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Chiumia FK, Chimimba F, Nyirongo HM, Kampira EL, Muula AS, Khuluza F. Adverse Drug Reactions Related with Antibiotic Medicines in Malawi: A Retrospective Analysis of Prevalence and Associated Factors. Drug Healthc Patient Saf 2024; 16:89-101. [PMID: 39070704 PMCID: PMC11283248 DOI: 10.2147/dhps.s468966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
Objective We aimed to assess the occurrence and characteristics of antibiotic-associated adverse drug reactions (ADRs) in Malawi. Methods We retrospectively reviewed 304 patient records from medical wards in three hospitals in Southern Malawi. A global trigger tool was applied for the detection of suspected ADRs, and we used the Naranjo scale, the World Health Organization classification and the Schumock and Thornton scale for causality, seriousness and preventability assessment respectively. ADRs were also further characterized according to anatomical systems. Statistical analysis was done in STATA 14.1. The Chi-square test was used to determine the association between categorical variables and logistic regression analysis was used to measure the strength of the association between various independent variables and the occurrence of ADRs. Results Suspected ADRs were detected in 24% (73/304) of patients, of which 1.4% were definite, 15.1% were probable and 83.6% were possible ADRs. Most of the sADRs were gastrointestinal events (42.5%), followed by: musculoskeletal (26.3%); cardiovascular (16.3%); central nervous system (13.8%; and urinary events (1.3%). About 27% of the sADRs were serious events such as convulsions. The geriatric age group (≥65 years) was more likely to experience sADRs as compared to the younger age group, with an adjusted odds ratio (aOR) of 4.53, 95% CI (2.21-9.28), P<0.001. Patients taking more than one antibiotic medicine had a higher risk of developing sADRs as compared to patients who were administered one type of antibiotic medicine, aOR 2.14, 95% CI (1.18-3.90), p < 0.012. A long hospital stay of >3days was associated with a higher risk of sADRs with aOR of 5.11, 95% CI (2.47-10.55), p < 0.001 than those who stayed ≤ 3 days in the hospital. Conclusion We found a higher prevalence of serious sADRs associated with antibiotic medicines than reported elsewhere. This may, among others, contribute to high patient mortality, poor treatment adherence, antibiotic resistance and increased cost of care.
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Affiliation(s)
- Francis Kachidza Chiumia
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Frider Chimimba
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Happy Magwaza Nyirongo
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Lusungu Kampira
- Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson Sinjani Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Felix Khuluza
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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Silva LT, Modesto ACF, de Oliveira RA, Amaral RG, Lopes FM. Mortality and years of life lost related to adverse drug events in Brazil. Rev Saude Publica 2024; 58:20. [PMID: 38747868 PMCID: PMC11090614 DOI: 10.11606/s1518-8787.2024058005458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/22/2023] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To assess regional and national mortality and years of life lost (YLL) related to adverse drug events in Brazil. METHODS This is an ecological study in which death records from 2009 to 2018 from the Mortality Information System were analyzed. Codes from the International Classification of Diseases 10th revision (ICD-10) that indicated drugs as the cause of death were identified. The number of deaths and the YLL due to adverse drug events were obtained. Crude, age- and gender-specific, and age-adjusted mortality rates and YLL rates per 100,000 inhabitants were formed by year, age group, gender, and Brazilian Federative Unit. Rate ratios were calculated by comparing rates from 2009 to 2018. A joinpoint regression model was applied for temporal analysis. RESULTS For the selected ICD-10 codes, a total of 95,231 deaths and 2,843,413 YLL were recorded. Mortality rates from adverse drug events increased by a mean of 2.5% per year, and YLL rates increased by 3.7%. Increases in rates were observed in almost all age groups for both genders. Variations in rates were found between Federative Units, with the highest age-adjusted mortality and YLL rates occurring in the Distrito Federal. CONCLUSIONS The numbers and rates of deaths and YLL increased during the study period, and variations in rates of deaths and YLL were observed between Brazilian Federative Units. Information on multiple causes of death from death certificates can be useful for quantifying adverse drug events and analyzing them geographically, by age and by gender.
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Affiliation(s)
- Lunara Teles Silva
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade 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
- Tribunal Regional do Trabalho da 18ª RegiãoGoiâniaGOBrasilTribunal Regional do Trabalho da 18ª Região. Goiânia, GO, Brasil
| | - Rita Goreti Amaral
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade 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 SaúdeGoiâniaGOBrasilUniversidade 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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Holbrook A, Perri D, Levine M, Mbuagbaw L, Jarmain S, Thabane L, Tarride JE, Dolovich L, Hyland S, Telford V, Silva J, Nieuwstraten C. Improving medication prescribing-related outcomes for vulnerable elderly in transitions on high-risk medications (IMPROVE-IT HRM): a pilot randomized trial protocol. Pilot Feasibility Stud 2024; 10:60. [PMID: 38600599 PMCID: PMC11005201 DOI: 10.1186/s40814-024-01484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Seniors with recurrent hospitalizations who are taking multiple medications including high-risk medications are at particular risk for serious adverse medication events. We will assess whether an expert Clinical Pharmacology and Toxicology (CPT) medication management intervention during hospitalization with follow-up post-discharge and communication with circle of care is feasible and can decrease drug therapy problems amongst this group. METHODS The design is a pragmatic pilot randomized trial with 1:1 patient-level concealed randomization with blinded outcome assessment and data analysis. Participants will be adults 65 years and older admitted to internal medicine services for more than 2 days, who have had at least one other hospitalization in the prior year, taking five or more chronic medications including at least one high-risk medication. The CPT intervention identifies medication targets; completes consult, including priorities for improving prescribing negotiated with the patient; starts the care plan; ensures a detailed discharge medication reconciliation and circle-of-care communication; and sees the patient at least twice after hospital discharge via virtual visits to consolidate the care plan in the community. Control group receives usual care. Primary outcomes are feasibility - recruitment, retention, costs, and clinical - number of drug therapy problems improved, with secondary outcomes examining coordination of transitions in care, quality of life, and healthcare utilization and costs. Follow-up is to 3-month posthospital discharge. DISCUSSION If results support feasibility of ramp-up and promising clinical outcomes, a follow-up definitive trial will be organized using a developing national platform and medication appropriateness network. Since the intervention allows a very scarce medical specialty expertise to be offered via virtual care, there is potential to improve the safety, outcomes, and cost of care widely. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT04077281.
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Affiliation(s)
- Anne Holbrook
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.
| | - Dan Perri
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Digital Solutions, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Mitch Levine
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Jarmain
- Medical and Academic Affairs, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Biotatistics Unit, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
- Center for Health Economic and Policy Analysis, McMaster University, Hamilton, ON, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sylvia Hyland
- Institute for Safe Medication Practices Canada, North York, ON, Canada
| | - Victoria Telford
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
| | - Jessyca Silva
- Clinical Pharmacology Research, Research Institute of St. Joes Hamilton, Hamilton, ON, Canada
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El Abdouni S, Kalfsvel LS, Rietdijk WJR, Van der Kuy H, van Rosse F. Differences in prescribing errors between electronic prescribing and traditional prescribing among medical students: A randomized pilot study. Br J Clin Pharmacol 2024. [PMID: 38520277 DOI: 10.1111/bcp.16053] [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: 11/21/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/25/2024] Open
Abstract
AIMS This randomized controlled pilot study aimed to assess the differences in the frequency, type and severity of prescribing errors made by medical students when assessed in an electronic (e-)prescribing system compared to a traditional prescribing method (e.g., typing out a prescription). METHODS Fourth year medical students in the period of 1 November to 31 July 2023, were asked to participate in this single-centre prospective, randomized, controlled intervention study. Participants performed a prescribing assessment in either an e-prescribing system (intervention group) or in a more traditional prescribing platform (control group). The prescriptions were checked for errors, graded and categorized. Differences in prescribing errors, error categories and severity were analysed. RESULTS Out of 334 students, 84 participated in the study. Nearly all participants (98.8%) made 1 or more prescribing errors, primarily involving inadequate information errors. In the intervention group, more participants made prescribing errors involving the prescribed amount (71.4 vs. 19.0%; P < .01), but fewer involving administrative errors (2.4 vs. 19.0%; P = .03). Prescribing-method-specific errors were identified in 4.8 and 40.5% of the intervention and control group, respectively, with significant differences in overlapping errors as well. CONCLUSION This pilot study shows the importance of training e-prescribing competencies in medical curricula, in addition to traditional prescribing methods. It identifies prescribing-method-specific prescribing errors and emphasizes the need for further research to define e-prescribing competencies. Additionally, the need for an accessible real-life-like e-prescribing environment tailored to educators and students is essential for effective learning and incorporation of e-prescribing into medical curricula.
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Affiliation(s)
- Samir El Abdouni
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Laura S Kalfsvel
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wim J R Rietdijk
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hugo Van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Floor van Rosse
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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5
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Komagamine J. Prevalence of urgent hospitalizations caused by adverse drug reactions: a cross-sectional study. Sci Rep 2024; 14:6058. [PMID: 38480855 PMCID: PMC10937656 DOI: 10.1038/s41598-024-56855-z] [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: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024] Open
Abstract
Adverse drug reactions account for a substantial portion of emergency hospital admissions. However, in the last decade, few studies have been conducted to determine the prevalence of hospitalization due to adverse drug reactions. Therefore, this cross-sectional study was conducted to determine the proportion of adverse drug reactions leading to emergency hospital admission and to evaluate the risk factors for these reactions. A total of 5707 consecutive patients aged > 18 years who were emergently hospitalized due to acute medical illnesses between June 2018 and May 2021 were included. Causality assessment for adverse drug reactions was performed by using the World Health Organization-Uppsala Monitoring Centre criteria. The median patient age was 78 years (IQR 63-87), and the proportion of women was 47.9%. Among all the hospitalizations, 287 (5.0%; 95% confidence interval (CI) 4.5-5.6%) were caused by 368 adverse drug reactions. The risk factors independently associated with hospitalization due to adverse drug reactions were polypharmacy (OR 2.66), age ≥ 65 years (OR 2.00), and ambulance use (OR 1.41). Given that the population is rapidly aging worldwide, further efforts are needed to minimize hospitalizations caused by adverse drug reactions.
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Affiliation(s)
- Junpei Komagamine
- Department of Emergency and Critical Care Medicine, NHO Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo, Japan.
- Department of Clinical Research, NHO Tochigi Medical Center, Utsunomiya, Japan.
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Kaur U, Chakrabarti SS, Gupta GK, Singh A, Gambhir IS. Drug-related problems in older adults in outpatient settings: Results from a 6-year long prospective study in a tertiary hospital of north India. Geriatr Gerontol Int 2024; 24 Suppl 1:285-291. [PMID: 37577765 DOI: 10.1111/ggi.14650] [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: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
AIM Drug-related problems (DRPs) are a common cause of hospitalization in older patients. So far, these issues have been studied in hospitalized settings, and evidence on patterns and outcomes of DRPs, such as adverse drug reactions, is relatively scarce in older outpatients. The main aim of this study was to provide a comprehensive description and possible solutions for DRPs in older adults in outpatient settings. METHODS The study was carried out from January 2015 to September 2021 in a tertiary hospital in north India. Patients aged ≥50 years with DRPs were enrolled. DRPs causing hospitalization, drug interactions and drug-disease interactions were identified, along with preventive measures. RESULTS Of 10 400 patients registered, 1031 DRPs occurred in 666 patients (9.9%). Adverse drug reactions were the major DRPs (n = 933, 8.9%). Metabolic disorders were the commonest DRP in individuals aged ≥65 years compared with gastrointestinal disorders in the 50-64 years group. Drug interactions and drug-disease interactions contributed to 20.1% and 7.9% of patients, respectively. Nearly 15.8% of DRPs directly led to hospitalization, with drug-induced metabolic disturbances and movement disorders as the common causes. The Naranjo scale was not applicable in 35.3% of patients, and drug interactions were the commonest cause. Frequent monitoring, omission of unnecessary drugs, slow titration and proper instructions on therapy, together, could avoid one-third of DRPs. CONCLUSION One out of 10 prescriptions of older outpatients carries a DRP. New-onset metabolic and neurological disturbances should prompt a thorough drug history. A multifaceted holistic approach can prevent significant drug-related morbidity and requires future evaluation. Geriatr Gerontol Int 2024; 24: 285-291.
