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Bergs I, Bell L, Fedrowitz S, Krüger T, Lemos M, Stingl JC, Just KS. Serious gaming as potential training tool for recognition of adverse drug reactions: side-effect exposure-medical education (SeeMe). Eur J Clin Pharmacol 2024:10.1007/s00228-024-03739-w. [PMID: 39158691 DOI: 10.1007/s00228-024-03739-w] [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: 06/06/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE The recognition of adverse drug reactions (ADRs) is an important part of daily clinical work. However, medical education in this field is mostly drug-based and does not address adequately the complexity of this field regarding individual risk factors and polypharmacy. This study investigates the potential of the web-based serious game SeeMe (side-effect exposure-medical education) in pharmacological education of medical students to improve the recognition of relevant ADRs. METHODS One hundred fifty-seven medical students were recruited to evaluate the serious game SeeMe. SeeMe was developed to improve knowledge and recognition of ADRs in clinical practice. Players take on the role of a physician trying to understand fictional patients with ADRs. Before and after an 8-week playing period, an evaluation was carried out through a pre- and post-questionnaire and a pre- and post- knowledge test. RESULTS The students achieved significantly better results in the knowledge test, as almost twice as many exam-relevant questions were answered correctly (p < 0.001). The serious game had a positive effect on the students' perception of the importance of ADRs. CONCLUSION This study demonstrates the potential of web- and case-based fictional serious games in medical education. The improved recognition of side effects represents a crucial step for education and training in clinical pharmacology. Future versions of the serious game may take this further and focus on training in the treatment of ADRs and their relevance in various healthcare professions.
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Affiliation(s)
- Ingmar Bergs
- Institute of Clinical Pharmacology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Pneumology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Laura Bell
- Audiovisual Media Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sebastian Fedrowitz
- Audiovisual Media Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Tim Krüger
- Institute of Clinical Pharmacology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Martin Lemos
- Audiovisual Media Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Katja S Just
- Institute of Clinical Pharmacology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
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Loeffler M, Maas R, Neumann D, Scherag A. [INTERPOLAR-prospective, interventional studies as part of the Medical Informatics Initiative to improve medication therapy safety in healthcare]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:676-684. [PMID: 38750238 PMCID: PMC11166858 DOI: 10.1007/s00103-024-03890-w] [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: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 06/12/2024]
Abstract
Medication analyses by ward pharmacists are an important measure of drug therapy safety (DTS). Medication-related problems (MRPs) are identified and resolved with the attending clinicians. However, staff resources for extended medication analyses and complete documentation are often limited. Until now, data required for the identification of risk patients and for an extended medication analysis often had to be collected from various parts of the institution's internal electronic medical record (EMR). This error-prone and time-consuming process is to be improved in the INTERPOLAR (INTERventional POLypharmacy-Drug interActions-Risks) project using an IT tool provided by the data integration centers (DIC).INTERPOLAR is a use case of the Medical Informatics Initiative (MII) that focuses on the topic of DTS. The planning phase took place in 2023, with routine implementation planned from 2024. DTS-relevant data from the EMR is to be presented and the documentation of MRPs in routine care is to be facilitated. The prospective multicenter, cluster-randomized INTERPOLAR‑1 study serves to evaluate the benefits of IT support in routine care. The aim is to show that more MRPs can be detected and resolved with the help of IT support. For this purpose, six normal wards will be selected at each of eight university hospitals, so that 48 clusters (with a total of at least 70,000 cases) are available for randomization.
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Affiliation(s)
- Markus Loeffler
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Härtelstraße 16-18, 04103, Leipzig, Deutschland
| | - Renke Maas
- Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Pharmakologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Daniel Neumann
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Härtelstraße 16-18, 04103, Leipzig, Deutschland.
| | - André Scherag
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Jena, Deutschland
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Christ P, Dubrall D, Just KS, Lewke B, Below M, Stingl JC, Schmid M, Sachs B. Identification and comparison of sex-specific serious adverse drug reactions in spontaneous reports and systematically collected reports (ADRED). Br J Clin Pharmacol 2024; 90:776-792. [PMID: 37897066 DOI: 10.1111/bcp.15941] [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: 04/04/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS Adverse drug reactions (ADRs) are known to show sex-specific differences in occurrence and phenotype. The aim of this study was to analyse sex-specific differences in ADR-drug combinations that required hospitalization based on two different datasets. METHODS We performed a complementary analysis of (i) spontaneously reported (n = 12 564, female = 51.7%) and (ii) systematically collected ADR reports from a prospective multicentre observational study (ADRED, n = 2355, female = 48.2%) from Germany in the ADR database EudraVigilance (EV). Both datasets were analysed separately concerning the suspected drugs, ADRs and ADR-drug combinations more frequently reported for females or males by calculating reporting odds ratios (ROR) with 95% confidence intervals. ADR-drug combinations more frequently reported for either females or males in EV reports were related to prescription data. Finally, the results from both datasets were discussed with regard to their (dis-)concordance. RESULTS In both datasets, some antineoplastic agents and nervous system drugs were found to be reported more often for females than males (RORs ranging from 1.5 [1.1-2.1] for quetiapine in spontaneous reports to 41.3 [13.1-130.0] for trastuzumab in spontaneous reports). ADRs of the respiratory system, and haemorrhages were described predominantly for males in both datasets. In spontaneous reports the ADR-drug combination self-injurious behaviour-quetiapine was more often reported for females without and with consideration of drug prescriptions (ROR: 3.8 [1.3-11.0]). Quetiapine and psychiatric disorders (superordinate level) was exclusively reported for females in ADRED reports. CONCLUSIONS Our results can contribute to raise awareness and further knowledge regarding sex-specific ADRs. The findings require further in-depth investigation.
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Affiliation(s)
- Patrick Christ
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Diana Dubrall
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Katja Susanne Just
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
| | - Britta Lewke
- Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany
| | - Maike Below
- Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany
| | - Julia Carolin Stingl
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Bernhardt Sachs
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
- Department for Dermatology and Allergy, University Hospital RWTH Aachen, Aachen, Germany
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Liebing N, Ziehr B, Röber S, Nibbe L, Oppert M, Warnke U. [Ward-based clinical pharmacists in intensive care medicine: an economic evaluation]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-023-01102-y. [PMID: 38263495 DOI: 10.1007/s00063-023-01102-y] [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: 07/21/2023] [Revised: 11/06/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The positive impact of pharmaceutical care in improving medication safety is considered proven. Little is known about the economic benefit of clinical pharmaceutical services in Germany. OBJECTIVE In 2020, a pilot project was started at the Ernst von Bergmann Hospital to introduce ward-based clinical pharmacists in intensive care medicine, also in order to determine the economic benefit of the medication management offered. METHODS By a team of experienced intensive care physicians and clinical pharmacists on the basis of a consensus principle, each pharmaceutical intervention (PI) was assigned a probability score (Nesbit probability score) with which an adverse drug event (ADE) would have occurred. Assuming that each ADE results in an increased length of stay, the costs of intensive care treatment/day were used as potential savings. The model thereby combines the findings of two international publications to enable an economic analysis of pharmaceutical services. RESULTS During the study period, 177 pharmaceutical interventions were evaluated and corresponding probability scores for the occurrence of ADE were determined. From this, annual savings of € 80,000 through avoided costs were calculated. CONCLUSION In this project, the economic benefit of pharmaceutical services in intensive care medicine was proven. Ward-based clinical pharmacists are now an integral part of the intensive care treatment team at the Ernst von Bergmann Hospital.
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Affiliation(s)
- Nadja Liebing
- Apotheke, Klinikum Ernst von Bergmann gGmbH, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Benjamin Ziehr
- Apotheke, Klinikum Ernst von Bergmann gGmbH, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Susanne Röber
- Zentrum für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann gGmbH, Potsdam, Deutschland
| | - Lutz Nibbe
- Zentrum für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann gGmbH, Potsdam, Deutschland
| | - Michael Oppert
- Zentrum für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann gGmbH, Potsdam, Deutschland
| | - Ulrich Warnke
- Apotheke, Klinikum Ernst von Bergmann gGmbH, Charlottenstr. 72, 14467, Potsdam, Deutschland.
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Hellinger BJ, Remane Y, Bertsche T, Gries A. [Adverse drug reactions as cause of nonspecific symptoms in patients in the emergency department]. DIE ANAESTHESIOLOGIE 2023; 72:887-893. [PMID: 37978070 DOI: 10.1007/s00101-023-01355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND In a large proportion of patients admitted to the emergency department (ED), the initial main symptom is nonspecific. One possible reason for this, especially in older patients, may be adverse drug reactions (ADR) due to their frequent polypharmacy. AIM To illustrate the incidence of ADRs, the affected patient population including risk factors, and drug classes with ADRs leading to nonspecific symptoms. To provide practice recommendations for the management of ADRs in the ED. MATERIAL AND METHODS Presentation of the pharmacological principles on ADRs, statistics of pharmacovigilance centers as well as original literature including experiences from clinical practice and own projects. RESULTS In 10% of patients with nonspecific symptoms an ADR is responsible for presentation in the ED. In 60% of cases these ADRs are not correctly identified in the ED setting. A small number of drug classes are responsible for most of these referrals. Databases, risk stratification, clinical pharmacists, or clinical decision support systems are available to improve ADR identification and management. As these options are partly associated with considerable costs or the validation for German EDs is missing, a widespread application does not take place. CONCLUSION Correct identification of ADRs in patients with nonspecific symptoms in the ED is necessary to initiate adequate treatment. These ADRs are often overlooked because processes and tools for identification and management are not applied in the ED, leading to a lack of awareness. For high-risk patients in the ED, the focus should be on drug history, ideally considering patient-specific risk factors and specific drug classes.
