and Google Scholar to find articles published in English from 2000 to 2015. Relevant observational studies were included. The median (with interquartile range [IQR]) prevalence of ADR-related hospitalisation in developed and developing countries was 6.3 % (3.3-11.0) and 5.5 % (1.1-16.9), respectively. The median proportions of preventable ADRs in developed and developing countries were 71.7 % (62.3-80.0) and 59.6 % (51.5-79.6), respectively. Similarly, the median proportions of ADRs resulting in mortality in developed and developing countries were 1.7 % (0.7-4.8) and 1.8 % (0.8-8.0), respectively. Commonly implicated drugs in both settings were antithrombotic, non-steroidal anti-inflammatory and cardiovascular drugs. Older age, female gender, number of medications, renal impairment and heart failure were reported to be associated with an increased risk for ADR-related hospitalisation in both settings while HIV/AIDS was implicated in developing countries only. The majority of ADRs were preventable in both settings, highlighting the importance of improving medication use, particularly in vulnerable patient groups such as the elderly, patients with multiple comorbidities and, in developing countries, patients with HIV/AIDS.
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Affiliation(s)
| | - Leanne Chalmers
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Colin M Curtain
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Luke R E Bereznicki
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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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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Filkova M, Carvalho J, Norton S, Scott D, Mant T, Molokhia M, Cope A, Galloway J. Polypharmacy and Unplanned Hospitalizations in Patients with Rheumatoid Arthritis. J Rheumatol 2017; 44:1786-1793. [PMID: 28966210 DOI: 10.3899/jrheum.160818] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Polypharmacy (PP), the prescribing of multiple drugs for an individual, is rising in prevalence. PP associates with an increased risk of adverse drug reactions (ADR) and hospital admissions. We investigated the relationship between PP, characteristics of rheumatoid arthritis (RA), and the risk of unplanned hospital admissions. METHODS Patients from a hospital RA cohort were retrospectively analyzed. Information was collected from electronic medical records. Cox proportional hazards were used to compare hospitalization risk according to levels of PP. Admissions were adjudicated to determine whether an ADR was implicated. RESULTS The study included 1101 patients; the mean number of all medications was 5. PP correlated with increasing age, disease duration, disease activity, and disability. At least 1 unplanned admission occurred for 16% of patients. Patients taking ≥ 10 medications had an adjusted HR for hospitalization of 3.1 (95% CI 2.1-4.5), compared to those taking 0-5 medications. Corticosteroid use associated with a doubling in adjusted risk of admission of 1.7 (95% CI 1.2-2.4). The most common reason for hospitalization was infection (28%). While in half of all admissions an ADR was a possible contributing factor, only 2% of admissions were found to directly result from an ADR. CONCLUSION PP is common in RA and is a prognostic marker associated with increased risk of acute hospitalizations. Our data suggest that PP may be an indicator of comorbidity burden rather than a contributing cause of a drug-related toxicity. PP should be monitored to minimize inappropriate combination of prescribed medications. PP may be a useful predictor of clinical outcomes in epidemiologic studies.
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Affiliation(s)
- Maria Filkova
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - João Carvalho
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Sam Norton
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - David Scott
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Tim Mant
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Mariam Molokhia
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - Andrew Cope
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal.,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London
| | - James Galloway
- From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal. .,M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London.
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Allin S, Rudoler D, Laporte A. Does Increased Medication Use among Seniors Increase Risk of Hospitalization and Emergency Department Visits? Health Serv Res 2017; 52:1550-1569. [PMID: 27678072 PMCID: PMC5517678 DOI: 10.1111/1475-6773.12560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the extent of the health risks of consuming multiple medications among the older population. DATA SOURCES/STUDY SETTING Secondary data from the period 2004-2006. The study setting was the province of Ontario, Canada, and the sample consisted of individuals aged 65 years or older who responded to a national health survey. STUDY DESIGN We estimated a system of equations for inpatient and emergency department (ED) services to test the marginal effect of medication use on hospital services. We controlled for endogeneity in medication use with a two-stage residual inclusion approach appropriate for nonlinear models. PRINCIPAL FINDINGS Increased prescription drug use has the effect of increasing the likelihood of both being admitted into hospital and visiting a hospital ED. Each additional medication is associated with a 2-3 percent increase in the likelihood of hospitalization and a 3-4 percent increase in the likelihood of an ED visit, after controlling for past utilization, health status, the endogeneity of medication use, and the unobserved factors that may affect the use of both services. CONCLUSIONS Multiple medications appear to increase the risk of hospitalization among seniors covered by a universal prescription drug plan. These results raise questions about the appropriateness of medication use and the need for increased oversight of current prescribing practices.