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Affiliation(s)
- Upinder Kaur
- Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sankha Shubhra Chakrabarti
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Gaurav Kumar Gupta
- Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Amit Singh
- Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Indrajeet Singh Gambhir
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Boyd CM, Shetterly SM, Powers JD, Weffald LA, Green AR, Sheehan OC, Reeve E, Drace ML, Norton JD, Maiyani M, Gleason KS, Sawyer JK, Maciejewski ML, Wolff JL, Kraus C, Bayliss EA. Evaluating the Safety of an Educational Deprescribing Intervention: Lessons from the Optimize Trial. Drugs Aging 2024; 41:45-54. [PMID: 37982982 PMCID: PMC11101016 DOI: 10.1007/s40266-023-01080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Patients, family members, and clinicians express concerns about potential adverse drug withdrawal events (ADWEs) following medication discontinuation or fears of upsetting a stable medical equilibrium as key barriers to deprescribing. Currently, there are limited methods to pragmatically assess the safety of deprescribing and ascertain ADWEs. We report the methods and results of safety monitoring for the OPTIMIZE trial of deprescribing education for patients, family members, and clinicians. METHODS This was a pragmatic cluster randomized trial with multivariable Poisson regression comparing outcome rates between study arms. We conducted clinical record review and adjudication of sampled records to assess potential causal relationships between medication discontinuation and outcomes. This study included adults aged 65+ with dementia or mild cognitive impairment, one or more additional chronic conditions, and prescribed 5+ chronic medications. The intervention included an educational brochure on deprescribing that was mailed to patients prior to primary care visits, a clinician notification about individual brochure mailings, and an educational tip sheets was provided monthly to primary care clinicians. The outcomes of the safety monitoring were rates of hospitalizations and mortality during the 4 months following brochure mailings and results of record review and adjudication. The adjudication process was conducted throughout the trial and included classifications: likely, possibly, and unlikely. RESULTS There was a total of 3012 (1433 intervention and 1579 control) participants. There were 420 total hospitalizations involving 269 (18.8%) people in the intervention versus 517 total hospitalizations involving 317 (20.1%) people in the control groups. Adjusted risk ratios comparing intervention to control groups were 0.92 [95% confidence interval (CI) 0.72, 1.16] for hospitalization and 1.19 (95% CI 0.67, 2.11) for mortality. Both groups had zero deaths "likely" attributed to a medication change prior to the event. A total of 3 out of 30 (10%) intervention group hospitalizations and 7 out of 35 (20%) control group hospitalizations were considered "likely" due to a medication change. CONCLUSIONS Population-based deprescribing education is safe in the older adult population with cognitive impairment in our study. Pragmatic methods for safety monitoring are needed to further inform deprescribing interventions. TRIAL REGISTRATION NCT03984396. Registered on 13 June 2019.
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Affiliation(s)
- Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Medical Center, Durham, NC, USA.
| | - Susan M Shetterly
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - John D Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Linda A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ariel R Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily Reeve
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA, Australia
| | - Melanie L Drace
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jonathan D Norton
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahesh Maiyani
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Kathy S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jennifer K Sawyer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jennifer L Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Courtney Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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8
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Kuteesa J, Nasasira M, Kiguba R. Epidemiology of adverse drug reactions to antihypertensive, antithrombotic and antidiabetic medications among adult inpatients at a National Referral Hospital, Uganda. Expert Opin Drug Saf 2024; 23:129-136. [PMID: 37552628 DOI: 10.1080/14740338.2023.2244421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Treatment for hypertension, thrombosis and type 2 diabetes mellitus is long term and usually requires a combination of drugs which increases the risk of adverse drug reactions (ADRs). This study aimed to establish the prevalence at admission, incidence during hospitalization and characteristics of ADRs linked to antihypertensive, antithrombotic and antidiabetic drugs among adult inpatients in Uganda. METHODS We conducted a secondary analysis of data from a previously assembled prospective cohort study in Uganda's Mulago National Referral Hospital. We reviewed the files of inpatients who received antihypertensive, antithrombotic and/or antidiabetic medications prior to and/or during hospitalization. The modified Schumock and Thornton Preventability Scale, the Division of AIDS Table for Grading the Severity of Adult and Paediatric Adverse Events and the World Health Organization - Uppsala Monitoring Centre seriousness criteria were used to characterize the ADRs. RESULTS More than a quarter (27%, 42/155) of the inpatients experienced an ADR at admission or during hospitalization. The point prevalence of ADRs at admission was 8% (13/155) and the incidence of ADRs during hospitalization was 23% (36/155). Forty-one percent (35/86) of the ADRs were serious and the majority (59%, 51/86) were preventable. CONCLUSION One in 13 inpatients experienced an ADR on admission and one in four experienced an ADR that developed during hospitalization. Clinicians ought to prescribe medicines with lower ADR risk profile for cardiovascular and/or diabetic patients whenever possible.
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Affiliation(s)
- Jonathan Kuteesa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marble Nasasira
- Research and Data Centre, Child and Family Foundation, Kampala, Uganda
| | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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Heck J, Noltemeyer N, Schulze Westhoff M, Deest-Gaubatz S, Schröder S, Krichevsky B, Simon N, Gerbel S, Friedrich M, Stichtenoth DO, Bleich S, Frieling H, Groh A. Adverse drug reactions in geriatric psychiatry-retrospective cohort study of a 6-year period. Ir J Med Sci 2023; 192:2917-2927. [PMID: 36807758 PMCID: PMC10692025 DOI: 10.1007/s11845-023-03300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To investigate the frequency and characteristics of adverse drug reactions (ADRs) that occurred on the gerontopsychiatric ward of Hannover Medical School over a 6-year period. DESIGN Retrospective monocentric cohort study. RESULTS Six hundred thirty-four patient cases (mean age 76.6 ± 7.1 years; 67.2% female) were analysed. In total, 92 ADRs in 56 patient cases were registered in the study population. The overall ADR prevalence, the ADR prevalence upon hospital admission, and the ADR prevalence during hospitalisation were 8.8%, 6.3%, and 4.9%, respectively. The most frequent ADRs were extrapyramidal symptoms, alterations in blood pressure or heart rate, and electrolyte disturbances. Of note, two cases of asystole and one case of obstructive airway symptoms related to general anaesthesia in the context of electroconvulsive therapy (ECT) were detected. The presence of coronary heart disease was associated with an increased risk of ADR occurrence (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.37-6.22), while the presence of dementia was associated with a decreased risk of ADR development (OR 0.45, 95% CI 0.23-0.89). CONCLUSIONS Type and prevalence of ADRs in the present study were largely in accordance with previous reports. By contrast, we did not observe a relationship between advanced age or female sex and ADR occurrence. We detected a risk signal for cardiopulmonary ADRs related to general anaesthesia in the context of ECT that warrants further investigation. Elderly psychiatric patients should be carefully screened for cardiopulmonary comorbidities before initiation of ECT.
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Affiliation(s)
- Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Nina Noltemeyer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Benjamin Krichevsky
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Medical Service of the German Armed Forces, Kiel, Germany
| | - Nicolas Simon
- Hannover Medical School, MHH Information Technology, Hannover, Germany
| | - Swetlana Gerbel
- Hannover Medical School, MHH Information Technology, Hannover, Germany
| | | | - Dirk O Stichtenoth
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Drug Commissioner of Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Cam H, Wennlöf B, Gillespie U, Franzon K, Nielsen EI, Ling M, Lindner KJ, Kempen TGH, Kälvemark Sporrong S. The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals' views. BMC Health Serv Res 2023; 23:1211. [PMID: 37932683 PMCID: PMC10626684 DOI: 10.1186/s12913-023-10192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Hospital discharge of older patients is a high-risk situation in terms of patient safety. Due to the fragmentation of the healthcare system, communication and coordination between stakeholders are required at discharge. The aim of this study was to explore communication in general and medication information transfer in particular at hospital discharge of older patients from the perspective of healthcare professionals (HCPs) across different organisations within the healthcare system. METHODS We conducted a qualitative study using focus group and individual or group interviews with HCPs (physicians, nurses and pharmacists) across different healthcare organisations in Sweden. Data were collected from September to October 2021. A semi-structured interview guide including questions on current medication communication practices, possible improvements and feedback on suggestions for alternative processes was used. The data were analysed thematically, guided by the systematic text condensation method. RESULTS In total, four focus group and three semi-structured interviews were conducted with 23 HCPs. Three main themes were identified: 1) Support systems that help and hinder describes the use of support systems in the discharge process to compensate for the fragmentation of the healthcare system and the impact of these systems on HCPs' communication; 2) Communication between two separate worlds depicts the difficulties in communication experienced by HCPs in different healthcare organisations and how they cope with them; and 3) The large number of medically complex patients disrupts the communication reveals how the highly pressurised healthcare system impacts on HCPs' communication at hospital discharge. CONCLUSIONS Communication at hospital discharge is hindered by the fragmented, highly pressurised healthcare system. HCPs are at risk of moral distress when coping with communication difficulties. Improved communication methods at hospital discharge are needed for the benefit of both patients and HCPs.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Björn Wennlöf
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Närvården Viksäng-Irsta, Region Västmanland, Västerås, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Mia Ling
- Department of Pharmacy, Region Västmanland, Västerås, Sweden
| | | | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sofia Kälvemark Sporrong
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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11
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Zaij S, Pereira Maia K, Leguelinel-Blache G, Roux-Marson C, Kinowski JM, Richard H. Intervention of pharmacist included in multidisciplinary team to reduce adverse drug event: a qualitative systematic review. BMC Health Serv Res 2023; 23:927. [PMID: 37649018 PMCID: PMC10470127 DOI: 10.1186/s12913-023-09512-6] [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: 10/18/2022] [Accepted: 05/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Preventable harm in healthcare is a growing public health challenge. In addition to the economic costs of safety failures, adverse drug events (ADE) may lead to complication or even death. Multidisciplinary care team involving a pharmacist appears to be an adequate response to prevention of adverse drug event. This qualitative systematic review aims to identify and describe multidisciplinary planned team-based care involving at least one pharmacist to limit or prevent adverse drug events in the adult patients. METHODS To determine the type of interprofessional collaboration to prevent adverse drug event in which a pharmacist was involved, we conducted a qualitative systematic review of the literature of randomized controlled trials. Two independent reviewers screened trials in three databases: Medline, Web of Science, ScienceDirect. Prospective studies of at least three different health professionals' interventions, one of whom was a pharmacist in the last five years were included. Two reviewers performed data extraction and quality appraisal independently. We used TIDieR checklist to appraise articles quality. RESULTS In total 803 citations were retrieved, 34 were analysed and 16 full-text articles were reviewed. Only 3 studies published an implementation evaluation. More than half of the interventions (62%) targeted elderly patients including 6 whom lived in nursing homes. Studies outcomes were heterogeneous, and we did not perform a statistical analysis of the impact of these interventions. Most teams are composed of a physician/pharmacist/nurse trio (94%; 100%; 88%). Half of the teams were composed of the primary care physician. Other professionals were included such as physical therapists (25%), social worker (19%), occupational therapists (12%), and community health educator (6%). Multidisciplinary medication review was the most common intervention and was generally structured in four steps: data collection and baseline assessment, appraisal report by health professionals, a multidisciplinary medication review meeting and a patient follow-up. CONCLUSIONS The most common multidisciplinary intervention to prevent ADE in the adult population is the multidisciplinary drug review meeting at least the physician/pharmacist/nurse trio. Interventions target mostly elderly people in nursing homes, although complex chronic patients could benefit from this type of assessment. TRIAL REGISTRATION PROSPERO registration: CRD42022334685.
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Affiliation(s)
- Sarah Zaij
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France.
| | - Kelly Pereira Maia
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
- Department of Law and Health Economics, Faculty of Pharmacy, University of Montpellier, Montpellier, France
| | - Clarisse Roux-Marson
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Jean Marie Kinowski
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Hélène Richard
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
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12
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Hilmer SN, Lo S, Kelly PJ, Viney R, Blyth FM, Le Couteur DG, McLachlan AJ, Arora S, Hossain L, Gnjidic D. Towards Optimizing Hospitalized Older adults' MEdications (TO HOME): Multi-centre study of medication use and outcomes in routine care. Br J Clin Pharmacol 2023; 89:2508-2518. [PMID: 36987555 DOI: 10.1111/bcp.15727] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 03/30/2023] Open
Abstract
AIMS Comprehensively investigate prescribing in usual care of hospitalized older people with respect to polypharmacy; potentially inappropriate medications (PIMs) according to Beers criteria; and cumulative anticholinergic and sedative medication exposure calculated with Drug Burden Index (DBI). Specifically, to quantify exposure to these measures on admission, changes between admission and discharge, associations with adverse outcomes and medication costs. METHODS Established new retrospective inpatient cohort of 2000 adults aged ≥75 years, consecutively admitted to 6 hospitals in Sydney, Australia, with detailed information on medications, clinical characteristics and outcomes. Conducted cross-sectional analyses of index admission data from cohort. RESULTS Cohort had mean (standard deviation) age 86.0 (5.8) years, 59% female, 21% from residential aged care. On admission, prevalence of polypharmacy was 77%, PIMs 34% and DBI > 0 in 53%. From admission to discharge, mean difference (95% confidence interval) in total number of medications increased 1.05 (0.92, 1.18); while prevalence of exposure to PIMs (-3.8% [-5.4, -2.1]) and mean DBI score (-0.02 [-0.04, -0.01]) decreased. PIMs and DBI score were associated with increased risks (adjusted odds ratio [95% confidence interval]) of falls (PIMs 1.63 [1.28, 2.08]; DBI score 1.21[1.00, 1.46]) and delirium (PIMs 1.76 [1.38, 1.46]; DBI score 1.42 [1.19, 1.71]). Each measure was associated with increased risk of adverse drug reactions (polypharmacy 1.42 [1.19, 1.71]; PIMs 1.87 [1.40, 2.49]; DBI score 1.90 [1.55, 2.15]). Cost (AU$/patient/hospital day) of medications contributing to PIMs and DBI was low ($0.29 and $0.88). CONCLUSION In this large cohort of older inpatients, usual hospital care results in an increase in number of medications and small reductions in PIMs and DBI, with variable associations with adverse outcomes.