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Affiliation(s)
- Benjamin J Hellinger
- Klinikapotheke, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
- Abteilung für Klinische Pharmazie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland.
- Zentrale Notaufnahme/Beobachtungsstation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Yvonne Remane
- Klinikapotheke, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Thilo Bertsche
- Abteilung für Klinische Pharmazie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - André Gries
- Zentrale Notaufnahme/Beobachtungsstation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
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Just KS, Schultze KA, Dormann H, Seufferlein T, Gräff I, Scholl C, Schwab M, Stingl JC. Use of overactive bladder anticholinergic medications associated with falls leading to emergency department visits: results from the ADRED study. Eur J Clin Pharmacol 2023; 79:1185-1193. [PMID: 37382655 PMCID: PMC10427532 DOI: 10.1007/s00228-023-03530-3] [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: 01/11/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Drug intake might be a modifiable factor for the individual fall-risk of older adults, and anticholinergic properties of drugs need to be considered. This study is aimed at analyzing the association of older adults' individual anticholinergic load with particular focus on use of overactive bladder anticholinergic medications with falls in multi-medicated patients. MATERIALS AND METHODS Cases of the prospective, observational, multi-center study on adverse drug reactions leading to emergency departments (ADRED study) between 2015 and 2018 in Germany were analyzed comparing the exposure of overactive bladder anticholinergic medications on the chance to present with a fall with patients without exposure. Logistic regression analysis was used adjusting for pre-existing conditions, drug exposure, and the individual anticholinergic burden by drug use. To this end, a combination of seven expert-based anticholinergic rating scales was used. RESULTS The anticholinergic burden was higher in patients with overactive bladder anticholinergic medications (median 2 [1; 3]) compared to not taking drugs of interest. Presenting with a fall was associated with overactive bladder anticholinergic medications (odds ratio (OR) 2.34 [95% confidence interval 1.14-4.82]). The use of fall-risk increasing drugs was likewise associated (OR 2.30 [1.32-4.00]). The anticholinergic burden itself seemed not to be associated with falls (OR 1.01 [0.90-1.12]). CONCLUSIONS Although falls occur multifactorial in older adults and confounding by indication cannot be ruled out, the indication for a drug treatment should be decided with caution when other, non-pharmacological treatment options have been tried. GERMAN CLINICAL TRIAL REGISTER DRKS-ID: DRKS00008979, registration date 01/11/2017.
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Affiliation(s)
- Katja S. Just
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Wendlingweg 2, D-52074 Aachen, Germany
| | - Karen A. Schultze
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Wendlingweg 2, D-52074 Aachen, Germany
| | - Harald Dormann
- Central Emergency Department, Hospital Fürth, Fürth, Germany
| | - Thomas Seufferlein
- Internal Medicine Emergency Department, Ulm University Medical Centre, Ulm, Germany
| | - Ingo Gräff
- Interdisciplinary Emergency Department (INZ), University Hospital of Bonn, Bonn, Germany
| | - Catharina Scholl
- Research Department, Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany
- Department of Clinical Pharmacology, University of Tuebingen, Tuebingen, Germany
- Department of Pharmacy and Biochemistry, University of Tuebingen, Tuebingen, Germany
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Wendlingweg 2, D-52074 Aachen, Germany
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Clark A, Tate B, Urban B, Schroeder R, Gennuso S, Ahmadzadeh S, McGregor D, Girma B, Shekoohi S, Kaye AD. Bupropion Mediated Effects on Depression, Attention Deficit Hyperactivity Disorder, and Smoking Cessation. Health Psychol Res 2023; 11:81043. [PMID: 37405312 PMCID: PMC10317506 DOI: 10.52965/001c.81043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Bupropion had been in use since the late 1980s as an unconventional treatment for depression. Unlike other antidepressants, bupropion has no serotonergic activity and inhibits the reuptake of norepinephrine and dopamine. The drug has been used to treat depression, Attention Deficit Hyperactivity Disorder (ADHD), and smoking cessation. This investigation reviews the pharmacokinetic and pharmacodynamic effects of bupropion and its mechanisms of action and interactions with other drugs. We evaluated the efficacy of major on and off-label uses of bupropion, focusing on the indications, benefits, and adverse effects. Our review demonstrates that bupropion is superior to placebo and non-inferior to SSRIs such as escitalopram in treating major depressive disorder. More research is needed to determine positive patient-centered outcomes such as increases in quality of life. In the case of ADHD, the evidence for efficacy is mixed with poorly conducted randomized clinical trials, small sample sizes, and a lack of long-term assessments. The same is true in the case of bipolar disorder in which there is still limited and controversial data available on bupropion's safety and efficacy. In the case of smoking cessation, bupropion is found to be an effective anti-smoking drug with synergistic benefits when used as a combination therapy. We conclude that bupropion has the potential to provide benefit for a subset of patients who do not tolerate other typical antidepressants or anti-smoking therapies or for those whose treatment goals align with bupropion's unique side effect profile, such as smokers who wish to quit and lose weight. Additional research is needed to determine the drug's full clinical potential, particularly in the areas of adolescent depression and combination therapy with varenicline or dextromethorphan. Clinicians should use this review to understand the varied uses of the drug and identify the situations and patient populations in which bupropion can lend its greatest benefit.
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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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Heck J, Krichevsky B, Groh A, Schulze Westhoff M, Laser H, Gerbel S, Strunz PP, Schumacher C, Klietz M, Stichtenoth DO, Höner Zu Siederdissen C, Krause O. Duplicate prescriptions in the emergency department: a retrospective cohort study. Eur J Clin Pharmacol 2023; 79:207-217. [PMID: 36478283 PMCID: PMC9734425 DOI: 10.1007/s00228-022-03436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the nature and frequency of duplicate prescriptions (DPs) in the emergency department (ED) by utilization of a novel categorization of DPs which differentiates between appropriate DPs (ADPs) and potentially inappropriate DPs (PIDPs). METHODS In this retrospective cohort study, adult patients who presented to the ED for internal medicine of a large university hospital in northern Germany in 2018 and 2019 were screened for the presence of DPs. Descriptive statistical methods were used to characterize the nature and frequency of PIDPs compared to the frequency of ADPs. RESULTS A total of 4208 patients were enrolled into the study. The median age of the study population was 63 years (interquartile range (IQR) 48-77), 53.9% were female. The patients took a median of 5 drugs (IQR 3-9). 10.9% of the study population were affected by at least one PIDP (at least one grade-1 PIDP: 6.1%; at least one grade-2 PIDP: 4.5%; at least one grade-3 PIDP: 1.1%). Non-opioid analgesics accounted for the majority of grade-1 PIDPs, while inhalatives were most frequently responsible for grade-2 and grade-3 PIDPs. Nearly half of the study population (48.6%) displayed at least one ADP. CONCLUSION PIDPs pose a frequent pharmacological challenge in the ED. The medication review should comprise a systematic screening for PIDPs with a particular focus on non-opioid analgesics and inhalatives. ADPs were detected more frequently than PIDPs, questioning the predominant notion in the medical literature that DPs are exclusively deleterious.
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Affiliation(s)
- Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, 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
| | - Adrian Groh
- 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
| | - Hans Laser
- Center for Information Management, Hannover Medical School, Hannover, Germany
| | - Swetlana Gerbel
- Center for Information Management, Hannover Medical School, Hannover, Germany
| | - Patrick-Pascal Strunz
- Department of Internal Medicine II, Rheumatology and Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | | | - Martin Klietz
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Dirk O Stichtenoth
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Drug Commissioner, Hannover Medical School, Hannover, Germany
| | | | - Olaf Krause
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Center for Medicine of the Elderly, DIAKOVERE Henriettenstift, Hannover, Germany
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Inhalation therapies in COPD - adverse drug reactions impact on emergency department presentations. Eur J Clin Pharmacol 2023; 79:219-227. [PMID: 36484792 PMCID: PMC9879805 DOI: 10.1007/s00228-022-03433-9] [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: 07/11/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Inhaled drugs have been cornerstones in the treatment of chronic obstructive pulmonary disease (COPD) for decades and show a high prescription volume. Due to the local application, drug safety issues of these therapies are often underestimated by professionals and patients. Data about adverse drug reactions (ADRs) caused by inhaled therapy in patients with COPD and polypharmacy are rare. We aimed to analyze the use and relevance of inhaled therapies in those patients in relation to ADR complaints, which were severe enough to warrant presentation to the emergency department. METHODS Emergency department cases due to suspected ADRs of the ADRED database (n = 2939, "Adverse Drug Reactions in Emergency Departments"; DRKS-ID: DRKS00008979, registration date 01/11/2017) were analyzed for inhaled drugs in patients with COPD. ADRs in cases with overdosed inhaled drugs were compared to non-overdosed cases. ADRs, potentially caused by inhaled drugs, were evaluated, clustered into complexes, and assessed for association with inhaled drug classes. RESULTS Of the 269 included COPD cases, 67% (n = 180) received inhaled therapy. In 16% (n = 28), these therapies were overdosed. Overdosed cases presented the complexes of malaise and local symptoms more frequently. Related to the use of inhaled anticholinergics, local (dysphagia-like) and related to inhaled beta-2 agonists, local (dysphagia-like) and sympathomimetic-like ADRs presented more frequently. CONCLUSION Overdosed inhaled therapies in patients with COPD lead to relevant ADRs and impact on emergency room presentations. These are rarely associated to inhaled therapy by healthcare professionals or patients. Due to the high volume of inhaled drug prescriptions, pharmacovigilance and patient education should be more focused in patients with COPD. German Clinical Trial Register: DRKS-ID: DRKS00008979.