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Affiliation(s)
- Sara Allin
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
| | - David Rudoler
- Centre for Addiction and Mental HealthTorontoONCanada
| | - Audrey Laporte
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada
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En route to precision medicine through the integration of biological sex into pharmacogenomics. Clin Sci (Lond) 2017; 131:329-342. [PMID: 28159880 DOI: 10.1042/cs20160379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/15/2016] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
Abstract
Frequently, pharmacomechanisms are not fully elucidated. Therefore, drug use is linked to an elevated interindividual diversity of effects, whether therapeutic or adverse, and the role of biological sex has as yet unrecognized and underestimated consequences. A pharmacogenomic approach could contribute towards the development of an adapted therapy for each male and female patient, considering also other fundamental features, such as age and ethnicity. This would represent a crucial step towards precision medicine and could be translated into clinical routine. In the present review, we consider recent results from pharmacogenomics and the role of sex in studies that are relevant to cardiovascular therapy. We focus on genome-wide analyses, because they have obvious advantages compared with targeted single-candidate gene studies. For instance, genome-wide approaches do not necessarily depend on prior knowledge of precise molecular mechanisms of drug action. Such studies can lead to findings that can be classified into three categories: first, effects occurring in the pharmacokinetic properties of the drug, e.g. through metabolic and transporter differences; second, a pharmacodynamic or drug target-related effect; and last diverse adverse effects. We conclude that the interaction of sex with genetic determinants of drug response has barely been tested in large, unbiased, pharmacogenomic studies. We put forward the theory that, to contribute towards the realization of precision medicine, it will be necessary to incorporate sex into pharmacogenomics.
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The GENDER ATTENTION Observational Study: Gender and Hormonal Status Differences in the Incidence of Adverse Events During Cyclosporine Treatment in Psoriatic Patients. Adv Ther 2017; 34:1349-1363. [PMID: 28432647 PMCID: PMC5487861 DOI: 10.1007/s12325-017-0526-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 11/17/2022]
Abstract
Introduction Female sex has been shown to be a risk factor for the development of adverse drug reactions; however, this has not been studied for cyclosporine (CsA). The aim of this study was to investigate, in Italian dermatological practice, the influence of gender and menopause and related hormones on the incidence of adverse events (AEs) during CsA treatment in psoriatic patients. Methods Multicenter, prospective, observational study conducted from May 2011 to June 2013. Patients with plaque psoriasis, undergoing a new CsA administration course, or about to start it, were enrolled in the outpatient clinics of Italian dermatological centers. During the 2–6 months of study duration, patients had to note all AEs that occurred in a diary that was reviewed by the investigators at the follow-up visit. Sex hormone levels were measured within 7 days from the start date of a menstrual cycle. Results A total of 969 adult psoriatic patients were enrolled in the study, divided into four cohorts: fertile women and corresponding age-matched men; postmenopausal women and corresponding age-matched men. A significant difference in the percentage of patients with AEs was observed between fertile and postmenopausal women, but not between women and age-matched men. AE incidence rate was about 37% higher in fertile women than in age-matched men and about 18% higher in postmenopausal women than in age-matched men, but differences were not statistically significant. Incidence rate ratio of fertile vs. postmenopausal women was 0.67, reaching statistical significance. AEs were mild or moderate in severity in the great majority of patients of all cohorts and postmenopausal women had significantly less grade 1–2 AEs compared to fertile women, but more grade 3–4 AEs. FSH levels were significantly higher in postmenopausal women reporting no AEs, and DHEA sulfate levels were about 10% higher in men with no AEs, compared to those reporting at least one AE. Cortisol levels were slightly though significantly higher in postmenopausal women with no AE. Conclusions A better understanding of sex- and hormone-related influences on drug responses may help to improve drug safety and efficacy, by permitting one to tailor pharmacological treatments to individual subjects or defined patient cohorts. Funding Novartis Farma S.p.A., Italy.
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Scripcaru G, Mateus C, Nunes C. A decade of adverse drug events in Portuguese hospitals: space-time clustering and spatial variation in temporal trends. BMC Pharmacol Toxicol 2017; 18:34. [PMID: 28486949 PMCID: PMC5424420 DOI: 10.1186/s40360-017-0140-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study is to identify the distribution by municipalities of adverse drug events (ADE) in Portugal, including adverse drug reactions (ADR) and accidental poisoning by drugs (AP), on municipality/years ADE rate clustering. Also we identify areas with different trends in time. Methods We used a national dataset of public hospital discharges in Continental Portugal from 2004 to 2013. Events were identified based on codes: from E930 to E949.9 (ADR) and from E850 to E858.9 (AP). Space-time clustering and spatial variation in temporal trends methods were applied in three different time-periods: globally, by year and grouped in 2 classes (periods of 5 years). Results A total of 9,320,076 patients were discharged within this period, with 133,688 patients (1.46%) having at least one ADE, 4% of them related with AP. Critical space-time identified clusters (p < 0.001) were the municipalities from Lisbon metropolitan area and Centro region area. The global rate increased at a 7.8% mean annual percentage change, with high space-time heterogeneity and variation in time trends clusters (p < 0.001). For whole period, 2004–2013, all clusters presented increasing trends. However when analyzed by period of 5 years we identified two clusters with decreasing trends in time in 2004–2008. Conclusion The impact of ADE is huge, with widely variations within country and in time, and represents an increasing challenge. Future research using individual and contextual risk factors are urgently needed to understand this spatiotemporal variability in order to promote local tailored and updated actions of prevention.