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Affiliation(s)
- Sarah N Hilmer
- Kolling Institute, The University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - Sarita Lo
- Kolling Institute, The University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
| | - Fiona M Blyth
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Hospital and The University of Sydney, Concord, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
| | - Lutfun Hossain
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Verbič MD, Brvar M, Kos MK. Adverse drug reactions in the ambulatory internal patients at the emergency department: Focus on causality assessment and drug-drug interactions. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:195-210. [PMID: 37307369 DOI: 10.2478/acph-2023-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/14/2023]
Abstract
A non-interventional retrospective study in ambulatory patients was conducted at the emergency department of the Division of internal medicine. In 2 months, 266 suspected adverse drug reactions (ADRs) were identified in 224/3453 patients (6.5 %). In 158/3453 patients (4.6 %), an ADR was the reason for emergency department visit and in 49 patients (1.4 %), ADRs led to hospitalisation. A causality assessment algorithm was developed, which included Naranjo algorithm and levels of ADR recognition by the treating physician and the investigators. Using this algorithm, 63/266 ADRs (23.7 %) were classified as "certain", whereas using solely the Naranjo score calculation, only 19/266 ADRs (7.1 %) were assessed as "probable" or "certain", and the rest of ADRs (namely, 247/266 = 92.9 %) were assessed as "possible". There were 116/266 (43.6 %) ADRs related to potential drug-drug interactions (DDIs), stated in at least one of the literature sources used. Based on the causality relationship, the rate of the clinically expressed DDIs was 19.0 %, or 12/63 "certain" ADR cases. Of these, 10 cases presented serious DDI-related ADRs. In summary, ADR causality assessment based exclusively on Naranjo algorithm demonstrated low sensitivity at an ambulatory emergency setting. Additional clinical judgment, including the opinion of the treating physician, proved necessary to avoid under-rating of the causality relationship, and enabled the determination of clinically expressed DDIs.
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Affiliation(s)
- Matej Dobravc Verbič
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
| | - Miran Brvar
- 1University Medical Centre Ljubljana Centre for Clinical Toxicology and Pharmacology, 1000 Ljubljana, Slovenia
- 2University of Ljubljana, Faculty of Medicine, Centre for Clinical Physiology Ljubljana, Slovenia
| | - Mojca Kerec Kos
- 3University of Ljubljana, Faculty of Pharmacy, 1000 Ljubljana, Slovenia
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Karlsson Lind L, Rydberg DM, Schenck-Gustafsson K. Sex and gender differences in drug treatment: experiences from the knowledge database Janusmed Sex and Gender. Biol Sex Differ 2023; 14:28. [PMID: 37173796 PMCID: PMC10182642 DOI: 10.1186/s13293-023-00511-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Evidence from clinical research indicates that men and women can differ in response to drug treatment. The knowledge database Janusmed Sex and Gender was developed to illuminate potential sex and gender differences in drug therapy and, therefore, achieve a better patient safety. The database contains non-commercial evidence-based information on drug substances regarding sex and gender aspects in patient treatment. Here, we describe our experiences and reflections from collecting, analyzing, and evaluating the evidence. JANUSMED SEX AND GENDER Substances have been systematically reviewed and classified in a standardized manner. The classification considers clinically relevant sex and gender differences based on available evidence. Mainly biological sex differences are assessed except for gender differences regarding adverse effects and compliance. Of the 400 substances included in the database, clinically relevant sex differences were found for 20%. Sex-divided data were missing for 22% and no clinically relevant differences were found for more than half of the substances (52%). We noted that pivotal clinical studies often lack sex analyses of efficacy and adverse effects, and post-hoc analyzes are performed instead. Furthermore, most pharmacokinetic analyses use weight correction, but medicines are often prescribed in standard doses. In addition, few studies have sex differences as a primary outcome and some pharmacokinetic analyses are unpublished, which may complicate the classification of evidence. CONCLUSIONS Our work underlines the need of sex and gender analyses, and sex-divided data in drug treatment, to increase the knowledge about these aspects in drug treatment and contribute to a more individualized patient treatment.
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Affiliation(s)
| | - Diana M Rydberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
- Clinical Pharmacology Unit, Karolinska University Hospital, Stockholm, Sweden.
| | - Karin Schenck-Gustafsson
- Centre for Gender Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden
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15
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Kindstedt J, Andersson P, Westberg A, Glader EL, Lövheim H, Gustafsson M. Exploring medication-related hospital admissions and their association with cognitive impairment among acutely admitted older people. Res Social Adm Pharm 2023; 19:1048-1053. [PMID: 37105774 DOI: 10.1016/j.sapharm.2023.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Medication-related hospital admissions (MRAs) are common among older people. Persons with cognitive impairment are especially vulnerable to adverse drug effects. At the same time, increased home health care and social support could theoretically prevent medication-related problems. This study aims to estimate the proportion of MRAs and explore their relationship with cognitive impairment in a population of acutely admitted older people. METHODS This cross-sectional study comprised 300 individuals aged 75 years or older admitted to an acute medical ward. Two assessors identified possibly MRAs using the Assessment Tool for Hospital Admissions Related to Medications 10 (AT-HARM10). Screening for cognitive impairment was performed during ward stay using a 4-item test related to time orientation. Prevalence odds ratios between cognitive test scores and MRAs were analysed through logistic regression. RESULTS Using AT-HARM10, 108 out of 300 admissions (36%) were classified as possibly MRAs by both assessors. Moreover, MRAs were least common among patients with the lowest cognitive test scores. There was an association regarding MRAs when the lowest test score was treated as a cut-off and compared against a reference category comprising all other scores (OR, 0.31 [95% CI 0.10-0.93]; p = 0.037) in a logistic regression model adjusted for cohabitation and home health care. CONCLUSION Approximately one-third of the hospital admissions among acutely admitted older people were considered at least possibly medication-related. Hence, there is still a great need to manage medication-related problems and reduce MRAs in this vulnerable population. Using a 4-item instrument to screen for cognitive impairment, there was a negative association between MRA and lowest cognitive test score. Further exploration of the relationship between MRAs and cognitive impairment may indicate appropriate components and target populations for interventions that aims to reduce the risk of MRA.
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Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Pernilla Andersson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Annica Westberg
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, 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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16
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Baré M, Lleal M, Sevilla-Sánchez D, Ortonobes S, Herranz S, Ferrandez O, Corral-Vázquez C, Molist N, Nazco GJ, Martín-González C, Márquez MÁ. Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3639. [PMID: 36834333 PMCID: PMC9964600 DOI: 10.3390/ijerph20043639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode.
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Affiliation(s)
- Marisa Baré
- Institutional Committee for the Improvement of Clinical Practice Adequacy, Clinical Epidemiology and Cancer Screening Department, CRiSP Research Group, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain
- Research Network on Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Marina Lleal
- Institutional Committee for the Improvement of Clinical Practice Adequacy, Clinical Epidemiology and Cancer Screening Department, CRiSP Research Group, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, 08193 Barcelona, Spain
| | | | - Sara Ortonobes
- Pharmacy Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Susana Herranz
- Research Network on Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Acute Care Geriatric Unit, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Olivia Ferrandez
- Pharmacy Department, Consorci Parc de Salut MAR, 08003 Barcelona, Spain
| | - Celia Corral-Vázquez
- Research Network on Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Núria Molist
- Geriatrics Department-C3RG Research Ggoup, Consorci Hospitalari de Vic, 08500 Vic, Spain
| | - Gloria Julia Nazco
- Pharmacy Department, Hospital Universitario de Canarias, 38320 La Laguna, Spain
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Cahir C, Curran C, Walsh C, Hickey A, Brannigan R, Kirke C, Williams DJ, Bennett K. Adverse drug reactions in an ageing PopulaTion (ADAPT) study: Prevalence and risk factors associated with adverse drug reaction-related hospital admissions in older patients. Front Pharmacol 2023; 13:1029067. [PMID: 36712658 PMCID: PMC9880441 DOI: 10.3389/fphar.2022.1029067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Older people experience greater morbidity with a corresponding increase in medication use resulting in a potentially higher risk of adverse drug reactions (ADRs). Objectives: The aim of this study was to; 1) determine the prevalence and characteristics of ADR-related hospital admissions among older patients (≥65 years) in Ireland; and 2) identify the risk factors associated with ADR-related hospital admissions. Methods: A cross-sectional study of ADR prevalence in patients aged ≥65 years admitted acutely to hospital in Ireland over a 8 month period (November 2016- June 2017). A multifaceted review of each hospital admission was undertaken to assess the likelihood of an ADR being a reason for admission (cause of admission or contributing to admission) in the context of the patient's medication, clinical conditions, comorbidities and investigations. A number of decision aids were applied by two independent reviewers to assess ADR causality, avoidability and severity. A random sample of patients, determined not to have a suspected ADR on screening, were assigned to a non-ADR control group. Multivariable logistic regression was used to assess the association between potential risk factors for ADR-related admissions compared with non-ADR-related admissions. Results: In total, 3,760 hospital admission episodes (in 3,091 patients) were screened and 377 admissions were considered ADR-related (10.0%, 95% CI 9.1%, 11.0%). 219 (58.1%) ADR-related admissions were caused by an ADR, while ADRs contributed to 158 (41.9%) admissions. 268 (71.1%) of all ADR-related admissions were deemed definitely or possibly preventable/avoidable. 350 (92.8%) ADRs were classified as being of moderate severity, with 27 (7.2%) classified as severe. Antithrombotic agents, mainly aspirin and warfarin, were the drugs most frequently associated with ADR-related admissions (gastrointestinal and vascular haemorrhagic disorders). In multivariable analysis, immobility, frailty, having delirium or ulcer disease and taking anticoagulant and antiplatelet medication on admission were significantly associated with an ADR-related hospital admission. Conclusion: One in ten hospital admissions, among those aged 65 + years, were considered ADR-related, with approximately 70% potentially avoidable. Reliable and validated ADR detection and prediction tools are needed to develop prevention strategies.
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Affiliation(s)
- Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland,*Correspondence: Caitriona Cahir,
| | - Carmel Curran
- Department of Geriatric and Stroke Medicine Beaumont Hospital, Dublin, Ireland
| | - Caroline Walsh
- National Centre for Pharmacoeconomics, St. James’s Hospital, Dublin, Ireland,Discipline of Pharmacology and Therapeutics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ross Brannigan
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ciara Kirke
- National Quality and Patient Safety Directorate at Health Service Executive, Dublin, Ireland
| | - David J. Williams
- Department of Geriatric and Stroke Medicine Beaumont Hospital, Dublin, Ireland,Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Potential Risk Factors of Drug-Related Problems in Hospital-Based Mental Health Units: A Systematic Review. Drug Saf 2023; 46:19-37. [PMID: 36369457 PMCID: PMC9829611 DOI: 10.1007/s40264-022-01249-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Reducing the occurrence of drug-related problems is a global health concern. In mental health hospitals, drug-related problems are common, leading to patient harm, and therefore understanding their potential risk factors is key for guiding future interventions designed to minimise their frequency. OBJECTIVE The aim of this systematic review was to explore the potential risk factors of drug-related problems in mental health inpatient units. METHODS Six databases were searched between 2000 and 2021 to identify studies that investigated the potential risk factors of drug-related problems in adults hospitalised in mental health inpatient units. Data extraction was performed by two authors independently and Allan and Barker's criteria were used for study quality assessment. Studies were categorised based on drug-related problem types and potential risk factors were stratified as patient, medication, and hospital related. RESULTS A total of 22 studies were included. Studies mostly originated in Europe (n = 19/22, 86.4%), and used a multivariable logistic regression to identify potential risk factors (n = 13, 59%). Frequently investigated factors were patient age (n = 14/22), sex (n = 14/22) and the number of prescribed medications (n = 14/22). Of these, increasing the number of prescribed medications was the only factor consistently reported to be significantly associated with the occurrence of most types of drug-related problems (n = 11/14). CONCLUSIONS A variety of patient, medication and hospital-related potential risk factors of drug-related problems in mental health inpatient units were identified. These factors could guide the development of interventions to reduce drug-related problems such as pharmaceutical screening tools to identify high-risk patients for timely interventions. Future studies could test a wider range of possible factors associated with drug-related problems using standardised approaches. CLINICAL TRIAL REGISTRATION PROSPERO: CRD42021279946.