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Dreischulte T, Shahid F, Muth C, Schmiedl S, Emil Haefeli W. Prescribing Cascades: How to Detect Them, Prevent Them, and Use Them Appropriately. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:745-752. [PMID: 36045504 PMCID: PMC9853235 DOI: 10.3238/arztebl.m2022.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/02/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND A prescribing cascade is the treatment of an adverse drug reaction (ADR) with another drug. In this review, we discuss (a) the different types of prescribing cascade and (b) the measures that can be taken so that they will be recognized and dealt with appropriately, both in the hospital and in the outpatient setting. METHODS This review is based on pertinent publications retrieved by a selective literature search. RESULTS The literature distinguishes intentional from unintentional prescribing cascades, and appropriate from inappropriate ones. We further distinguish prophylactic from therapeutic prescribing cascades and draw a line between those that are necessary and those that are merely appropriate. The following main questions are essential for dealing with prescribing cascades appropriately: (1) Did the precipitating drug cause a clinically relevant ADR or risk of an ADR? (2) Is the precipitating drug still indicated? (3) Can an ADR be avoided by altering the treatment with the precipitating drug, or by (4) switching to another drug instead? (5) Can the drug used to treat the ADR actually affect it beneficially? (6) Do the benefits of the prescribing cascade outweigh its risks? CONCLUSION Prescribing cascades are not problematic in themselves; on the contrary, they are sometimes a necessary part of good prescribing practice. There is still a lack of practically implementable instruments to help physicians detect prescribing cascades reliably, assess them properly, and put them to appropriate use.
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Affiliation(s)
- Tobias Dreischulte
- *These authors share first authorship.,Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich,*Institut für Allgemeinmedizin Klinikum der Ludwig-Maximilians-Universität München Campus Innenstadt Pettenkoferstraße 10 80336 München
| | - Faiza Shahid
- *These authors share first authorship.,Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich
| | - Christiane Muth
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld
| | - Sven Schmiedl
- Philipp Klee-of Clinical Pharmacology, Helios Clinic Wuppertal; Clinical Pharmacology, Witten/Herdecke University, Witten/Herdecke
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelbergg
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12
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Jung-Poppe L, Nicolaus HF, Roggenhofer A, Altenbuchner A, Dormann H, Pfistermeister B, Maas R. Systematic Review of Risk Factors Assessed in Predictive Scoring Tools for Drug-Related Problems in Inpatients. J Clin Med 2022; 11:jcm11175185. [PMID: 36079114 PMCID: PMC9457151 DOI: 10.3390/jcm11175185] [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: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Drug-related problems (DRP, defined as adverse drug events/reactions and medication errors) are a common threat for patient safety. With the aim to aid improved allocation of specialist resources and to improve detection and prevention of DRP, numerous predictive scoring tools have been proposed. The external validation and evidence for the transferability of these tools still faces limitations. However, the proposed scoring tools include partly overlapping sets of similar factors, which may allow a new approach to estimate the external usability and validity of individual risk factors. Therefore, we conducted this systematic review and analysis. We identified 14 key studies that assessed 844 candidate risk factors for inclusion into predictive scoring tools. After consolidation to account for overlapping terminology and variable definitions, we assessed each risk factor in the number of studies it was assessed, and, if it was found to be a significant predictor of DRP, whether it was included in a final scoring tool. The latter included intake of ≥ 8 drugs, drugs of the Anatomical Therapeutic Chemical (ATC) class N, ≥1 comorbidity, an estimated glomerular filtration rate (eGFR) <30 mL/min and age ≥60 years. The methodological approach and the individual risk factors presented in this review may provide a new starting point for improved risk assessment.
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Affiliation(s)
- Lea Jung-Poppe
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence: (L.J.-P.); (R.M.)
| | - Hagen Fabian Nicolaus
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- University Hospital Erlangen, 91054 Erlangen, Germany
| | - Anna Roggenhofer
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Anna Altenbuchner
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Harald Dormann
- Central Emergency Department, Fürth Hospital, 90766 Fürth, Germany
| | | | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence: (L.J.-P.); (R.M.)
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13
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Bergs I, Just KS, Müller A, Stingl JC, Dreher M. Emergency Department Visits Due to Dyspnea: Association with Inhalation Therapy in COPD and Cases with Adverse Drug Reactions. Int J Chron Obstruct Pulmon Dis 2022; 17:1827-1834. [PMID: 35983166 PMCID: PMC9379107 DOI: 10.2147/copd.s367062] [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: 03/19/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Dyspnea is a leading symptom of COPD that causes presentations in emergency departments or negatively impacts on them. Guideline-based inhalation therapies are intended to reduce dyspnea in COPD patients. This study analyzed how common guideline recommended inhalation therapy regimens are occurring in clinical practice among COPD patients presenting to emergency departments due to adverse drug reactions in polytherapy using data of the German ADRED database. Patients and Methods In total, 269 COPD cases were identified. In a further analysis, all cases were analyzed for documented GOLD stage and guideline-recommended inhalation therapy for COPD. Dyspnea and other symptoms identified during ED presentation were analyzed and compared between patients who did and did not receive the guideline’s recommended inhalation therapy. Results In this observation, 41% (n = 46) of all 112 cases with a documented COPD and GOLD stage received an underdosed therapy according to current guidelines. Dyspnea was the most common identified symptom (32%, n = 36) in this cohort and occurred more often in patients who received an underdosage of inhalation therapy (p < 0.01). Conclusion Patients with COPD presenting to ED with ADRs show a high rate of non-guideline-recommended inhalation therapy and present more often with dyspnea compared to those COPD patients who received an adequate dosing of inhalation therapy.
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Affiliation(s)
- Ingmar Bergs
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Katja S Just
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
| | - Annegret Müller
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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14
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Prioritisation of Adverse Drug Events Leading to Hospital Admission and Occurring during Hospitalisation: A RAND Survey. J Clin Med 2022; 11:jcm11154254. [PMID: 35893345 PMCID: PMC9332872 DOI: 10.3390/jcm11154254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Adverse drug events (ADEs) are a common cause of emergency department visits and occur frequently during hospitalisation. Instruments that facilitate the detection of the most relevant ADEs could lead to a more targeted and efficient use of limited resources in research and practice. (2) We conducted two consensus processes based on the RAND/UCLA appropriateness method, in order to prioritise ADEs leading to hospital admission (panel 1) and occurring during hospital stay (panel 2) for inclusion in future ADE measurement instruments. In each panel, the experts were asked to assess the “overall importance” of each ADE on a four-point Likert scale (1 = not important to 4 = very important). ADEs with a median rating of ≥3 without disagreement were defined as “prioritised“. (3) The 13 experts in panel 1 prioritised 38 out of 65 ADEs, while the 12 experts in panel 2 prioritised 34 out of 63 ADEs. The highest rated events were acute kidney injury and hypoglycaemia (both panels), as well as Stevens–Johnson syndrome in panel 1 and rhabdomyolysis in panel 2. (4) The survey led to a set of ADEs for which there was consensus that they were of particular importance as presentations of acute medication-related harm, thereby providing a focus for further medication safety research and clinical practice.
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15
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Langmia IM, Just KS, Yamoune S, Müller JP, Stingl JC. Pharmacogenetic and drug interaction aspects on ketamine safety in its use as antidepressant - implications for precision dosing in a global perspective. Br J Clin Pharmacol 2022; 88:5149-5165. [PMID: 35863300 DOI: 10.1111/bcp.15467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022] Open
Abstract
Ketamine and its enantiomer S-ketamine (esketamine) are known to produce rapid-onset antidepressant effects in major depression. Intranasal esketamine has recently come into the market as an antidepressant. Besides experience from short-term use in anesthesia and analgesia, the experience with ketamine as long-term medication is rather low. The use of ketamine and esketamine is limited due to potential neurotoxicity, psychocomimetic side effects, potential abuse and interindividual variability in treatment response including cessation of therapy. Therefore, taking a look at individual patient risks and potential underlying variability in pharmacokinetics may improve safety and dosing of these new antidepressant drugs in clinical practice. Differential drug metabolism due to polymorphic cytochrome P450 (CYP) enzymes and gene-drug interactions are known to influence the efficacy and safety of many drugs. Ketamine and esketamine are metabolized by polymorphic CYP enzymes including CYP2B6, CYP3A4, CYP2C9 and CYP2A6. In antidepressant drug therapy, usually multiple drugs are administered which are substrates of CYP enzymes, increasing the risk for drug-drug interactions (DDIs). We reviewed the potential impact of polymorphic CYP variants and common DDIs in antidepressant drug therapy affecting ketamine pharmacokinetics, and the role for dose optimization. The use of ketamine or intranasal esketamine as antidepressants demands a better understanding of the factors that may impact its metabolism and efficacy in long-term use. In addition to other clinical and environmental confounders, prior information on the pharmacodynamic and pharmacokinetic determinants of response variability to ketamine and esketamine may inform on dose optimization and identification of individuals at risk of adverse drug reactions.