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Affiliation(s)
- Gianina Scripcaru
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Av Padre Cruz, 1600-560, Lisbon, Portugal.,AMGEN Biofarmaceutica, Lisbon, Portugal
| | - Ceu Mateus
- Health Economics Group Division of Health Research, Lancaster University, Lancaster, UK
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Av Padre Cruz, 1600-560, Lisbon, Portugal. .,Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
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Leporini C, Marrazzo G, Mumoli L, Esposito S, Gallelli L, Mangano G, Brancati G, De Francesco EA, Russo E, De Sarro G. Adverse drug reactions reporting in Calabria (Southern Italy) in the four-year period 2011-2014: impact of a regional pharmacovigilance project in light of the new European Legislation. Expert Opin Drug Saf 2017; 16:515-522. [DOI: 10.1080/14740338.2017.1316486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Christian Leporini
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giuseppina Marrazzo
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Laura Mumoli
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | | | - Luca Gallelli
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giovanna Mangano
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giacomino Brancati
- Department of Health and Health Politics, Calabria Region, Sector 3 Area 3 LEA, Department of health and health politics, Calabria, Italy
| | | | - Emilio Russo
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
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Hohl CM, Partovi N, Ghement I, Wickham ME, McGrail K, Reddekopp LN, Sobolev B. Impact of early in-hospital medication review by clinical pharmacists on health services utilization. PLoS One 2017; 12:e0170495. [PMID: 28192477 PMCID: PMC5305222 DOI: 10.1371/journal.pone.0170495] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/05/2017] [Indexed: 11/19/2022] Open
Abstract
Background Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients. Methods We used a quasi-randomized design to evaluate a quality improvement project in three hospitals in British Columbia, Canada. We incorporated a clinical decision rule into emergency department triage pathways, allowing nurses to identify patients at high-risk for adverse drug events. After randomly selecting the first eligible patient for participation, clinical pharmacists systematically allocated subsequent high-risk patients to medication review or usual care. Medication review included obtaining a best possible medication history and reviewing the patient’s medications for appropriateness and adverse drug events. The primary outcome was the number of days spent in-hospital over 30 days, and was ascertained using administrative data. We used median and inverse propensity score weighted logistic regression modeling to determine the effect of pharmacist-led medication review on downstream health services use. Results Of 10,807 high-risk patients, 6,416 received early pharmacist-led medication review and 4,391 usual care. Their baseline characteristics were balanced. The median number of hospital days was reduced by 0.48 days (95% confidence intervals [CI] = 0.00 to 0.96; p = 0.058) in the medication review group compared to usual care, representing an 8% reduction in the median length of stay. Among patients under 80 years of age, the median number of hospital days was reduced by 0.60 days (95% CI = 0.06 to 1.17; p = 0.03), representing 11% reduction in the median length of stay. There was no significant effect on emergency department revisits, admissions, readmissions, or mortality. Limitations We were limited by our inability to conduct a randomized controlled trial, but used quasi-random patient allocation methods and propensity score modeling to ensure balance between treatment groups, and administrative data to ensure blinded outcomes ascertainment. We were unable to account for alternate level of care days, and therefore, may have underestimated the treatment effect in frail elderly patients who are likely to remain in hospital while awaiting long-term care. Conclusions Early pharmacist-led medication review was associated with reduced hospital-bed utilization compared to usual care among high-risk patients under 80 years of age, but not among those who were older. The results of our evaluation suggest that medication review by pharmacists in the emergency department may impact the length of hospital stay in select patient populations.
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Affiliation(s)
- Corinne M. Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Emergency Department, Vancouver General Hospital, Vancouver, Canada
- * E-mail:
| | - Nilu Partovi
- Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Coordinator, Clinical Pharmacy Services, Vancouver General Hospital, Vancouver, Canada
| | | | - Maeve E. Wickham
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | | | | | - Boris Sobolev
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
- School of Population and Public Health, Vancouver, Canada
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Lin CW, Wen YW, Chen LK, Hsiao FY. Potentially high-risk medication categories and unplanned hospitalizations: a case-time-control study. Sci Rep 2017; 7:41035. [PMID: 28112193 PMCID: PMC5253626 DOI: 10.1038/srep41035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/15/2016] [Indexed: 12/22/2022] Open
Abstract
Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case–time–control study was performed using Taiwan’s National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1–14 days before the visit) and the control period (366–379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37–1.73]), followed by NSAIDs (1.50, [1.44–1.56]), anticonvulsants (1.34, [1.10–1.64]), diuretics (1.24, [1.15–1.33]), BZD/Z-hypnotics (1.23, [1.16–1.31]), antidepressants (1.17, [1.05–1.31]) and antiplatelets (1.16, [1.07–1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay ≥10 days. These medication categories should be targeted for clinical and policy interventions.
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Affiliation(s)
- Chih-Wan Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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2017, Sexual Dimorphism, Sexual Pluralism, and More. Clin Ther 2017; 39:1-5. [DOI: 10.1016/j.clinthera.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/20/2022]
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Hospitalizations due to preventable adverse reactions—a systematic review. Eur J Clin Pharmacol 2016; 73:385-398. [PMID: 27913837 DOI: 10.1007/s00228-016-2170-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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