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Choi E, Kim S, Suh HS. Exploring the prevalence and characteristics of adverse drug events among older adults in South Korea using a national health insurance database. Front Pharmacol 2022; 13:1047387. [DOI: 10.3389/fphar.2022.1047387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Adverse drug events (ADEs) in the elderly frequently occur because of their multiple chronic diseases and complexity of drug therapy. To better understand adverse drug events, the prevalence and characteristics of adverse drug events in elderly South Korean patients were assessed.Methods: The National Health Insurance databases for 2015 and 2016 were used for the analysis. We included patients aged ≥65 years that had at least one claim with the diagnosis codes ‘drug-induced,’ ‘poisoning by drug,’ and ‘vaccine-associated’ each year for the base-case analysis. To minimize the underestimation of adverse drug event prevalence, we also used an extended definition analysis by adding the ‘adverse drug event very likely’ codes. We estimated the prevalence of adverse drug events by sex, age group, and type of insurance and examined the frequent types of adverse drug events in 2015 and 2016.Results: In the base-case analysis, adverse drug event prevalence in individuals aged 65 years and older was 2.75% in 2015 and 2.77% in 2016. With advanced age, the prevalence of adverse drug event tended to increase, peaking in the age group of 75–79 years. In addition, the adverse drug event prevalence was higher in females and Medical Aid enrollees. The most frequently occurring adverse drug event was ‘allergy, unspecified,’ followed by ‘other drug-induced secondary parkinsonism,’ and ‘generalized skin eruption due to drugs and medicaments.’ When we examined the extended definition analysis, the prevalence of adverse drug events was 4.47% in 2015 and 4.52% in 2016, which significantly increased from those estimated in the base-case analysis.Conclusion: Among the older adults, the prevalence of adverse drug event was higher in advanced age, females, and Medical Aid enrollees. In particular, allergy and drug-induced secondary parkinsonism frequently occurred. This study provides evidence that health policies addressing the prevention and management of adverse drug events should be a priority for the most vulnerable elderly patients.
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Barceló-Vidal J, Echeverría-Esnal D, Carballo N, De Antonio-Cuscó M, Fernández-Sala X, Navarrete-Rouco ME, Colominas-González E, Luque S, Fuster-Esteva M, Domingo L, Sala M, Duran X, Grau S, Ferrández O. Drug-related problems in patients admitted for SARS-CoV-2 infection during the COVID-19 pandemic. Front Pharmacol 2022; 13:993158. [PMID: 36506516 PMCID: PMC9730804 DOI: 10.3389/fphar.2022.993158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Drug-related problems (DRP) are events or circumstances in which drug therapy does or could interfere with desired health outcomes. In December 2019, a new coronavirus, SARS-CoV-2, appeared. Little knowledge about this type of infection resulted in the administration of various drugs with limited use in other pathologies. Evidence about DRP in patients with COVID-19 is lacking. Objective: The aim of the present study is to describe identified cases of DRP and those drugs involved in the first wave of patients with COVID-19, and evaluate associated risk factors. Material and methods: Observational, retrospective study performed in a tertiary university hospital between 14th March 2020 and 31 May 2020 (corresponding to the first COVID-19 wave). We recruited patients admitted during the study period. Exclusion criteria included age < 18 years; admission to critically ill units; and care received either in the emergency room, at-home hospitalization or a healthcare center. Results: A total of 817 patients were included. The mean age was 62.5 years (SD 16.4) (range 18-97), and 453 (55.4%) were male. A total of 516 DRP were detected. Among the patients, 271 (33.2%) presented at least one DRP. The mean DRP per patient with an identified case was 1.9. The prevailing DRPs among those observed were: incorrect dosage (over or underdosage) in 145 patients (28.2%); wrong drug combination in 131 (25.5%); prescriptions not in adherence to the then COVID-19 treatment protocol in 73 (14.1%); prescription errors due to the wrong use of the computerized physician order entry in 47 (9.2%); and incorrect dosage due to renal function in 36 (7%). The logistic regression analysis showed that patients who received only prescriptions of antibacterials for systemic use (J01 ATC group) faced a higher likelihood of experiencing a DRP (OR 2.408 (1.071-5.411), p = 0.033). Conclusion: We identified several factors associated with an increased risk of DRPs, similar to those reported in other pre-pandemic studies, including a prolonged length of stay, higher number of prescribed drugs and antimicrobial administration. The relevance of pharmacists and tools like pharmacy warning systems can help prevent, identify and resolve DRP efficiently.
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Affiliation(s)
- J. Barceló-Vidal
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,*Correspondence: J. Barceló-Vidal,
| | - D. Echeverría-Esnal
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - N. Carballo
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - X. Fernández-Sala
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | | | - S. Luque
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - M. Fuster-Esteva
- Faculty of Medicine, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - L. Domingo
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,Department of Epidemiology and Evaluation, Barcelona, Spain
| | - M. Sala
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,Department of Epidemiology and Evaluation, Barcelona, Spain
| | - X. Duran
- Statistics Deparment, Institut Hospital del Mar D'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - S. Grau
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain,Faculty of Medicine, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - O. Ferrández
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain,Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
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21
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Shen Z, Ding S, Shi S, Zhong Z. Association between social support and medication literacy in older adults with hypertension. Front Public Health 2022; 10:987526. [PMID: 36419989 PMCID: PMC9677095 DOI: 10.3389/fpubh.2022.987526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Background Reduced physical function and reduced social networks place older adults with hypertension at high risk for medication-related harm. Medication literacy is one of the preventable factors that affect the success of drug therapy for hypertension. However, little is known about the level of medication literacy and its influencing factors in older adults with hypertension. Objective The purpose of this study was to investigate the levels of social support and medication literacy, and the association between them in older Chinese adult patients with hypertension. Methods A total of 362 older adult patients with hypertension were investigated using a demographic characteristics questionnaire, the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP) and the Social Support Rating Scale (SSRS). Pearson correlation analysis, canonical correlation analysis (CCA) and hierarchical linear regression were used to analyse the relationship between social support and medication literacy. Results Our results showed that the mean scores for the C-MLSHP and the SSRS for older adult patients with hypertension were 23.89 (SD = 4.66) and 39.22 (SD = 5.53), respectively. The results of the Pearson correlation analysis suggested that the score for social support was positively correlated with the score for medication literacy (r = 0.431, P < 0.01). The results of CCA demonstrate that older adult patients with hypertension who had more subjective (r s = 0.682) and objective support (r s = 0.817) performed better in knowledge (r s = 0.633), skills (r s = 0.631) and behavior literacy (r s = 0.715). Hierarchical linear regression indicated that two dimensions of subjective support (B = 0.252, P < 0.001) and objective support (B = 0.690, P < 0.001) in social support were found to be independent predictors of medication literacy (R2 = 0.335, F = 19.745, P < 0.001). Conclusion Social support is positively associated with medication literacy in older Chinese adult patients with hypertension. The study highlights the importance of social support in promoting medication literacy among older adult patients with hypertension.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China,Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Shuangjiao Shi
| | - Zhuqing Zhong
- Clinical Nursing Safety Management Research Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China,Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China,Zhuqing Zhong
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22
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Johansen JS, Halvorsen KH, Svendsen K, Havnes K, Robinson EG, Wetting HL, Haustreis S, Småbrekke L, Kamycheva E, Garcia BH. Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study) - a randomized controlled trial. BMC Health Serv Res 2022; 22:1290. [PMID: 36289541 PMCID: PMC9597977 DOI: 10.1186/s12913-022-08648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Suboptimal medication use contributes to a substantial proportion of hospitalizations and emergency department visits in older adults. We designed a clinical pharmacist intervention to optimize medication therapy in older hospitalized patients. Based on the integrated medicine management (IMM) model, the 5-step IMMENSE intervention comprise medication reconciliation, medication review, reconciled medication list upon discharge, patient counselling, and post discharge communication with primary care. The objective of this study was to evaluate the effects of the intervention on healthcare use and mortality. Methods A non-blinded parallel group randomized controlled trial was conducted in two internal medicine wards at the University Hospital of North Norway. Acutely admitted patients ≥ 70 years were randomized 1:1 to intervention or standard care (control). The primary outcome was the rate of emergency medical visits (readmissions and emergency department visits) 12 months after discharge. Results Of the 1510 patients assessed for eligibility, 662 patients were asked to participate, and 516 were enrolled. After withdrawal of consent and deaths in hospital, the modified intention-to-treat population comprised 480 patients with a mean age of 83.1 years (SD: 6.3); 244 intervention patients and 236 control patients. The number of emergency medical visits in the intervention and control group was 497 and 499, respectively, and no statistically significant difference was observed in rate of the primary outcome between the groups [adjusted incidence rate ratio of 1.02 (95% CI: 0.82–1.27)]. No statistically significant differences between groups were observed for any of the secondary outcomes, neither in subgroups, nor for the per-protocol population. Conclusions We did not observe any statistical significant effects of the IMMENSE intervention on the rate of emergency medical visits or any other secondary outcomes after 12 months in hospitalized older adults included in this study. Trial registration The trial was registered in clinicaltrials.gov on 28/06/2016, before enrolment started (NCT02816086). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08648-1.
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Affiliation(s)
- Jeanette Schultz Johansen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjell H. Halvorsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristian Svendsen
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kjerstin Havnes
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Surgery, Cancer and Women’s Health Clinic, The University Hospital of North Norway, Tromsø, Norway
| | | | - Hilde Ljones Wetting
- grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
| | | | - Lars Småbrekke
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elena Kamycheva
- Nøste Private Healthcare Centre, Lier, Norway ,grid.412244.50000 0004 4689 5540Department of Geriatric Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Beate Hennie Garcia
- grid.10919.300000000122595234Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Hospital Pharmacy of North Norway Trust, Tromsø, Norway
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23
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Frequency, Characteristics, and Predictive Factors of Adverse Drug Events in an Adult Emergency Department according to Age: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11195731. [PMID: 36233599 PMCID: PMC9572040 DOI: 10.3390/jcm11195731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.
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24
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Brajković A, Bićanić LA, Strgačić M, Orehovački H, Ramalho-de-Oliveira D, Mucalo I. The Impact of Pharmacist-Led Medication Management Services on the Quality of Life and Adverse Drug Reaction Occurrence. PHARMACY 2022; 10:pharmacy10050102. [PMID: 36136835 PMCID: PMC9498323 DOI: 10.3390/pharmacy10050102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this research was to assess the impact of comprehensive medication management (CMM) services on patients’ health-related quality of life (HRQoL) and frequency of adverse drug reactions (ADRs) in older patients with cardiovascular diseases (CVDs). A prospective, pre- and post-intervention study with a one-year follow-up was conducted at the Health Care Centre Zagreb—Centre (HCZC). The Euro-Quality of Life Questionnaire 5 Dimensions 5 Levels (EQ-5D-5L) was used to measure the HRQoL at baseline (initial visit at the HCZC) and 12 months following CMM services. The ADRs collected at the initial assessment of the CMM services and throughout follow-up consultations were analyzed according to the occurrence mechanism, seriousness, expectedness and distribution of the Preferred Term according to the System Organ Class. Following the CMM intervention, 65 patients reported significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003), whereas no significant change was found in the “mobility” (p = 0.203), “pain/discomfort” (p = 0.173) and “anxiety/depression” (p = 0.083) dimensions and the self-rated VAS scale (p = 0.781). A total of 596 suspected ADR reports were found, the majority at patients’ initial assessment (67.3%), with a mean ± SD of 9.2 ± 16.9 per patient. The CMM services significantly reduced the rate of suspected ADRs, namely 2.7 ± 1.7 ADRs per patient at the initial assessment vs. 1.0 ± 1.5 ADRs per patient at the last consultation (p < 0.001). The obtained results indicate that CMM services may improve patients’ HRQoL. Additionally, as CMM services diminished the proportion of ADRs following 1-year patient follow-up, they may serve as a viable solution for safety management.