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Affiliation(s)
- Immaculate M Langmia
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Katja S Just
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Sabrina Yamoune
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany.,Federal Institute for Drugs and Medical Devices, BfArM, Bonn, Germany
| | - Julian Peter Müller
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
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16
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Schmidberger J, Kloth C, Müller M, Kratzer W, Klaus J. Evaluation of Potential Drug Interactions with AiDKlinik® in a Random Population Sample. Integr Pharm Res Pract 2022; 11:61-69. [PMID: 35308067 PMCID: PMC8926013 DOI: 10.2147/iprp.s351938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
Abstract
Purpose Undesirable drug interactions are frequent, they endanger the success of therapy, and they lead to adverse drug reactions. The present study aimed to evaluate statistically potentially drug interactions in a locally circumscribed, random sample population. Patients and Methods In a random sample population of 264 patients taking medications, we performed analyses with the drug information system AiDKlinik®. Statistical analysis was performed using SAS version 9.4. Results Statistically potentially drug interactions were recorded in 82/264 (31.1%) subjects, including 39/82 (47.56%) men, and 43/82 (52.43%) women (χ2= 0.081; p = 0.776). The average number of potential possible interactions detected per person was 1.60 ± 1.21. The regression model with the variables age, body-mass-index and number of long-term-medications shows a significant association between the number of long-term medications taken and the number of moderately severe and severe reactions to drug interactions (F(3.239) = 28.67, p < 0.0001; (t(239) 8.28; p < 0.0001)). After backward elimination, the regression model showed a significant interaction with the number of long-term medications (t (240) = 8.73, p < 0.0001) and body-mass-index (t (240) = 2.02, p = 0.0442). In descriptive analysis, the highest percentages of potential drug interactions occurred in 42/82 (51.22%) subjects with body mass indices (BMIs) >25 kg/m2 and in 28/82 (34.15%) subjects aged 61–70 years. Conclusion Number of long-term medications use, age, and obesity may lead to increased drug–drug interactions in a random population sample.
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Affiliation(s)
- Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| | - Martin Müller
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
- Correspondence: Wolfgang Kratzer, Department of Internal Medicine I, University Hospital Ulm, Albert-EInstein-Allee 23, Ulm, 89081, Germany, Tel +49 731 500 44730, Fax +49 731 500 44705, Email
| | - Jochen Klaus
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
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17
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Just KS. [Current Challenges in Pharmacotherapy]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:652-665. [PMID: 34704243 DOI: 10.1055/a-1226-4647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Analysis of preoperative medication is used to assess the benefit and risk associated with continuing or discontinuing medication before and during surgery. Identifying adverse drug reactions and assessing its risks often leads to uncertainty. Typical challenges are medication underuse, but also overuse occurs and is often more difficult to recognize, especially in the context of drug interactions and individual patient characteristics.Typical consequences of multi-medication and medical overuse may include an increased potential for drug interactions, an increased risk of adverse drug reactions and medication errors, and in particular in older adults, geriatric syndromes may occur or worsen. Adverse drug reactions may occur as a result of the dose administered and as an effect of time of exposure. Older, multi-morbid, and multi-medicated patients are often affected by adverse drug reactions. For drugs primarily metabolized via the phase I enzymes CYP2D6, CYP2C9, or CYP2C19, pharmacogenetically rapid or slow metabolism may result in altered drug exposures. Clinically relevant pharmacokinetic drug interactions frequently occur with drugs primarily metabolized via the phase I enzyme CYP3A4.
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18
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[84/f with spondylodiscitis and multiple medications : Preparation for the medical specialist examination: part 110]. Internist (Berl) 2021; 63:52-56. [PMID: 34668993 DOI: 10.1007/s00108-021-01174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
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19
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Unerwünschte Arzneimittelwirkungen und Medikationsfehler – was Akut- und Notfallmediziner wissen sollten. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Qualitative Study of Community Pharmacists' and General Practitioners' Views toward Pharmacovigilance in Lithuania. Healthcare (Basel) 2021; 9:healthcare9081072. [PMID: 34442209 PMCID: PMC8392662 DOI: 10.3390/healthcare9081072] [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: 05/30/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Lithuania is the leader in pharmacovigilance among the three Baltic countries. However, comparisons with other European countries are difficult because the reported number of adverse drug reactions (ADRs) in Lithuania is too low to rely on in terms of the annual use of medicines by the population over the year. The aim of this study was to explore challenges related to the understanding and practices of general practitioners and community pharmacists in reporting ADRs in Lithuania. The qualitative study approach of face-to-face interviews was used. All interviews were recorded, transcribed verbatim, and thematically analyzed. Twelve interviews with general practitioners and community pharmacists were conducted from March 2020 through December 2020. All participants had a basic knowledge of pharmacovigilance, but only four participants reported ADRs to the interviewer. Six main barriers regarding ADR reporting were identified, and appropriate interventions were suggested. The importance of collaboration between physicians and pharmacists was highlighted, and the need for guidelines supporting collaboration was expressed. Medications are becoming more complex, and comprehensive medication management is key for the optimization of patient outcomes. Our results reveal the need to improve and innovate the current pharmacovigilance system at all levels, starting from education for pharmacy and healthcare students and continuing through the development of ADR procedures.
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21
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Paradissis C, Cottrell N, Coombes I, Scott I, Wang W, Barras M. Patient harm from cardiovascular medications. Ther Adv Drug Saf 2021; 12:20420986211027451. [PMID: 34367546 PMCID: PMC8317255 DOI: 10.1177/20420986211027451] [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: 10/23/2020] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Medication harm can lead to hospital admission, prolonged hospital stay and poor patient outcomes. Reducing medication harm is a priority for healthcare organisations worldwide. Recent Australian studies demonstrate cardiovascular (CV) medications are a leading cause of harm. However, they appear to receive less recognition as ‘high risk’ medications compared with those classified by the medication safety acronym, ‘APINCH’ (antimicrobials, potassium, insulin, narcotics, chemotherapeutics, heparin). Our aim was to determine the scale and type of medication harm caused by CV medications in healthcare. Methods A narrative review of adult (>16 years) medication harm literature identified from PubMed and CINAHL databases was undertaken. Studies with the primary outcome of measuring the incidence of medication harm were included. Harm caused by CV medications was described and ranked against other medication classes at four key stages of a patient’s healthcare journey. Where specified, the implicated medications and type of harm were investigated. Results A total of 75 studies were identified, including seven systematic reviews and three meta-analyses, with most focussing on harm causing hospital admission. CV medications were responsible for approximately 20% of medication harm; however, this proportion increased to 50% in older populations. CV medications were consistently ranked in the top five medication categories causing harm and were often listed as the leading cause. Conclusion CV medications are a leading cause of medication harm, particularly in older adults, and should be the focus of harm mitigation strategies. A practical approach to generate awareness among health professionals is to incorporate ‘C’ (for CV medications) into the ‘APINCH’ acronym. Plain language summary
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Affiliation(s)
- Chariclia Paradissis
- School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia
| | - Neil Cottrell
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Coombes
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Wang
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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Langmia IM, Just KS, Yamoune S, Brockmöller J, Masimirembwa C, Stingl JC. CYP2B6 Functional Variability in Drug Metabolism and Exposure Across Populations-Implication for Drug Safety, Dosing, and Individualized Therapy. Front Genet 2021; 12:692234. [PMID: 34322158 PMCID: PMC8313315 DOI: 10.3389/fgene.2021.692234] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
Adverse drug reactions (ADRs) are one of the major causes of morbidity and mortality worldwide. It is well-known that individual genetic make-up is one of the causative factors of ADRs. Approximately 14 million single nucleotide polymorphisms (SNPs) are distributed throughout the entire human genome and every patient has a distinct genetic make-up which influences their response to drug therapy. Cytochrome P450 2B6 (CYP2B6) is involved in the metabolism of antiretroviral, antimalarial, anticancer, and antidepressant drugs. These drug classes are commonly in use worldwide and face specific population variability in side effects and dosing. Parts of this variability may be caused by single nucleotide polymorphisms (SNPs) in the CYP2B6 gene that are associated with altered protein expression and catalytic function. Population variability in the CYP2B6 gene leads to changes in drug metabolism which may result in adverse drug reactions or therapeutic failure. So far more than 30 non-synonymous variants in CYP2B6 gene have been reported. The occurrence of these variants show intra and interpopulation variability, thus affecting drug efficacy at individual and population level. Differences in disease conditions and affordability of drug therapy further explain why some individuals or populations are more exposed to CYP2B6 pharmacogenomics associated ADRs than others. Variabilities in drug efficacy associated with the pharmacogenomics of CYP2B6 have been reported in various populations. The aim of this review is to highlight reports from various ethnicities that emphasize on the relationship between CYP2B6 pharmacogenomics variability and the occurrence of adverse drug reactions. In vitro and in vivo studies evaluating the catalytic activity of CYP2B6 variants using various substrates will also be discussed. While implementation of pharmacogenomic testing for personalized drug therapy has made big progress, less data on pharmacogenetics of drug safety has been gained in terms of CYP2B6 substrates. Therefore, reviewing the existing evidence on population variability in CYP2B6 and ADR risk profiles suggests that, in addition to other factors, the knowledge on pharmacogenomics of CYP2B6 in patient treatment may be useful for the development of personalized medicine with regards to genotype-based prescription.