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Affiliation(s)
- Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Lucija Ana Bićanić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Marija Strgačić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Djenane Ramalho-de-Oliveira
- Centre for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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25
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Jiang H, Lin Y, Ren W, Fang Z, Liu Y, Tan X, Lv X, Zhang N. Adverse drug reactions and correlations with drug–drug interactions: A retrospective study of reports from 2011 to 2020. Front Pharmacol 2022; 13:923939. [PMID: 36133826 PMCID: PMC9483724 DOI: 10.3389/fphar.2022.923939] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/19/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Adverse drug reactions (ADRs) represent a public health problem worldwide that deserves attention due to the impact on mortality, morbidity, and healthcare costs. Drug–drug interactions (DDIs) are an important contributor to ADRs. Most of the studies focused only on potential DDIs (pDDIs), while the detailed data are limited regarding the ADRs associated with actual DDIs. Methods: This retrospective study evaluated ADRs reported between 2011 and 2020 in a tertiary hospital. The causality and severity of ADRs were evaluated through the Naranjo Algorithm and Hartwig’s scale, respectively. Preventability classification was based on the modified Schoumock and Thornton scale. For ADRs with at least two suspected drugs, pDDIs were identified according to the Lexi-Interact. We further checked whether the ADR description in the reports corresponded to the clinical consequences of the pDDIs. Results: A total of 1,803 ADRs were reported, of which 36.77% ADRs were classified as mild, 43.26% as moderate, and 19.97% as severe. The assessment of causality showed that the distributions of definite, probable, and possible categories were 0.33%, 58.68%, and 40.99%, respectively. A total of 53.97% of ADRs were identified as preventable ADRs, while 46.03% were recognized as unpreventable. The severity of ADRs was significantly correlated with age, the number of suspected drugs and preventability. Antimicrobial agents were the most common implicated pharmacological group, and the most frequently affected system was the gastrointestinal system. Considering individual drugs, aspirin was the most frequently reported drug. Among 573 ADRs with at least two suspected drugs, 105 ADRs were caused by actual DDIs, of which only 59 and 6 ADRs were caused by actual DDIs in category D and X, respectively. The most frequent drugs involved in actual DDIs of category D were aspirin and heparin, with the majority of ADRs being gastrointestinal bleeding. Conclusion: This study analyzed the pattern of ADRs in detail and obtained clinical evidence about ADRs associated with actual DDIs. These findings may be useful to compare patterns between different centers and to design preventive strategies for ADRs. Continuous education and training should be provided for physicians regarding the knowledge and recognition of ADRs associated with DDIs.
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Affiliation(s)
- Huaqiao Jiang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yanhua Lin
- Department of Nursing, Jinshan Hospital, Fudan University, Shanghai, China
| | - Weifang Ren
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zhonghong Fang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yujuan Liu
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiaofang Tan
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xiaoqun Lv
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaoqun Lv, ; Ning Zhang,
| | - Ning Zhang
- Department of Pharmacy, Jinshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiaoqun Lv, ; Ning Zhang,
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26
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Han J, Yang J, Du Y. Adverse Reaction of Acupuncture and Antihypertensive Drugs for Treatment of Essential hypertension: A Protocol for Bayesian Network Meta-Analysis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:7397307. [PMID: 36045996 PMCID: PMC9420606 DOI: 10.1155/2022/7397307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Background Hypertension, as a high risk factor of cardiovascular disease, has led to a significant upward trend in the population and incidence of the disease. Hypertension patients need to take antihypertensive drugs for life, and therefore people gradually pay more attention to the adverse reactions of antihypertensive drugs. This study protocol outlines a plan to assess the adverse reaction of the different antihypertensive drugs and acupuncture in order for clinical application. Objective To compare the side effects of different antihypertensive drugs and acupuncture in the treatment of hypertension. Methods and analysis. We will search the databases containing CNKI, Wan-Fang database, Chinese Scientific Journal Database(VIP), PubMed, Cochrane, and Embase, and randomized controlled trials (RCTs) of commonly used antihypertensive drugs or acupuncture for primary hypertension will be obtained. Then, Stata14.0 and Gemtc will be used to assess the statistics. Ethics and dissemination. Since no personal patient consent will be required in the study, there is no ethical approval. The results of this reporting will be submitted to a peer-reviewed publication. PROSPERO registration number: CRD42020152703.
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Affiliation(s)
- Jiawei Han
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin 300381, China
| | - Jiwei Yang
- Institution of Acupuncture and Moxibustion, China Academy of Traditional Medical Science, Beijing 100700, China
| | - Yuanhao Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin 300381, China
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27
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Nymoen LD, Björk M, Flatebø TE, Nilsen M, Godø A, Øie E, Viktil KK. Drug-related emergency department visits: prevalence and risk factors. Intern Emerg Med 2022; 17:1453-1462. [PMID: 35129789 PMCID: PMC9352618 DOI: 10.1007/s11739-022-02935-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022]
Abstract
The study aimed to investigate the prevalence of drug-related emergency department (ED) visits and associated risk factors. This retrospective cohort study was conducted in the ED, Diakonhjemmet Hospital, Oslo, Norway. From April 2017 to May 2018, 402 patients allocated to the intervention group in a randomized controlled trial were included in this sub-study. During their ED visit, these patients received medication reconciliation and medication review conducted by study pharmacists, in addition to standard care. Retrospectively, an interdisciplinary team assessed the reconciled drug list and identified drug-related issues alongside demographics, final diagnosis, and laboratory tests for all patients to determine whether their ED visit was drug-related. The study population's median age was 67 years (IQR 27, range 19-96), and patients used a median of 4 regular drugs (IQR 6, range 0-19). In total, 79 (19.7%) patients had a drug-related ED visits, and identified risk factors were increasing age, increasing number of regular drugs and medical referral reason. Adverse effects (72.2%) and non-adherence (16.5%) were the most common causes of drug-related ED visits. Antithrombotic agents were most frequently involved in drug-related ED visits, while immunosuppressants had the highest relative frequency. Only 11.4% of the identified drug-related ED visits were documented by physicians during ED/hospital stay. In the investigated population, 19.7% had a drug-related ED visit, indicating that drug-related ED visits are a major concern. If not recognized and handled, this could be a threat against patient safety. Identified risk factors can be used to identify patients in need of additional attention regarding their drug list during the ED visit.
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Affiliation(s)
- Lisbeth Damlien Nymoen
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway.
- Department of Pharmacy, University of Oslo, Oslo, Norway.
| | - Malin Björk
- Faculty of Pharmacy, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | | | - Aasmund Godø
- Department of Anaesthesia and Intensive Care, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Kirsten Kilvik Viktil
- Diakonhjemmet Hospital Pharmacy, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
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28
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Lee GB, Etherton-Beer C, Hosking SM, Pasco JA, Page AT. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Ther Adv Drug Saf 2022; 13:20420986221100117. [PMID: 35814333 PMCID: PMC9260603 DOI: 10.1177/20420986221100117] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
In the context of an ageing population, the burden of disease and medicine use is
also expected to increase. As such, medicine safety and preventing avoidable
medicine-related harm are major public health concerns, requiring further
research. Potentially suboptimal medicine regimens is an umbrella term that
captures a range of indicators that may increase the risk of medicine-related
harm, including polypharmacy, underprescribing and high-risk prescribing, such
as prescribing potentially inappropriate medicines. This narrative review aims
to provide a background and broad overview of the patterns and implications of
potentially suboptimal medicine regimens among older adults. Original research
published between 1990 and 2021 was searched for in MEDLINE, using key search
terms including polypharmacy, inappropriate prescribing, potentially
inappropriate medication lists, medication errors, drug interactions and drug
prescriptions, along with manual checking of reference lists. The review
summarizes the prevalence, risk factors and clinical outcomes of polypharmacy,
underprescribing and potentially inappropriate medicines. A synthesis of the
evidence regarding the longitudinal patterns of polypharmacy is also provided.
With an overview of the existing literature, we highlight a number of key gaps
in the literature. Directions for future research may include a longitudinal
investigation into the risk factors and outcomes of extended polypharmacy,
research focusing on the patterns and implications of underprescribing and
studies that evaluate the applicability of tools measuring potentially
inappropriate medicines to study settings.
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Affiliation(s)
- Georgie B Lee
- Epi-Centre for Healthy Ageing, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, HERB-Building Level 3, C/- University Hospital Geelong, 285 Ryrie Street, P.O. Box 281, Geelong, VIC 3220, Australia
| | | | - Sarah M Hosking
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Amy T Page
- WA Centre for Health and Ageing, The University of Western Australia, Crawley, WA, Australia
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Bories M, Bouzillé G, Cuggia M, Le Corre P. Drug–Drug Interactions with Oral Anticoagulants as Potentially Inappropriate Medications: Prevalence and Outcomes in Elderly Patients in Primary Care and Hospital Settings. Pharmaceutics 2022; 14:pharmaceutics14071410. [PMID: 35890305 PMCID: PMC9325322 DOI: 10.3390/pharmaceutics14071410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023] Open
Abstract
Direct oral anticoagulants and vitamin K antagonists are considered as potentially inappropriate medications (PIM) in several situations according to Beers Criteria. Drug–drug interactions (DDI) occurring specifically with these oral anticoagulants considered PIM (PIM–DDI) is an issue since it could enhance their inappropriate character and lead to adverse drug events, such as bleeding events. The aim of this study was (1) to describe the prevalence of oral anticoagulants as PIM, DDI and PIM–DDI in elderly patients in primary care and during hospitalization and (2) to evaluate their potential impact on the clinical outcomes by predicting hospitalization for bleeding events using machine learning methods. This retrospective study based on the linkage between a primary care database and a hospital data warehouse allowed us to display the oral anticoagulant treatment pathway. The prevalence of PIM was similar between primary care and hospital setting (22.9% and 20.9%), whereas the prevalence of DDI and PIM–DDI were slightly higher during hospitalization (47.2% vs. 58.9% and 19.5% vs. 23.5%). Concerning mechanisms, combined with CYP3A4–P-gp interactions as PIM–DDI, were among the most prevalent in patients with bleeding events. Although PIM, DDI and PIM–DDI did not appeared as major predictors of bleeding events, they should be considered since they are the only factors that can be optimized by pharmacist and clinicians.
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Affiliation(s)
- Mathilde Bories
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- CHU Rennes, INSERM, LTSI-UMR 1099, Univ Rennes, 35000 Rennes, France; (G.B.); (M.C.)
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
| | - Guillaume Bouzillé
- CHU Rennes, INSERM, LTSI-UMR 1099, Univ Rennes, 35000 Rennes, France; (G.B.); (M.C.)
| | - Marc Cuggia
- CHU Rennes, INSERM, LTSI-UMR 1099, Univ Rennes, 35000 Rennes, France; (G.B.); (M.C.)
| | - Pascal Le Corre
- Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU de Rennes, 35033 Rennes, France;
- Laboratoire de Biopharmacie et Pharmacie Clinique, Faculté de Pharmacie, Université de Rennes 1, 35043 Rennes, France
- CHU Rennes, INSERM, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Univ Rennes, 35000 Rennes, France
- Correspondence:
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30
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Randles MA, O'Mahony D, Gallagher PF. Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship? Drugs Aging 2022; 39:597-606. [PMID: 35764865 PMCID: PMC9355920 DOI: 10.1007/s40266-022-00952-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 01/10/2023]
Abstract
Frail older adults commonly experience multiple co-morbid illnesses and other risk factors for potentially inappropriate prescribing. However, determination of frailty varies depending on the frailty instrument used. Older people’s degree of frailty often influences their care and treatment priorities. Research investigating the association between frailty and potentially inappropriate prescribing is hindered by a wide variety of frailty definitions and measurement tools. We undertook a narrative review of selected articles of PubMed and Google Scholar databases. Articles were selected on the basis of relevance to the core themes of frailty and potentially inappropriate prescribing. We identified observational studies that clearly link potentially inappropriate prescribing, potential prescribing omissions, and adverse drug reactions with frailty in older adults. Equally, the literature illustrates that measured frailty in older adults predisposes to inappropriate polypharmacy and associated adverse drug reactions and events. In essence, there is a bi-directional relationship between frailty and potentially inappropriate prescribing, the underlying substrates being multimorbidity and inappropriate polypharmacy. We conclude that there is a need for consensus on rapid and accurate identification of frailty in older people using appropriate and user-friendly methods for routine clinical practice as a means of identifying older multimorbid patients at risk of potentially inappropriate prescribing. Detection of frailty should, we contend, lead to structured screening for inappropriate prescribing in this high-risk population. Of equal importance, detection of potentially inappropriate prescribing in older people should trigger screening for frailty. All clinicians undertaking a medication review of multimorbid patients with associated polypharmacy should take account of the important interaction between frailty and potentially inappropriate prescribing in the interest of minimizing patient harm.
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Affiliation(s)
- Mary A Randles
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland. .,Department of Medicine, University College Cork, Cork, Ireland.
| | - Denis O'Mahony
- Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Paul F Gallagher
- Department of Medicine, University College Cork, Cork, Ireland.,Department of Geriatric Medicine, Bon Secours Hospital, Cork, Ireland
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31
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Gaspar F, Lutters M, Beeler PE, Lang PO, Burnand B, Rinaldi F, Lovis C, Casjka C, Le Pogam MA. Automatic detection of adverse drug events in the geriatric care: a study proposal (Preprint). JMIR Res Protoc 2022; 11:e40456. [DOI: 10.2196/40456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
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32
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van Dam CS, Labuschagne HA, van Keulen K, Kramers C, Kleipool EE, Hoogendijk EO, Knol W, Nanayakkara PWB, Muller M, Trappenburg MC, Peters MJL. Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department. Eur Geriatr Med 2022; 13:849-857. [PMID: 35723840 PMCID: PMC9378326 DOI: 10.1007/s41999-022-00664-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
Aim To investigate the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Findings Excessive polypharmacy (≥ 10 medications) is highly prevalent in older adults at the emergency department and associated with falls, mortality and readmission. Frailty and comorbidity partly drive the association of polypharmacy with adverse health outcomes. Message Trials that target polypharmacy and inappropriate prescribing are needed to answer the lingering question of causality in the observed polypharmacy–mortality association and to evaluate whether medication review improves health outcomes in older patients at the ED. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00664-y. Purpose Older adults at the emergency department (ED) with polypharmacy, comorbidity, and frailty are at risk of adverse health outcomes. We investigated the association of polypharmacy with adverse health outcomes, in relation to comorbidity and frailty. Methods This is a prospective cohort study in ED patients ≥ 70 years. Non-polypharmacy was defined as 0–4 medications, polypharmacy 5–9 and excessive polypharmacy ≥ 10. Comorbidity was classified by the Charlson comorbidity index (CCI). Frailty was defined by the Identification of Seniors At Risk—Hospitalized Patients (ISAR-HP) score. The primary outcome was 3-month mortality. Secondary outcomes were readmission to an ED/hospital ward and a self-reported fall < 3 months. The association between polypharmacy, comorbidity and frailty was analyzed by logistic regression. Results 881 patients were included. 43% had polypharmacy and 18% had excessive polypharmacy. After 3 months, 9% died, 30% were readmitted, and 21% reported a fall. Compared with non-polypharmacy, the odds ratio (OR) for mortality ranged from 2.62 (95% CI 1.39–4.93) in patients with polypharmacy to 3.92 (95% CI 1.95–7.90) in excessive polypharmacy. The OR weakened after adjustment for comorbidity: 1.80 (95% CI 0.92–3.52) and 2.32 (95% CI 1.10–4.90). After adjusting for frailty, the OR weakened to 2.10 (95% CI 1.10–4.00) and OR 2.40 (95% CI 1.15–5.02). No significant association was found for readmission or self-reported fall. Conclusions Polypharmacy is common in older patients at the ED. Polypharmacy, and especially excessive polypharmacy, is associated with an increased risk of mortality. The observed association is complex given the confounding effect of comorbidity and frailty. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00664-y.
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Affiliation(s)
- Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
| | - Helena A Labuschagne
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Kris van Keulen
- Department of Pharmacy, Amstelland Hospital, Amstelveen, the Netherlands
| | - Cornelis Kramers
- Department of Pharmacology-Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emma E Kleipool
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Pharmacy, Amstelland Hospital, Amstelveen, the Netherlands
| | - Mike J L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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33
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Klopotowska JE, Kuks PFM, Wierenga PC, Stuijt CCM, Arisz L, Dijkgraaf MGW, de Keizer N, Smorenburg SM, de Rooij SE. The effect of structured medication review followed by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients - a multicenter interrupted time series study. BMC Geriatr 2022; 22:505. [PMID: 35715742 PMCID: PMC9206349 DOI: 10.1186/s12877-022-03118-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of interventions to improve medication safety in older inpatients is unclear, given a paucity of properly designed intervention studies applying clinically relevant endpoints such as hospital-acquired preventable Adverse Drug Events (pADEs) and unrecognized Adverse Drug Events (uADEs). Therefore, we conducted a quality improvement study and used hospital-acquired pADEs and uADEs as main outcomes to assess the effect of an intervention aimed to improve medication safety in older inpatients. Method The study followed an interrupted time series design and consisted of three equally spaced sampling points during baseline and during intervention measurements. Each sampling point included between 80 to 90 patients. A total of 500 inpatients ≥65 years and admitted to internal medicine wards of three Dutch hospitals were included. An expert team retrospectively identified and assessed ADEs via a structured patient chart review. The findings from baseline measurement and meetings with the internal medicine and hospital pharmacy staff were used to design the intervention. The intervention consisted of a structured medication review by hospital pharmacists, followed by face-to-face feedback to prescribers, on average 3 days per week. Results The rate of hospital-acquired pADEs per 100 hospitalizations was reduced by 50.6% (difference 16.8, 95% confidence interval (CI): 9.0 to 24.6, P < 0.001), serious hospital-acquired pADEs by 62.7% (difference 12.8, 95% CI: 6.4 to 19.2, P < 0.001), and uADEs by 51.8% (difference 11.2, 95% CI: 4.4 to 18.0, P < 0.001). Additional analyses confirmed the robustness of the intervention effect, but residual bias cannot be excluded. Conclusions The intervention significantly decreased the overall and serious hospital-acquired pADE occurrence in older inpatients, and significantly improved overall ADE recognition by prescribers. Trial registration International Standard Randomized Controlled Trial Number Register, trial registration number: ISRCTN64974377, registration date (date assigned): 07/02/2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03118-z.
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Affiliation(s)
- Joanna E Klopotowska
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands. .,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - Paul F M Kuks
- Amsterdam University Medical Centers location University of Amsterdam, Pharmacy and Clinical Pharmacology, Amsterdam, The Netherlands
| | - Peter C Wierenga
- Gelderse Vallei Hospital, Hospital Pharmacy, Ede, The Netherlands
| | - Clementine C M Stuijt
- Center of Excellence on Parkinson's disease (Punt voor Parkinson), Groningen, The Netherlands
| | - Lambertus Arisz
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Amsterdam University Medical Centers location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands.,Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Amsterdam University Medical Centers location University of Amsterdam, Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Susanne M Smorenburg
- Amsterdam University Medical Centers location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Amstelland Hospital, Board of Directors, Amstelveen, The Netherlands
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34
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Galai E, Scotti L, Gilardetti M, Ucciero A, Ferrante D, Poluzzi E, Genazzani AA, Barone-Adesi F. Time-Trends of Drug-Drug Interactions among Elderly Outpatients in the Piedmont Region (Italy): A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127353. [PMID: 35742605 PMCID: PMC9224286 DOI: 10.3390/ijerph19127353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023]
Abstract
Adverse drug reactions (ADRs) are a major health problem in the primary care setting, particularly among the elderly population. While the high frequency of ADRs in the elderly has several causes, a major and common determinant is polypharmacy, which can in turn increase the risk of drug-drug interactions (DDIs). In this paper, we analyzed the drugs prescriptions dispensed to elderly outpatients, to assess changes in the prevalence of selected DDIs in the period 2013−2019. Overall, about 15% of the patients aged >65 years were poly-treated. Among them, a decreasing trend in prevalence was observed for the majority of DDIs during the study period. This trend was particularly noticeable for DDIs involving fluoroquinolones and vitamin K antagonists, where a sharp reduction of over 40% was observed. On the opposite, a small increase in prevalence was observed for the association of antidiabetics and beta-blocking agents and for that of clopidogrel and PPIs. While the occurrence of most of the considered DDIs among poly-treated elderly decreased over time, the prevalence of some of them is still worrying. The complexity of the national drug formularies, as well as the increased number of prescribing actors that are involved, further urges the update of DDI lists to be used to monitor drug appropriateness and reduce avoidable ADRs.
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Affiliation(s)
- Elisabetta Galai
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, 28100 Novara, Italy; (E.G.); (A.A.G.)
- Azienda Ospedaliero-Universitaria “Maggiore della Carità”, 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
- Correspondence:
| | - Marco Gilardetti
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l’Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, 10100 Torino, Italy;
| | - Andrealuna Ucciero
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40100 Bologna, Italy;
| | - Armando A. Genazzani
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, 28100 Novara, Italy; (E.G.); (A.A.G.)
| | - Francesco Barone-Adesi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (A.U.); (D.F.); (F.B.-A.)
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35
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Noorda NMF, Sallevelt BTGM, Langendijk WL, Egberts TCG, van Puijenbroek EP, Wilting I, Knol W. Performance of a trigger tool for detecting adverse drug reactions in patients with polypharmacy acutely admitted to the geriatric ward. Eur Geriatr Med 2022; 13:837-847. [PMID: 35635713 PMCID: PMC9378479 DOI: 10.1007/s41999-022-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
Aim To investigate the performance of an adverse drug reaction (ADR) trigger tool in patients with polypharmacy acutely admitted to our geriatric ward. Findings The ADR trigger tool had a positive predictive value (PPV) of 41.8%. Usual care recognised 83.5% of ADRs considered as possible, probable or certain, increasing to 97.1% when restricted to probable and certain ADRs. Message It is unlikely that implementation of the ADR trigger tool will improve detection of unrecognised ADRs in older patients acutely admitted to our geriatric ward. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00649-x. Purpose Adverse drug reactions (ADRs) account for 10% of acute hospital admissions in older people, often under-recognised by physicians. The Dutch geriatric guideline recommends screening all acutely admitted older patients with polypharmacy with an ADR trigger tool comprising ten triggers and associated drugs frequently causing ADRs. This study investigated the performance of this tool and the recognition by usual care of ADRs detected with the tool. Methods A cross-sectional study was performed in patients ≥ 70 years with polypharmacy acutely admitted to the geriatric ward of the University Medical Centre Utrecht. Electronic health records (EHRs) were screened for trigger–drug combinations listed in the ADR trigger tool. Two independent appraisers assessed causal probability with the WHO-UMC algorithm and screened EHRs for recognition of ADRs by attending physicians. Performance of the tool was defined as the positive predictive value (PPV) for ADRs with a possible, probable or certain causal relation. Results In total, 941 trigger–drug combinations were present in 73% (n = 253/345) of the patients. The triggers fall, delirium, renal insufficiency and hyponatraemia covered 86% (n = 810/941) of all trigger–drug combinations. The overall PPV was 41.8% (n = 393/941), but the PPV for individual triggers was highly variable ranging from 0 to 100%. Usual care recognised the majority of ADRs (83.5%), increasing to 97.1% when restricted to possible and certain ADRs. Conclusion The ADR trigger tool has predictive value; however, its implementation is unlikely to improve the detection of unrecognised ADRs in older patients acutely admitted to our geriatric ward. Future research is needed to investigate the tool’s clinical value when applied to older patients acutely admitted to non-geriatric wards. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00649-x.
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Affiliation(s)
- Nikki M F Noorda
- Geriatric Medicine Department, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, the Netherlands.
| | | | - Wivien L Langendijk
- Geriatric Medicine Department, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, the Netherlands
| | - Toine C G Egberts
- Clinical Pharmacy Department, University Medical Centre Utrecht, Utrecht, the Netherlands.,Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Eugène P van Puijenbroek
- The Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands.,Division of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Ingeborg Wilting
- Clinical Pharmacy Department, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Wilma Knol
- Geriatric Medicine Department, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, the Netherlands
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Yadesa TM, Kitutu FE, Tamukong R, Alele PE. Predictors of hospital-acquired adverse drug reactions: a cohort of Ugandan older adults. BMC Geriatr 2022; 22:359. [PMID: 35461224 PMCID: PMC9033930 DOI: 10.1186/s12877-022-03003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Globally, it is estimated that the number of older adults will become 2 billion by 2050. The identification of the predictors of adverse drug reaction (ADR) in hospitalized older patients is crucial to the development of prediction tools and preventive strategies to mitigate the burden of ADRs. This study aimed to determine the predictors of hospital-acquired ADR occurrence among hospitalized older adults in a low-income country. Methods We conducted a prospective cohort of older adults admitted to medical, oncology, and surgery wards at Mbarara Regional Referral Hospital (MRRH) for a consecutive 6 months where each patient was followed up daily from admission to discharge. We used Edwards and Aronson’s definition of ADR and the Naranjo ADR Causality Scale. We employed Beer’s criteria and Lexicomp to determine potentially inappropriate medications, and drug interactions, respectively. We conducted univariate and multivariable logistic regression using Statistical Package for the Social Science (SPSS) Version 23.0. Results Out of 523 participants with median (Inter Quartile Range) age of 67 (62–76) years, 256 (48.9%) experienced at least one ADR. Independent predictors of occurrence of hospital acquired ADRs included age of 60–75 (Adjusted odds ratio (AOR) = 1.97, 95% C.I: 1.14–3.41; p value = 0.015) compared to > 75 years, previous ADR in 1 year (AOR = 2.43, 95% C.I: 1.42–4.17; p value = 0.001), potentially inappropriate medication (AOR = 4.56, 95% C.I: 2.70–7.70; p value< 0.001), polypharmacy (AOR = 3.29, 95% C.I: 1.98–5.46; p value< 0.001)), having a Charlison Comorbidity Index (CCI) ≥ 6 (AOR = 8.47, 95% C.I: 4.85–14.99; p value< 0.001), having heart failure (AOR = 2.83, 95% C.I: 1.34–6.02; p value = 0.007) or kidney disease (AOR = 1.95, 95% C.I: 1.05–3.61; p value = 0.034) and a hospital stay > 10 days (AOR = 3.53, 95% C.I: 1.89–6.61; p value< 0.001) compared to < 5 days. Conclusion The current prevalence of ADR is higher than previously reported in high-income countries. Disease-related factors followed by medication-related factors were shown to be the most important predictors of hospital-acquired ADRs. CCI and PIM showed the strongest association with ADR. The predictors of ADRs identified in our study were generally comparable with those reported by previous studies. Plain language title Conditions that predispose older patients to experience harmful effects from their medications while in hospital. Plain language summary Identifying the conditions that predispose older adults to incur harmful effects of their medications helps to plan on how best to predict, take precautions and closely follow up on them and thus, to prevent these undesirable outcomes. This study aimed to identify these conditions which determine which older adults are higher risk to incur these harmful undesirable effects of medicines. Everydayduring their hospital stay, we closely followed older patients who were 60 years and above from their entry to the hospital wards until they left the hospital. We interviewed the participants, reviewed their medication files and we also examined them physically to identify any unwanted and harmful outcome from their current medications. Out of 523 participants, almost half of them experienced at least one harmful or undesired effect related to their medicine. Conditions which predisposed them to experience a harmful effect from their medicines included being in age bracket of 60–75 years, having a history of experiencing harmful outcomes from medicines in the previous 1 year, taking a medication which was listed as potentially inappropriate for older adults, taking 5 or more medications concurrently, having a lower 10 years survival chance, having heart or kidney disease and a hospital stay > 10 days.