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Affiliation(s)
- Immaculate M. Langmia
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Katja S. Just
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Sabrina Yamoune
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Collen Masimirembwa
- African Institute of Biomedical Science and Technology (AiBST), Harare, Zimbabwe
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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23
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The presentational flow chart "unwell adult" of the Manchester Triage System-Curse or blessing? PLoS One 2021; 16:e0252730. [PMID: 34081753 PMCID: PMC8174732 DOI: 10.1371/journal.pone.0252730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background The presentational flow chart “unwell adult” of the Manchester Triage System (MTS) occupies a special role in this triage system, defined as the nonspecific presentation of an emergency patient. Current scientific studies show that a considerable proportion of emergency room patients present with so-called "nonspecific complaints". The aim of the present study is to investigate in detail the initial assessment of emergency patients triaged according to the presentational flow chart "unwell adult". Methods Monocentric, retrospective observational study. Results Data on 14,636 emergency department visits between March 12th and August 12th, 2019 were included. During the observation period, the presentational flow chart "unwell adult" was used 1,143 times and it was the third most frequently used presentational flow chart. Patients triaged with this flow chart often had unspecific complaints upon admission to the emergency department. Patients triaged with the “unwell adult” chart were often classified with a lower triage level. Notably, patients who died in hospital during the observation period frequently received low triage levels. The AUC for the MTS flow chart “unwell adult” and hospitalization in general for older patients (age ≥ 65 years) was 0.639 (95% CI 0.578–0.701), and 0.730 (95% CI 0.714–0.746) in patients triaged with more specific charts. The AUC for the MTS flow chart “unwell adult” and admission to ICU for older patients (age ≥65 years) was 0.631 (95% CI 0.547–0.715) and 0.807 (95% CI 0.790–0.824) for patients triaged with more specific flow charts. Comparison of the predictive ability of the MTS for in-hospital mortality in the group triaged with the presentational flow chart “unwell adult” revealed an AUC of 0.682 (95% CI 0.595–0.769) vs. 0.834 (95% CI 0.799–0.869) in the other presentational flow charts. Conclusion The presentational flow chart "unwell adult" is frequently used by triage nurses for initial assessment of patients. Patient characteristics assessed with the presentational flow chart "unwell adult" differ significantly from those assessed with MTS presentational flow charts for more specific symptoms. The quality of the initial assessment in terms of a well-functioning triage priority assessment tool is less accurate than the performance of the MTS described in the literature.
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Just KS, Dormann H, Freitag M, Schurig M, Böhme M, Steffens M, Scholl C, Seufferlein T, Graeff I, Schwab M, Stingl JC. CYP2D6 in the Brain: Potential Impact on Adverse Drug Reactions in the Central Nervous System-Results From the ADRED Study. Front Pharmacol 2021; 12:624104. [PMID: 34025403 PMCID: PMC8138470 DOI: 10.3389/fphar.2021.624104] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Cytochrome P450 (CYP) 2D6 is a polymorphic enzyme expressed in the central nervous system (CNS), important in drug metabolism and with a potentially constitutive role in CNS function such as vigilance. This study aimed to analyze variability in CYP2D6 activity linked to vigilance-related adverse drug reactions (ADRs) in the CNS. A dataset of N = 2939 ADR cases of the prospective multicenter observational trial in emergency departments (EDs) (ADRED; trial registration: DRKS-ID: DRKS00008979) was analyzed. Dizziness as the most frequent reported CNS ADR symptom (12.7% of patients, n = 372) related to vigilance was chosen as the outcome. The association of dizziness with CYP2D6 activity markers was analyzed. The number of CYP2D6 substrates taken, a CYP2D6 saturation score (no, moderate, and strong saturation), a CYP2D6 saturation/inhibition score (no, weak, moderate, and strong), and composed CYP2D6 activity using a genotyped subsample (n = 740) calculating additive effects of genotype and CYP2D6 saturation by drug exposure were used as CYP2D6 activity markers. Effects were compared to other frequent nonvigilance-related CNS ADR symptoms (syncope and headache). Secondary analyses were conducted to control for other ADR symptoms frequently associated with dizziness (syncope, nausea, and falls). The majority of all patients (64.5%, n = 1895) took at least one drug metabolized by CYP2D6. Around a third took a CNS drug (32.5%, n = 955). The chance to present with drug-related dizziness to the ED increased with each CYP2D6 substrate taken by OR 1.11 [1.01–1.23]. Presenting with drug-related dizziness was more likely with CYP2D6 saturation and saturation/inhibition (both OR 1.27 [1.00–1.60]). The composed CYP2D6 activity was positively associated with dizziness (p = 0.028), while poorer activity affected patients more often with dizziness as an ADR. In contrast, nonvigilance-related ADR symptoms such as syncope and nausea were not consistently significantly associated with CYP2D6 activity markers. This study shows an association between the number of CYP2D6 substrates, the predicted CYP2D6 activity, and the occurrence of dizziness as a CNS ADR symptom. As dizziness is a vigilance-related CNS symptom, patients with low CYP2D6 activity might be more vulnerable to drug-related dizziness. This study underlines the need for understanding individual drug metabolism activity and individual risks for ADRs.
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Affiliation(s)
- Katja S Just
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Harald Dormann
- Central Emergency Department, Hospital Fürth, Fürth, Germany
| | - Mathias Freitag
- Department of Geriatric Medicine, University Hospital of RWTH Aachen, Aachen, Germany
| | - Marlen Schurig
- Research Department, Federal Institute of Drugs and Medical Devices, Bonn, Germany
| | - Miriam Böhme
- Research Department, Federal Institute of Drugs and Medical Devices, Bonn, Germany
| | - Michael Steffens
- Research Department, Federal Institute of Drugs and Medical Devices, Bonn, Germany
| | - Catharina Scholl
- Research Department, Federal Institute of Drugs and Medical Devices, Bonn, Germany
| | - Thomas Seufferlein
- Internal Medicine Emergency Department, Ulm University Medical Centre, Ulm, Germany
| | - Ingo Graeff
- Interdisciplinary Emergency Department (INZ), University Hospital of Bonn, Bonn, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,Department of Clinical Pharmacology, University of Tuebingen, Tuebingen, Germany.,Department of Pharmacy and Biochemistry, University of Tuebingen, Tuebingen, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, Aachen, Germany
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Crescioli G, Bettiol A, Bonaiuti R, Tuccori M, Rossi M, Capuano A, Pagani S, Spada G, Venegoni M, Vighi GD, Mannaioni G, Vannacci A, Lombardi N. Risk of Hospitalization Associated with Cardiovascular Medications in the Elderly Italian Population: A Nationwide Multicenter Study in Emergency Departments. Front Pharmacol 2021; 11:611102. [PMID: 33708120 PMCID: PMC7941274 DOI: 10.3389/fphar.2020.611102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background: There is a significant gap in knowledge addressing cardiovascular (CV) medications safety in elderly. In this context, our purposes were to define clinical and pharmacological characteristics of outpatients’ adverse drug events (ADEs) related to CV medications leading to emergency department (ED) visits in the elderly Italian patients according to different age groups, and to evaluate the risk of hospitalization associated to ADEs in this population. Methods: A multicentre, retrospective study was performed on reports of suspected ADEs collected between 2007–2018 in 94 EDs involved in the MEREAFaPS Study. Elderly patients who experienced one or more CV medications-related ADEs leading to ED visit were selected. Patients’ characteristics, suspected (ATC classes B and C) and concomitant drugs, and ADE description were collected. Elderly patients were stratified into three age groups (65–74, 75–84, and ≥85 years) and compared to adults (18–64 years). Logistic regression analyses were used to estimate the reporting odds ratios (RORs) with 95% confidence intervals (CIs) of ADE-related hospitalization adjusting for sex, presence of two or more suspected drugs, concomitant drugs, and one or more comorbidities. Results: Among elderly, 16,926 reports of suspected ADE related to CV medications were collected, and 6,694 (39.5%) resulted in hospitalization. Patients were mostly female, Caucasians, and middle-old (75–84). 78.9% of patients were treated with only one suspected drug, and 71.9% and 47.1% reported concomitant medications and comorbidities, respectively. Compared to adults, risk of hospitalization was significantly higher for middle-old and oldest-old patients exposed to vitamin K antagonists (1.29 [1.09–1.52] and 1.56 [1.30–187]), direct thrombin inhibitors (3.41 [1.44–8.08] and 4.12 [1.67–10.17]), antiplatelets (1.51 [1.26–1.81] and 2.09 [1.71–2.57]), and beta-blockers (1.89 [1.38–2.59 and 2.31 [1.60–3.35]). Overall, a higher risk of hospitalization was observed for renin-angiotensin system inhibitors (1.32 [1.04–1.68], 1.65 [1.32–2.06], and 2.20 [1.70–2.85]), presence of two or more concomitant drugs, and concomitant conditions. Conclusion: Our real-world findings underline relevant safety aspects of CV medications in the elderly Italian population. ED clinicians must always consider the higher risk of hospitalization related to the use of CV drugs in elderly, particularly in oldest-old ones, for antiarrhythmics, beta-blocking agents, renin-angiotensin system inhibitors, antiplatelets, and anticoagulants.