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Affiliation(s)
- Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, P.O.Box 1410, Uganda. .,Department of Pharmacy, Ambo University, Ambo, Ethiopia. .,Pharm-Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health Schiences, Makerere University, Kampala, Uganda.,Sustainable Pharmaceutical Systems (SPS) unit, School of Health Schiences, Makerere University, Kampala, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, P.O.Box 1410, Uganda.,Pharm-Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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Drug-Related Problems and Polypharmacy in Nursing Home Residents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074313. [PMID: 35409994 PMCID: PMC8998432 DOI: 10.3390/ijerph19074313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023]
Abstract
At present, 19.2% of the Spanish population is aged 65 or older. Polypharmacy is a frequent condition among the elderly, especially in those living in nursing homes, which is associated with adverse outcomes, such as adverse drug events or drug-drug interactions. This study aimed to assess the pattern of polypharmacy in a nursing home in Leon, one of Spain's most ageing regions, and its relationship with different drug-related problems. A descriptive, observational, and cross-sectional study design was used; 222 residents were involved in this study. Data on drug use were collected from medical charts. Information was screened with the software CheckTheMeds, BOT PLUS and Drug-Reax. Residents were on a median of 7 medicines. Polypharmacy and inappropriate medications were present in 78.8% and 96.8% of residents, respectively. Drug-related problems were present in almost all the populations evaluated. Drug-drug interactions were very common in participants (81.1%), being severe/moderate in 24.7%. A high prevalence of polypharmacy and drug-related problems in the nursing home population assessed has been observed. A significantly higher risk of suffering drug-drug interactions was revealed for increasing polypharmacy and anticholinergic risk. A regular evaluation of drug prescribing in nursing home residents is necessary to minimize drug-related problems risk.
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Mertens B, Hias J, Hellemans L, Walgraeve K, Spriet I, Tournoy J, Van der Linden LR. Drug-related hospital admissions in older adults: comparison of the Naranjo algorithm and an adjusted version of the Kramer algorithm. Eur Geriatr Med 2022; 13:567-577. [PMID: 35312975 DOI: 10.1007/s41999-022-00623-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Drug-related admissions (DRAs) are an important cause of preventable harm in older adults. Multiple algorithms exist to assess causality of adverse drug reactions, including the Naranjo algorithm and an adjusted version of the Kramer algorithm. The performance of these tools in assessing DRA causality has not been robustly shown. This study aimed to evaluate the ability of the adjusted Kramer algorithm to adjudicate DRA causality in geriatric inpatients. METHODS DRAs were assessed in a convenience sample of patients admitted to the acute geriatric wards of an academic hospital. DRAs were identified by expert consensus and causality was evaluated using the Naranjo and the adjusted Kramer algorithms. Positive agreement with expert consensus was calculated for both algorithms. A multivariable logistic regression analysis was performed to explore determinants for a DRA. RESULTS A total of 218 geriatric inpatients was included of whom 65 (29.8%) experienced a DRA. Positive agreement was 72.3% (95% confidence interval (CI), 59.6-82.3%) and 100% (95% CI, 93.0-100%) for the Naranjo and the adjusted Kramer algorithm, respectively. Diuretics were the main culprits and most DRAs were attributed to a fall (n = 18; 27.7%). A fall-related principal diagnosis was independently associated with a DRA (odds ratio 20.11; 95% CI, 5.60-72.24). CONCLUSION The adjusted Kramer algorithm demonstrated a higher positive agreement with expert consensus in assessing DRA causality in geriatric inpatients compared to the Naranjo algorithm. Our results further support implementation of the adjusted Kramer algorithm as part of a standardized DRA assessment in older adults.
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Affiliation(s)
- Beatrijs Mertens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. .,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.
| | - Julie Hias
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Laura Hellemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lorenz Roger Van der Linden
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
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BEKİROĞLU ERGÜN T, ERGÜN Y. Adverse Events after Receipt of an Inactive COVID-19 Vaccine in Healthcare Professionals: a Cross-Sectional Study. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1037370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The vaccine manufactured by Sinovac has been licensed according to the emergency use authorization program in Turkey. Inherently, this product has many shortcomings regarding safety issues. The aim was to explore the potential adverse reactions of the vaccine.
Materials and methods: A retrospective cross-sectional study via a 24-item self-administered questionnaire was conducted among healthcare professionals.
Results: Of 133 persons, 51 subjects (38%) experienced adverse events after the first dose of the vaccine. The most common adverse events were fatigue, headache, diarrhea, and fever. Ninety five percent of the subjects (n=126) had the second dose of the vaccine and only 43 subjects (26%) described adverse events. These events were similar to those seen after the first dose. In one person, acute hypertension elevation was considered to be a serious adverse event. A female dominance regarding the frequency of adverse events was, solely, detected after the first dose administration.
Conclusion: Although there is a significant amount of adverse events in response to the vaccine, these cannot be identified as serious events. Therefore, this vaccine seems to be safety enough for those under the threat of the coronavirus disease 2019.
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Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients. J Clin Med 2022; 11:jcm11020397. [PMID: 35054090 PMCID: PMC8780223 DOI: 10.3390/jcm11020397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.
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Aguiar JP, Gama Marques J, Leufkens HGM, Alves da Costa F. Healthcare Professionals' Views on the Management of Medication Complexities in the Elderly With Mental Health Disorders: A Cross-Sectional Study. Front Psychiatry 2022; 13:885216. [PMID: 35677869 PMCID: PMC9168079 DOI: 10.3389/fpsyt.2022.885216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many challenges in elderly pharmacotherapy are identified, including the use of Potentially Inappropriate Medications (PIMs) which may increase the odds of adverse events, especially in elderly patients with mental health disorders (e. g., behavioral, and psychological symptoms of dementia-BPSD, schizophrenia, bipolar disorder). However, information on the knowledge and practice of healthcare professionals (HCPs) about this topic is still scarce. METHODS A cross-sectional study was undertaken from July-October 2019. An online questionnaire was specifically designed and validated for this study. We sought HCPs (physicians, pharmacists, and nurses) worldwide, using (a) social media, via Facebook, Twitter, and LinkedIn; and (b) email contacts of the research team (convenience sample). Either way participants were asked to share on their social media or via e-mail the questionnaires with other HCPs (snowballing sample). The survey assessed two main domains: knowledge and practice. Knowledge was evaluated by self-report (perceived knowledge by a 5-item Likert confidence scale) and using three clinical cases, scored between 0 and 30 points (each one rated from 0 to 10 points; real knowledge). Barriers in clinical practice were evaluated using a 5-item Likert scale judging practitioners' opinion. RESULTS A total of 165 questionnaires were collected. HCPs were mainly female (n = 114; 69.1%), with a mean age of 35.3 ± 11.3 years old. Seventy-two percent (n = 118) were pharmacists, 21.1% (n = 35) were physicians, and 7.3% (n = 12) nurses. There was a weak correlation, albeit significant, between perceived and real knowledge (r = 0.199; p = 0.001). The mean score of the clinical vignettes regarding elderly patients with dementia and bipolar disorder were 4.59 ± 4.08 and 4.86 ± 2.97 points, respectively. Most HCPs were classified as having an intermediate knowledge (n = 100; 60.6%) about medication complexities in the elderly with mental disorders. Most HCPs agreed that lack of time (81.6%; n = 138), lack of education and training on elderly pharmacotherapy (72.2%; n = 122), and lack of tools adapted to daily practice (61.8%; n = 105) were the main barriers. CONCLUSIONS Most of the HCPs felt confident to manage medication complexities in elder patients with mental disorders, but only a minority obtained a good score in the knowledge assessment test. The main barriers identified included structural barriers (tools unfit for practice) and process barriers (time).
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Affiliation(s)
- João Pedro Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
| | - João Gama Marques
- Serviço de Psiquiatria Geral e Transcultural, Centro Hospitalar Psiquiátrico de Lisboa (CHPL), Lisboa, Portugal.,Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa (FMUL), Lisboa, Portugal
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
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Weingart SN, Atoria CL, Pfister D, Classen D, Killen A, Fortier E, Epstein AS, Anderson C, Lipitz-Snyderman A. Risk Factors for Adverse Events in Patients With Breast, Colorectal, and Lung Cancer. J Patient Saf 2021; 17:e701-e707. [PMID: 29419566 PMCID: PMC6078829 DOI: 10.1097/pts.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to identify risk factors associated with medical errors and iatrogenic injuries during an initial course of cancer-directed treatment. METHODS In this retrospective cohort study of 400 patients 18 years or older undergoing an initial course of treatment for breast, colorectal, or lung cancer at a comprehensive cancer center, we abstracted patient, disease, and treatment-related variables from the electronic medical record. We examined adverse events (AEs) and preventable AEs by risk factor using the χ2 or Fisher exact tests. We estimated the association between risk factors and the relative risk of an additional AE or preventable AE in multivariable negative binomial regression models with backwards selection (P < 0.1). RESULTS There were 304 AEs affecting 136 patients (34%) and 97 preventable AEs affecting 53 patients (13%). In multivariable analyses, AEs were overrepresented in those with lung cancer compared with patients with breast cancer (incident rate ratio = 1.9, 95% confidence interval = 1.1-3.2). Nonwhite race (1.6, 1.0-2.6), Hispanic or Latino ethnicity (2.0, 0.9-4.1), advanced disease (1.7, 1.1-2.6), use of each additional class of high-risk nonchemotherapy medication (1.6, 1.3-1.9), and chemotherapy (2.1, 1.3-3.3) were all associated with risk of an additional AE. Preventable AEs were associated with lung cancer (7.4, 2.4-23.2), Hispanic or Latino ethnicity (5.5, 1.7-17.9), and high-risk nonchemotherapy medications (1.5, 1.2-2.0). CONCLUSIONS Risk factors for AEs among patients with cancer reflected patients' underlying disease, cancer-directed therapy, and high-risk noncancer medications. The association of AEs with ethnicity merits further research. Risk factor models could be used prospectively to identify patients with cancer at increased risk of harm.
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Affiliation(s)
- Saul N. Weingart
- Department of Medicine, Tufts Medical Center and Tufts University School of Medicine
| | - Coral L. Atoria
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center
| | - David Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - David Classen
- Pascal Metrics and University of Utah School of Medicine
| | - Aileen Killen
- Department of Quality and Safety, Memorial Sloan Kettering Cancer Center (at time of this study); AIG (present)
| | - Elizabeth Fortier
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center
| | | | - Christopher Anderson
- Department of Surgery, Memorial Sloan Kettering Cancer Center (at time of this study); Department of Urology, Columbia University (present)
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Geriatric characteristics and the risk of drug-related hospital admissions in older Emergency Department patients. Eur Geriatr Med 2021; 13:329-337. [PMID: 34755308 DOI: 10.1007/s41999-021-00580-7] [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: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Drug-Related Admissions (DRAs) are a well-known problem among older patients in the Emergency Department (ED). The aim of this study was (a) to investigate the prevalence and clinical manifestations of DRAs and the responsible drugs, (b) to study the association between geriatric characteristics and DRAs, and (c) to study the predictive performance of geriatric screeners for identifying DRAs in older ED patients. METHODS Patients aged ≥ 70 hospitalized from the ED were included. Demographics, geriatric characteristics and medications were collected. The the Acutely Presenting Older Patient (APOP)-screener, the Identification of Seniors At Risk (ISAR) and the ISAR-Hospitalized Patients (ISAR-HP) were used as geriatric screeners. Potential DRAs were identified retrospectively, the association between geriatric screeners and DRAs was investigated with logistic regression and the predictive performance was assessed by calculating the Area under the Curve (AUC) of the Receiver Operator Characteristics (ROC). RESULTS The mean age of patients was 78 (IQR 73-83), using an average of 6 medications. Out of 240 admissions, 77 (30%) were classified as a DRA. Independent risk factors for DRAs were polypharmacy (OR 2.42; 95% CI 1.23-4.74) and the ADL dependency (OR 1.23; 95%CI 1.05-1.44). ISAR (OR 3.27; 95%CI 1.60-6.69) and ISAR-HP (OR 1.83; 95% CI 1.02-3.27) associated with increased risk of DRAs, whereas the APOP screener did not (OR 1.56; 95% CI 0.82-2.97). The predictive performance of all geriatric screeners for predicting DRAs was poor (AUC for all screeners < 0.60). CONCLUSION DRAs are highly prevalent in older ED patients. Polypharmacy, ADL dependency and a high ISAR or ISAR-HP are associated with higher risk for DRAs, but the predictive value of geriatric screeners is insufficient.
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Cam H, Kempen TGH, Eriksson H, Abdulreda K, Franzon K, Gillespie U. Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review. BMC Geriatr 2021; 21:618. [PMID: 34724895 PMCID: PMC8561898 DOI: 10.1186/s12877-021-02564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. METHODS We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. RESULTS A total of 699 patients were included. The patients' mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). CONCLUSIONS The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.,Academic Primary Health Care Centre, Region Uppsala, Uppsala, Sweden
| | | | | | - Kristin Franzon
- Geriatric Department, Uppsala University Hospital, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.,Department of Pharmacy, Uppsala University, Uppsala, Sweden
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Gangannagaripalli J, Porter I, Davey A, Ricci Cabello I, Greenhalgh J, Anderson R, Briscoe S, Hughes C, Payne R, Cockcroft E, Harris J, Bramwell C, Valderas JM. STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background
Drug-related problems and potentially inappropriate prescribing impose a huge burden on patients and the health-care system. The most widely used tools for appropriate prescription in older adults in England and in other European countries are the Screening Tool of Older People’s Prescriptions (STOPP)/Screening Tool to Alert to the Right Treatment (START) tools. STOPP/START tools support medicines optimisation for older adults.
Objectives
To identify, test and refine the programme theories underlying how interventions based on the STOPP/START tools are intended to work, for whom, in what circumstances and why, as well as the resource use and cost requirements or impacts.
Design
A realist synthesis.
Setting
Primary care, hospital care and nursing homes.
Patients
Patients aged ≥ 65 years.
Interventions
Any intervention based on the use of the STOPP/START tools.
Review methods
Database and web-searching was carried out to retrieve relevant evidence to identify and test programme theories about how interventions based on the use of the STOPP/START tools work. A project reference group made up of health-care professionals, NHS decision-makers, older people, carers and members of the public was set up. In phase 1 we identified programme theories about STOPP/START interventions on how, for whom, in what contexts and why they are intended to work. We searched the peer-reviewed and grey literature to identify documents relevant to the research questions. We interviewed experts in the field in our reference group to gain input on our list of candidate context–mechanism–outcome configurations, to identify additional context–mechanism–outcome configurations and to identify additional literature and/or relevant concepts. In phase 2 we reviewed and synthesised relevant published and unpublished empirical evidence and tested the programme theories using evidence from a larger set of empirical studies.
Results
We developed a single logic model structured around three key mechanisms: (1) personalisation, (2) systematisation and (3) evidence implementation. Personalisation: STOPP/START-based interventions are based on shared decision-making, taking into account patient preferences, experiences and expectations (mechanisms), leading to increased patient awareness, adherence, satisfaction, empowerment and quality of life (outcomes). Systematisation: STOPP/START tools provide a standardised/systematic approach for medication reviews (mechanisms), leading to changes in professional and organisational culture and burden/costs (outcomes). Evidence implementation: delivery of STOPP/START-based interventions is based on the implementation of best evidence (mechanisms), reducing adverse outcomes through appropriate prescribing/deprescribing (outcomes). For theory testing, we identified 40 studies of the impact of STOPP/START-based interventions in hospital settings, nursing homes, primary care and community pharmacies. Most of the interventions used multiple mechanisms. We found support for the impact of the personalisation and evidence implementation mechanisms on selected outcome variables, but similar impact was achieved by interventions not relying on these mechanisms. We also observed that the impact of interventions was linked to the proximity of the selected outcomes to the intervention in the logic model, resulting in a clearer benefit for appropriateness of prescribing, adverse drug events and prescription costs.
Limitations
None of the available studies had been explicitly designed for evaluating underlying causal mechanisms, and qualitative information was sparse.
Conclusions
No particular configuration of the interventions is associated with a greater likelihood of improved outcomes in given settings.
Study registration
This study is registered as PROSPERO CRD42018110795.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 23. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Ignacio Ricci Cabello
- Gerència d’Atenció Primària de Mallorca, Fundació Institut d’Investigació Sanitària Illes Balears – IdISBa, Mallorca, Spain
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Rob Anderson
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
- Evidence Synthesis & Modelling for Health Improvement (ESMI) Research Group, University of Exeter Medical School, Exeter, UK
| | - Simon Briscoe
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Rupert Payne
- Population Health Sciences, University of Bristol, Bristol Medical School, Bristol, UK
| | - Emma Cockcroft
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jim Harris
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Charlotte Bramwell
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
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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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Laatikainen O, Sneck S, Turpeinen M. Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge. Eur J Clin Pharmacol 2021; 78:159-170. [PMID: 34611721 PMCID: PMC8748358 DOI: 10.1007/s00228-021-03213-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022]
Abstract
Purpose Although medication-related adverse events (MRAEs) in health care are vastly studied, high heterogeneity in study results complicates the interpretations of the current situation. The main objective of this study was to form an up-to-date overview of the current knowledge of the prevalence, risk factors, and surveillance of MRAEs in health care. Methods Electronic databases (PubMed, MEDLINE, Web of Science, and Scopus) were searched with applicable search terms to collect information on medication-related adverse events. In order to obtain an up-to-date view of MRAEs, only studies published after 2000 were accepted. Results The prevalence rates of different MRAEs vary greatly between individual studies and meta-analyses. Study setting, patient population, and detection methods play an important role in determining detection rates, which should be regarded while interpreting the results. Medication-related adverse events are more common in elderly patients and patients with lowered liver or kidney function, polypharmacy, and a large number of additional comorbidities. However, the risk of MRAEs is also significantly increased by the use of high-risk medicines but also in certain care situations. Preventing MRAEs is important as it will decrease patient mortality and morbidity but also reduce costs and functional challenges related to them. Conclusions Medication-related adverse events are highly common and have both immediate and long-term effects to patients and healthcare systems worldwide. Conclusive solutions for prevention of all medication-related harm are impossible to create. In the future, however, the development of efficient real-time detection methods can provide significant improvements for event prevention and forecasting.
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Affiliation(s)
- O Laatikainen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland. .,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.
| | - S Sneck
- Oulu University Hospital, Oulu, Finland
| | - M Turpeinen
- Research Unit of Biomedicine and Medical Research Center Oulu, Oulu, Finland.,Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Yadesa TM, Kitutu FE, Tamukong R, Alele PE. Prevalence, Incidence, and Characteristics of Adverse Drug Reactions Among Older Adults Hospitalized at Mbarara Regional Referral Hospital, Uganda: A Prospective Cohort Study. Clin Interv Aging 2021; 16:1705-1721. [PMID: 34588772 PMCID: PMC8473935 DOI: 10.2147/cia.s332251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Adverse drug reactions (ADRs) are associated with significant clinical and economic effects. Among the elderly population, the risk for ADRs is even higher. Data of ADR prevalence and incidence among the elderly population in Uganda and many low- and middle-income countries are lacking. Objective This study determined the prevalence, incidence, and characteristics of ADRs among hospitalized elderly patients at Mbarara Regional Referral Hospital (MRRH), Uganda. Methods and Materials We conducted a prospective cohort of older adults admitted to medical, oncology, and surgery wards at MRRH for consecutive 6 months. The primary data were obtained by interviewing patients and caregivers and reviewing patient medication charts, taking vital signs, and physical examinations. We used Edwards and Aronson’s definition of ADR and the Naranjo ADR Causality Scale. We conducted descriptive statistics and the Kolmogorov–Smirnov test using SPSS Version 23.0. Results We studied a total of 523 older adults 60 to 103 years of age. During their hospital stay, 256 (48.9%) of the patients experienced at least one ADR. A total of 365 ADRs were identified during 4702 person-days of follow-up. The incidence of ADRs was 78 ADRs/1000 person-days. ADRs affecting the gastrointestinal tract were the most frequently (40.6%) identified categories. Probable and type A ADRs accounted for 260 (71.2%) and 305 (83.6%) of the total incidents, respectively. Overall, 237 (64.9%) of the ADRs were rated as mild, whereas 10 (2.8%) of them as severe. Lastly, 165 (45.2%) of the ADRs were categorized as preventable. Conclusion Almost half of the hospitalized patients aged 60 to 103 years experienced at least one ADR during their hospital stay, which is higher than has been previously documented. Almost three-thirds of the ADRs were probable, about 4 out of 5 were type A and almost two-thirds were mild. Nearly half of the ADRs were preventable.
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Affiliation(s)
- Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Pharmacy, Ambo University, Ambo, Ethiopia.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University, Kampala, Uganda.,Sustainable Pharmaceutical Systems (SPS), Makerere University, Kampala, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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Age-Related Change in Hepatic Clearance Inferred from Multiple Population Pharmacokinetic Studies: Comparison with Renal Clearance and Their Associations with Organ Weight and Blood Flow. Clin Pharmacokinet 2021; 61:295-305. [PMID: 34514537 DOI: 10.1007/s40262-021-01069-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to examine the magnitude of age-related change in hepatic clearance by integrating the data of multiple drugs and to compare this with renal clearance, considering associations with age-related changes in organ weight and blood flow. METHODS The results of multiple population pharmacokinetic analyses that detected age-related clearance changes in hepatically eliminated drugs were collected. The relationship between hepatic clearance of the unbound drug and age was then analyzed using the nonlinear least-squares method, adjusting for interdrug differences. The obtained change in hepatic clearance was compared with age-related changes in liver weight and hepatic blood flow in Japanese and Westerners. For comparison, the changes in renal clearance were analyzed similarly. RESULTS In total, 18 drugs were analyzed. The hepatic unbound clearance decreased by 32% at age 80 years and by 40% at age 90 years, compared with age 40 years, suggesting that it decreased by 0.80% per year with aging. The rate of the decrease was consistent with decreases in hepatic weight per person or blood flow per person, regardless of ethnicity and sex. Since age-related change in body weight varied somewhat by sex or ethnicity, hepatic weight per body weight was less consistent to account for age-related change in hepatic clearance. As for an index of renal clearance, the changes in inulin clearance with age were similar to those in renal blood flow, with a decrease of 0.97% per year from the age of 40 years. CONCLUSIONS Hepatic clearance consistently decreased by 0.80% per year from the age of 40 years, with aging for multiple drugs analyzed in this study. Changes in organ weight and blood flow are considered to be primarily responsible for the age-related changes in hepatic and renal clearance.
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Risk Factor Considerations in Statistical Signal Detection: Using Subgroup Disproportionality to Uncover Risk Groups for Adverse Drug Reactions in VigiBase. Drug Saf 2021; 43:999-1009. [PMID: 32564242 PMCID: PMC7497682 DOI: 10.1007/s40264-020-00957-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction In the treatment of the individual patient, a vision is to achieve the best possible balance between benefit and harm. Such tailored therapy relies upon the identification and characterisation of risk factors for adverse drug reactions. Information relevant to risk factor considerations can be captured in adverse event reports and could be utilised in statistical signal detection. Objective The aim of this study was to explore whether statistical screening of a broad range of risk factors within a global database of adverse event reports could uncover signals of risk groups for adverse drug reactions. Methods Subgroup disproportionality analysis was applied to 15.4 million reports entered in VigiBase, the World Health Organization (WHO) global database of individual case safety reports, up to August 2017. Disproportionality analyses for drug–adverse event pairs were performed (1) in the full database and (2) across a range of subgroups defined by the following covariates: patient age, sex, body mass index, pregnancy, underlying condition, reporting country, and geographical region. Drug–adverse event pairs disproportionately over-reported in such subgroups, but not in the full database, and with a substantial difference between the two observed-to-expected ratios, were highlighted as statistical signals. These were further prioritised, through filtering and sorting, for clinical assessment, whereafter clinically relevant signals were communicated to the pharmacovigilance community and the public. Results Assessments were performed for 354 prioritised statistical signals, resulting in seven communicated signals describing previously unrecognised potential risk groups related to age (elderly), sex (male and female), body mass index (underweight and obese), and geographical region (Asia), all except one for already established adverse drug reactions. Important aspects considered in the assessments included an evaluation of the disproportionate over-reporting in the subgroup by reviewing alternative explanations and reporting patterns for similar drugs/adverse events/subgroups, and a search for plausible mechanisms to support the risk hypothesis. Conclusions This study reveals that it is possible to uncover signals of risk groups for adverse drug reactions through incorporation of broad risk factor screening into statistical signal detection in a global database of adverse event reports. Our findings suggest the potential to use such statistical methodologies for risk characterisation in subpopulations of concern. Electronic supplementary material The online version of this article (10.1007/s40264-020-00957-w) contains supplementary material, which is available to authorized users.
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