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Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Joint Laboratory of Technological Solutions for Clinical Pharmacology, Pharmacovigilance and Bioinformatics, University of Florence, Florence, Italy
| | - Marco Tuccori
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy.,Unit of Adverse Drug Reactions Monitoring, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Rossi
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Annalisa Capuano
- Campania Regional Center for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Silvia Pagani
- Internal Medicine, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | - Giulia Spada
- Hospital Pharmacy, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | | | - Giuseppe Danilo Vighi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | - Guido Mannaioni
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Tuscan Regional Center of Pharmacovigilance, Florence, Italy.,Joint Laboratory of Technological Solutions for Clinical Pharmacology, Pharmacovigilance and Bioinformatics, University of Florence, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Tuscan Regional Center of Pharmacovigilance, Florence, Italy.,Toxicology Unit and Poison Center, Careggi University Hospital, Florence, Italy
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Effects of the number of drugs used on the prevalence of adverse drug reactions in children. Sci Rep 2020; 10:21341. [PMID: 33288793 PMCID: PMC7721890 DOI: 10.1038/s41598-020-78358-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
In pediatric individuals, polypharmacy would increase the prevalence of adverse drug reactions (ADRs). However, there is no report on the ADR increase adjusted for the influence of concomitant disease types. We conducted a retrospective study in pediatric patients to determine whether polypharmacy is a risk factor for ADR development, after the adjustment. Patients aged 1–14 years on medication who visited Gifu Municipal Hospital (Gifu, Japan) were included. We evaluated patient characteristics, ADR causality, ADR classification and severity, and ADR-causing drugs. We examined the association between ADR prevalence and number of drugs used. We performed multiple logistic regression analyses to investigate risk factors for ADR development. Of 1330 patients, 3.5% sought medical attention for ADRs. ADR causality was most often assessed as “possible,” with gastrointestinal ADRs being the most common. Grade 1 ADRs were the most and antibiotics were the most common suspected ADR-inducing drug. The multiple logistic regression analysis showed that ≥ 2 or ≥ 4 drug use, neoplasms, mental and behavioral disorders, and circulatory system diseases significantly increased ADR prevalence. Polypharmacy increased the prevalence of ADR resulting in hospital visits in children, after adjusting for the influence of disease types. Therefore, proactive polypharmacy control measures are necessary for children.
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Just KS, Dormann H, Schurig M, Böhme M, Steffens M, Plank‐Kiegele B, Ettrich K, Seufferlein T, Gräff I, Igel S, Schricker S, Jaeger SU, Schwab M, Stingl JC. The phenotype of adverse drug effects: Do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study. Br J Clin Pharmacol 2020; 86:2144-2154. [PMID: 32250457 PMCID: PMC7576634 DOI: 10.1111/bcp.14304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/03/2020] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Older patients in particular suffer from adverse drug reactions (ADR) when presenting in the emergency department. We aimed to characterise the phenotype of those ADRs, to be able to recognise an ADR in older patients. METHODS Cases of ADRs in emergency departments collected within the multicentre prospective observational study (ADRED) were analysed (n = 2215). We analysed ADR-associated diagnoses, symptoms and their risk profiles. We present frequencies and odds ratios (OR) with 95% confidence intervals for adults (18-64 years) compared to older adults (≥65 years; young-old 65-79, old-old ≥80 years) and regression coefficients (B) for each year of age. RESULTS Most prominent differences were seen for drug-associated confusion, dehydration, and bradycardia (OR 6.70 [1.59-28.27], B .054; OR 6.02 [2.41-15.03], B .081, and 4.82 [2.21-10.54], B .040), more likely seen in older adults. Bleedings were reported in all age groups, but gastrointestinal bleedings occurred with more than doubled chance in older adults (OR 2.46 [1.77-3.41], B .030), likewise did other bleedings such as haemorrhage from respiratory passages (OR 2.89 [1.37-6.11], B.036). Falls were more likely in older adults (OR 2.84 [1.77-4.53], B .030), while dizziness was frequent in both age groups. CONCLUSION Our data point to differences in symptoms of ADRs between adults and older individuals, with dangerous drug-associated phenomena in the older adult such as bleedings or falls. Physicians should consider drug-associated origins of symptoms in older adults with an increased risk for serious health problems.
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Affiliation(s)
- Katja S. Just
- Institute of Clinical PharmacologyUniversity Hospital of RWTH AachenAachenGermany
| | | | - Marlen Schurig
- Research DepartmentFederal Institute for Drugs and Medical DevicesBonnGermany
| | - Miriam Böhme
- Research DepartmentFederal Institute for Drugs and Medical DevicesBonnGermany
| | - Michael Steffens
- Research DepartmentFederal Institute for Drugs and Medical DevicesBonnGermany
| | | | - Kristin Ettrich
- Internal Medicine Emergency DepartmentUlm University Medical CentreUlmGermany
| | - Thomas Seufferlein
- Internal Medicine Emergency DepartmentUlm University Medical CentreUlmGermany
| | - Ingo Gräff
- Interdisciplinary Emergency Department (INZ)University Hospital of BonnBonnGermany
| | - Svitlana Igel
- Dr. Margarete Fischer‐Bosch‐Institute of Clinical PharmacologyStuttgartGermany
| | - Severin Schricker
- Department of Internal Medicine, Division of General Internal Medicine and NephrologyRobert‐Bosch‐HospitalStuttgartGermany
| | - Simon U. Jaeger
- Dr. Margarete Fischer‐Bosch‐Institute of Clinical PharmacologyStuttgartGermany
- Department of Clinical PharmacologyUniversity of TuebingenTuebingenGermany
| | - Matthias Schwab
- Dr. Margarete Fischer‐Bosch‐Institute of Clinical PharmacologyStuttgartGermany
- Department of Clinical PharmacologyUniversity of TuebingenTuebingenGermany
- Department of Pharmacy and BiochemistryUniversity of TuebingenTuebingenGermany
| | - Julia C. Stingl
- Institute of Clinical PharmacologyUniversity Hospital of RWTH AachenAachenGermany
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Schuster S, Singler K, Lim S, Machner M, Döbler K, Dormann H. Quality indicators for a geriatric emergency care (GeriQ-ED) - an evidence-based delphi consensus approach to improve the care of geriatric patients in the emergency department. Scand J Trauma Resusc Emerg Med 2020; 28:68. [PMID: 32678052 PMCID: PMC7364502 DOI: 10.1186/s13049-020-00756-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In emergency care, geriatric requirements and risks are often not taken sufficiently into account. In addition, there are neither evidence-based recommendations nor scientifically developed quality indicators (QI) for geriatric emergency care in German emergency departments. As part of the GeriQ-ED© research project, quality indicators for geriatric emergency medicine in Germany have been developed using the QUALIFY-instruments. METHODS Using a triangulation methodology, a) clinical experience-based quality aspects were identified and verified, b) research-based quality statements were formulated and assessed for relevance, and c) preliminary quality indicators were operationalized and evaluated in order to recommend a feasible set of final quality indicators. RESULTS Initially, 41 quality statements were identified and assessed as relevant. Sixty-seven QI (33 process, 29 structure and 5 outcome indicators) were extrapolated and operationalised. In order to facilitate implementation into daily practice, the following five quality statements were defined as the GeriQ-ED© TOP 5: screening for delirium, taking a full medications history including an assessment of the indications, education of geriatric knowledge and skills to emergency staff, screening for patients with geriatric needs, and identification of patients with risk of falls/ recurrent falls. DISCUSSION QIs are regarded as gold standard to measure, benchmark and improve emergency care. GeriQ-ED© QI focused on clinical experience- and research-based recommendations and describe for the first time a standard for geriatric emergency care in Germany. GeriQ-ED© TOP 5 should be implemented as a minimum standard in geriatric emergency care.
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Affiliation(s)
- Susanne Schuster
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Emergency Department, Klinikum Fürth, Fürth, Germany
- Institute for Nursing Research, Gerontology and Ethics, Lutheran University of Applied Sciences - Evangelische Hochschule Nürnberg, Nuremberg, Germany
| | - Katrin Singler
- Institute for Biomedicine of Ageing, Friedrich-Alexander Universität Erlangen-Nürnberg, Nuremberg, Germany
- Geriatric Department - Medizinische Klinik 2, Geriatrie, Klinikum Nürnberg, Paracelsus Private Medical University, Nuremberg, Germany
| | - Stephen Lim
- Academic Geriatric Medicine, University of Southampton, University Hospital Southampton NHS FT, Southampton, UK
| | - Mareen Machner
- Charité – University of Medicine, Public Health Academy, Berlin, Germany
- Charité – University of Medicine, Lernzentrum, Medical Skills Lab, Berlin, Germany
| | - Klaus Döbler
- Competence Center Quality Management in Health Care, MDK Baden-Württemberg, Stuttgart, Germany
| | - Harald Dormann
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Emergency Department, Klinikum Fürth, Fürth, Germany
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Kratz T, Diefenbacher A. Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:508-518. [PMID: 31452508 DOI: 10.3238/arztebl.2019.0508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/18/2019] [Accepted: 06/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the elderly population increases, so, too, does the number of multimorbid patients and the risk of polypharmacy. The consequences include drug interactions, undesired side effects of medication, health impairment, and the need for hospital- ization. 5-10% of hospital admissions among the elderly are attributable to undesired side effects of medication. METHODS This review is based on publications retrieved by a selective search in PubMed and the Cochrane Library that employed the search terms "drug interaction," "undesired side effect," "polypharmacy," "pharmacokinetics," and "pharmacody- namics." RESULTS Elderly patients are particularly at risk of polypharmacy, both because of the prevalence of multimorbidity in old age and because of physicians' uncritical implementation of guidelines. The more drugs a person takes, the greater the risk of drug interactions and undesired side effects. Age-associated changes in pharmacokinetics and pharmacodynamics elevate this risk as well. Physicians prescribing drugs for elderly patients need to know about the drugs' catabolic pathways, protein binding, and inductive and inhibitory effects on cytochrome P450 in order to avoid drug interactions and polypharmacy. CONCLUSION Multiple aids and instruments are available to ensure practical and reasonable drug monitoring, so that the risks of drug interactions and undesired side effects can be detected early and avoided.
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Affiliation(s)
- Torsten Kratz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelisches Krankenhaus "Königin Elisabeth" Herzberge, Berlin
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Just KS, Dormann H, Schurig M, Böhme M, Fracowiak J, Steffens M, Scholl C, Seufferlein T, Gräff I, Schwab M, Stingl JC. Adverse Drug Reactions in the Emergency Department: Is There a Role for Pharmacogenomic Profiles at Risk?-Results from the ADRED Study. J Clin Med 2020; 9:jcm9061801. [PMID: 32527038 PMCID: PMC7355597 DOI: 10.3390/jcm9061801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023] Open
Abstract
Individual differences in required drug dosages exist based on the pharmacogenomic (PGx) profiles. This study aimed to assess associations between PGx profiles and adverse drug reactions (ADR) that lead to admissions to the emergency department (ED). ADR cases of the prospective multi-center observational trial in EDs (ADRED study) were analyzed (n = 776) together with the relevant PGx phenotypes of the enzymes CYP2D6, CYP2C19, CYP2C9, and VKORC1. Overall, the allele frequency distribution in this cohort did not differ from the population frequencies. We compared the frequencies of phenotypes in the subgroups with the drugs suspected of certain ADR, in the remaining cases. The frequency distribution of CYP2C19 differed for the ADR bleeding cases suspected of clopidogrel (p = 0.020). In a logistic regression analysis, higher CYP2C19 activity (OR (95% CI): 4.97 (1.73−14.27)), together with age (1.05 (1.02−1.08)), showed an impact on the clopidogrel-suspecting ADRs, when adjusting for the clinical parameters. There was a trend for an association of phenprocoumon-risk profiles (low VKORC1 or CYP2C9 activity) with phenprocoumon-suspecting ADRs (p = 0.052). The PGx impact on serious ADRs might be highest in drugs that cannot be easily monitored or those that do not provoke mild ADR symptoms very quickly. Therefore, patients that require the intake of those drugs with PGx variability such as clopidogrel, might benefit from PGx testing.
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Affiliation(s)
- Katja S. Just
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, 52074 Aachen, Germany;
| | - Harald Dormann
- Central Emergency Department, Hospital Fürth, 90766 Fürth, Germany;
| | - Marlen Schurig
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Miriam Böhme
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Jochen Fracowiak
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Michael Steffens
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Catharina Scholl
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Thomas Seufferlein
- Internal Medicine Emergency Department, Ulm University Medical Centre, 89081 Ulm, Germany;
| | - Ingo Gräff
- Interdisciplinary Emergency Department (INZ), University Hospital of Bonn, 53127 Bonn, Germany;
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany;
- Department of Clinical Pharmacology, University of Tuebingen, 72076 Tuebingen, Germany
- Department of Pharmacy and Biochemistry, University of Tuebingen, 72076 Tuebingen, Germany
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, 52074 Aachen, Germany;
- Correspondence: ; Tel.: +49-241-8089-130
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Huebner T, Steffens M, Linder R, Fracowiak J, Langner D, Garling M, Falkenberg F, Roethlein C, Gomm W, Haenisch B, Stingl J. Influence of metabolic profiles on the safety of drug therapy in routine care in Germany: protocol of the cohort study EMPAR. BMJ Open 2020; 10:e032624. [PMID: 32345696 PMCID: PMC7213853 DOI: 10.1136/bmjopen-2019-032624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Pre-emptive testing of pharmacogenetically relevant single-nucleotide polymorphisms can be an effective tool in the prevention of adverse drug reactions and therapy resistance. However, most of the tests are not used as standard in routine care in Germany because of lacking evidence for the clinical and economical benefit and their impact on the usage of healthcare services. We address this issue by investigating the influence of pharmacogenetic profiles on the use of healthcare services over an extended period of several years using routine care data from a statutory health insurance company. The goal is to provide clinical evidence whether pre-emptive pharmacogenetic testing of metabolic profiles in routine care in Germany is beneficial and cost-effective. METHODS AND ANALYSIS The EMPAR (Einfluss metabolischer Profile auf die Arzneimitteltherapiesicherheit in der Routineversorgung) study is a non-interventional cohort study conducted to analyse pharmacogenetic risk factors that are important for drug therapy by means of endpoints relevant for healthcare. The analysis is based on pharmacogenetic profiles and statutory health insurance data. We perform pharmacogenetic, pharmacoepidemiological and pharmacoeconomic analyses using health care utilisation scores and machine learning techniques. Therefore, we aim to include about 10 000 patients (≥18 years) insured by the health insurance provider Techniker Krankenkasse. The study focuses on patients with prescriptions of anticoagulants and prescriptions of cholesterol-lowering drugs. Also, a screening for special pharmacogenetic characteristics will be performed in patients with at least one Y57.9! diagnosis (Complication of medical and surgical care: drug or medicament, unspecified). Outcomes include the utilisation of health insurance services, the incidence of incapacity for work and costs for drugs and treatment. ETHICS AND DISSEMINATION The protocol was approved by the Ethics Committee of the Medical Faculty, University of Bonn (Lfd. Nr. 339/17). The results of this research project will be published in scientific open access journals and at conferences. TRIAL REGISTRATION NUMBER German Clinical Trials Register, DRKS00013909.
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Affiliation(s)
- Tatjana Huebner
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, North Rhine-Westphalia, Germany
| | - Michael Steffens
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, North Rhine-Westphalia, Germany
| | | | - Jochen Fracowiak
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, North Rhine-Westphalia, Germany
| | | | | | | | - Christoph Roethlein
- Population Health Sciences, German Centre for Neurodegenerative Diseases, Bonn, North Rhine-Westphalia, Germany
| | - Willy Gomm
- Population Health Sciences, German Centre for Neurodegenerative Diseases, Bonn, North Rhine-Westphalia, Germany
| | - Britta Haenisch
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, North Rhine-Westphalia, Germany
- Population Health Sciences, German Centre for Neurodegenerative Diseases, Bonn, North Rhine-Westphalia, Germany
- Centre for Translational Medicine, University of Bonn, Bonn, North Rhine-Westphalia, Germany
| | - Julia Stingl
- Institute for Clinical Pharmacology, RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
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Dubrall D, Just KS, Schmid M, Stingl JC, Sachs B. Adverse drug reactions in older adults: a retrospective comparative analysis of spontaneous reports to the German Federal Institute for Drugs and Medical Devices. BMC Pharmacol Toxicol 2020; 21:25. [PMID: 32293547 PMCID: PMC7092423 DOI: 10.1186/s40360-020-0392-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Older adults are more prone to develop adverse drug reactions (ADRs) since they exhibit numerous risk factors. The first aim was to analyse the number of spontaneous ADR reports regarding older adults (> 65) in the ADR database of the German Federal Institute for Drugs and Medical Devices (BfArM) and to set them in relation to i) the number of ADR reports concerning younger adults (19-65), and ii) the number of inhabitants and assumed drug-exposed inhabitants. The second aim was to analyse, if reported characteristics occurred more often in older vs. younger adults. METHODS All spontaneous ADR reports involving older or younger adults within the period 01/01/2000-10/31/2017 were identified in the ADR database. Ratios concerning the number of ADR reports/number of inhabitants and ADR reports/drug-exposed inhabitants were calculated. The reports for older (n = 69,914) and younger adults (n = 111,463) were compared using descriptive and inferential statistics. RESULTS The absolute number of ADR reports involving older adults increased from 1615 (2000) up to 5367 ADR reports (2016). The age groups 76-84 and 70-79 had the highest number of ADR reports with 25 ADR reports per 100,000 inhabitants and 27 ADR reports per 100,000 assumed drug-exposed inhabitants. For both ratios, the number of reports was higher for males (26 and 28 ADR reports) than for females (24 and 26 ADR reports). Fatal outcome was reported almost three times more often in older vs. younger adults. Six out of ten drug substances most frequently suspected were antithrombotics (vs. 1/10 in younger adults). For some drug substances (e.g. rivaroxaban) the ADRs reported most frequently differed between older (epistaxis) and younger adults (menorrhagia). CONCLUSIONS There is a need to further investigate ADRs in older adults since they occurred more frequently in older vs. younger adults and will likely increase in future. Physicians should be aware of different ADRs being attributed to the same drug substances which may be more prominent in older adults. Regular monitoring of older adults taking antithrombotics is recommended.
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Affiliation(s)
- Diana Dubrall
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital of Bonn, Bonn, North Rhine-Westphalia, Germany.
- Research Division, Federal Institute for Drugs and Medical Devices (BfArM), Bonn, North Rhine-Westphalia, Germany.
| | - Katja S Just
- Institute of Clinical Pharmacology, University Hospital of the RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital of Bonn, Bonn, North Rhine-Westphalia, Germany
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital of the RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
| | - Bernhardt Sachs
- Research Division, Federal Institute for Drugs and Medical Devices (BfArM), Bonn, North Rhine-Westphalia, Germany
- Department for Dermatology and Allergy, University Hospital of the RWTH Aachen, Aachen, North Rhine-Westphalia, Germany
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Tang J, Toma M, Gray NM, Delvaux J, Guthrie B, Grant A, Duncan EM, Dreischulte T. Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP): a qualitative study of anticipated implementation factors informed by the Theoretical Domains Framework. BMJ Open 2020; 10:e033574. [PMID: 32114469 PMCID: PMC7050331 DOI: 10.1136/bmjopen-2019-033574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The quality and safety of drug therapy in primary care are global concerns. The Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool, which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. Study objectives were (1) to identify and prioritise factors that could influence P-DQIP implementation from the perspective of practice pharmacists and (2) to identify potentially effective, acceptable and feasible strategies to support P-DQIP implementation. DESIGN Semistructured face-to-face interviews using a Theoretical Domains Framework informed topic guide. The framework method was used for data analysis. Identified implementation factors were prioritised for intervention based on research team consensus. Candidate intervention functions, behavioural change techniques (BCTs) and policies targeting these were identified from the behavioural change wheel. The final intervention content and modes of delivery were agreed with local senior pharmacists. SETTING General practices from three Health and Social Care Partnerships in National Health Service (NHS) Tayside. PARTICIPANTS 14 NHS employed practice pharmacists. RESULTS Identified implementation factors were linked to thirteen theoretical domains (all except intentions) and six (skill, memory/attention/decision making, behavioural regulation, reinforcement, environmental context/resources, social influences) were prioritised. Three intervention functions (training, enablement and environmental restructuring) were relevant and were served by two policy categories (guidelines, communication/marketing) and eight BCTs (instructions on how to perform a behaviour, problem solving, action planning, prompt/cues, goal setting, self-monitoring, feedback and restructuring the social environment). Intervention components encompass an informatics tool, written educational material, a workshop for pharmacists, promotional activities and small financial incentives. CONCLUSIONS This study explored pharmacists' perceptions of implementation factors which could influence management of DTRs in general practices to inform implementation of P-DQIP, which will initially be implemented in one Scottish health board with parallel evaluation of effectiveness and implementation.
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Affiliation(s)
- Jason Tang
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
| | - Madalina Toma
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
| | - Nicola M Gray
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
| | - Joke Delvaux
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
- Physiotherapy Department, NHS Tayside, Dundee, Angus, UK
| | - Bruce Guthrie
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Population Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK
| | - Aileen Grant
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - Eilidh M Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Tobias Dreischulte
- Scottish Improvement Science Collaborating Centre (SISCC), School of Nursing and Health Sciences, University of Dundee, Dundee, Angus, UK
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University, Munchen, Bayern, Germany
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Alayed N, Alkhalifah B, Alharbi M, Alwohaibi N, Farooqui M. Adverse Drug Reaction (ADR) as a Cause of Hospitalization at a Government Hospital in Saudi Arabia: A Prospective Observational Study. Curr Drug Saf 2020; 14:192-198. [PMID: 31109277 PMCID: PMC6865052 DOI: 10.2174/1574886314666190520105330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/19/2019] [Accepted: 05/01/2019] [Indexed: 11/24/2022]
Abstract
Background: ADRs represent a substantial burden on health care resources worldwide and are considered as one of the leading causes of morbidity and mortality which significantly affects hospitalization rates. However, ADR related hospital admissions are not well explored in Saudi Arabia. Objective: The current study aims to evaluate ADR-related admissions at King Saud Hospital, Unaizah, Qassim, Saudi Arabia. Methods: A prospective, observational study was conducted at King Saud Hospital Unaizah. Over a period of 6 months, patients above 12 years of age who visited the Emergency Department (ED) with an ADR were included in this study. The investigators collected patient data by reviewing the patient's medical records and the ED records for admission. The Naranjo algorithm was used to assess the causality of the suspected ADR, and Hartwig’s Severity Assessment Scale was used to assess the severity of the ADR. Results: Out of 4739 admissions to the wards, 38 (0.801%) were related to an ADR. The majority of patients were male (52.6%), with a mean age of ± 49.08 years. The total length of hospital stay was 565 days with a mean of ± 14.87 days. The causality assessment shows that 35 (92.1%) cases were probable ADRs, whereas 3 (7.9%) cases were possible ADRs. Moreover, the severity assessment showed that 6 (15.1%) cases were mild, and 27 (71.1%) and 5 (13.2%) cases were moderate and severe, respectively. In regard to the outcome of patients, most patients recovered after the ADR, and 2 ADRs resulted in the death of the patient. Conclusion: Our study shows that ADRs as a cause of hospitalization in Qassim population is considerably low. However, ADRs may contribute to morbidity and mortality and result in a considerable financial burden.
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Affiliation(s)
- Nouf Alayed
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Bushra Alkhalifah
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Munirah Alharbi
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Naief Alwohaibi
- Department of Pharmacy, King Saud Hospital Unaizah, Qassim, Saudi Arabia
| | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
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Just KS, Dormann H, Böhme M, Schurig M, Schneider KL, Steffens M, Dunow S, Plank-Kiegele B, Ettrich K, Seufferlein T, Gräff I, Igel S, Schricker S, Jaeger SU, Schwab M, Stingl JC. Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED). Eur J Clin Pharmacol 2019; 76:439-448. [DOI: 10.1007/s00228-019-02797-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
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Güner MD, Ekmekci PE. Healthcare professionals' pharmacovigilance knowledge and adverse drug reaction reporting behavior and factors determining the reporting rates. J Drug Assess 2019; 8:13-20. [PMID: 30729064 PMCID: PMC6352929 DOI: 10.1080/21556660.2019.1566137] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/06/2018] [Indexed: 01/30/2023] Open
Abstract
Background: Spontaneous adverse drug reaction (ADR) reports prepared by healthcare professionals (HCPs) are the backbone of collecting post-marketing safety data. However, underreporting is a global problem creating health, economic, and ethical burden. Objectives: To determine the factors limiting ADR reporting rates from the HCPs’ point of view. Methods: A questionnaire containing 43 questions evaluating sociodemographic characteristics, pharmacovigilance knowledge and activities, and prescription behaviors was prepared on “surveymonkey.com.” The link was distributed mainly by professional organizations. Results: Although this survey aimed to reach all HCPs, most of the respondents were physicians and nurses. Of the 259 (69.6%) participants who encountered ADR at least once, only 105 (40.5%) reported ADR. The term “pharmacovigilance” was heard for the first time in this survey by 35.5% (n = 132) of the participants. Only 34.7% (n = 129) of the participants knew where to find the ADR reporting form, and 25.5% (n = 95) had previously filled the form and/or read it. Only 28.5% (n = 106) of the participants were aware of the ADR reporting and monitoring system of their institutions and related professionals. Almost all the participants agreed that pharmacovigilance and ADR reporting training are necessary. Conclusion: The main reason for underreporting is limited pharmacovigilance knowledge of HCPs. Training activities based on the needs and preferences of HCPs and close follow-up by authorities are the main steps to improve pharmacovigilance activities.
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Affiliation(s)
| | - Perihan Elif Ekmekci
- Department of History of Medicine and Ethics, TOBB ETU Medical School, Ankara, Turkey
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Stingl JC, Dormann H, LastName FM. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:594-595. [PMID: 30236220 DOI: 10.3238/arztebl.2018.0594b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kratz T. Increase in Risk of Acute Confusional State in Dementia Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:594. [PMID: 30236219 PMCID: PMC6206249 DOI: 10.3238/arztebl.2018.0594a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Torsten Kratz
- *Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Berlin
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