Lack of Awareness of Community-Acquired Adverse Drug Reactions Upon Hospital Admission
Tóm tắt
Objective: Adverse drug reactions (ADRs) are a well-known cause of hospital admission. Nevertheless a quantitative estimate of the preventability of and physicians’ awareness of these reactions is lacking. Study Design and Methods: Using intensive bedside and computer-assisted drug surveillance methods a 13-month prospective pharmacoepidemiological survey was carried out on patients admitted to two medical wards of the Erlangen-Nuremberg University Hospital in Erlangen, Germany. This study aimed to define the incidence of preventable and unavoidable ADRs. In addition we investigated the awareness of the physicians to ADRs at the time of admission and the rate of contraindicated pre-admission prescriptions. Results: In 78 (8.5%) of 915 (10.9%) admissions a total of 102 (42 preventable) community-acquired ADRs were detected on admission. In 45 (3.8%) of the admissions ADRs led directly to hospitalisation. 56.9% of the ADRs were not recognised by the attending physician on admission. Marked correlation was found between the awareness of ADRs and their probability and severity scores (r = 0.85 and r = 0.94, respectively; p < 0.05). The most frequently detected ADRs were due to direct toxicity and secondary pharmacological effects. Idiosyncratic reactions were often missed and 18.6% of all drugs prescribed prior to admission were contraindicated. Leading the list were diuretics, analgesics/NSAIDs and antipsychotics/sedatives. Conclusions: Awareness of existing ADRs on hospital admission and appropriate prescribing prior to hospital admission require attention. Early detection of ADRs on hospital admission can be achieved by the use of computer support systems. Many ADRs could be prevented by adhering to indications and contraindications.
Tài liệu tham khảo
citation_journal_title=JAMA; citation_title=The costs of adverse drug events in hospitalized patients: Adverse Drug Events Prevention Study Group; citation_author=DW Bates, N Spell, DJ Cullen; citation_volume=277; citation_issue=4; citation_publication_date=1997; citation_pages=307-11; citation_doi=10.1001/jama.1997.03540280045032; citation_id=CR1
citation_journal_title=Arch Intern Med; citation_title=Hospital admissions caused by iatrogenic disease; citation_author=MC Lakshmanan, CO Hershey, D Breslau; citation_volume=146; citation_issue=10; citation_publication_date=1986; citation_pages=1931-4; citation_doi=10.1001/archinte.1986.00360220075016; citation_id=CR2
citation_journal_title=Am J Med; citation_title=How many deaths occur annually from adverse drug reactions in the United States?; citation_author=PA Chyka; citation_volume=109; citation_issue=2; citation_publication_date=2000; citation_pages=122-30; citation_doi=10.1016/S0002-9343(00)00460-5; citation_id=CR3
citation_journal_title=N Engl J Med; citation_title=The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II; citation_author=LL Leape, TA Brennan, N Laird; citation_volume=324; citation_issue=6; citation_publication_date=1991; citation_pages=377-84; citation_doi=10.1056/NEJM199102073240605; citation_id=CR4
citation_journal_title=J Intern Med; citation_title=Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention; citation_author=J Hallas, B Harvald, LF Gram; citation_volume=228; citation_issue=2; citation_publication_date=1990; citation_pages=83-90; citation_doi=10.1111/j.1365-2796.1990.tb00199.x; citation_id=CR5
citation_journal_title=Ann Pharmacother; citation_title=Drug-related hospital admissions; citation_author=TR Einarson; citation_volume=27; citation_issue=7-8; citation_publication_date=1993; citation_pages=832-40; citation_id=CR6
citation_journal_title=Am J Med; citation_title=Assessing the preventability of emergency hospital admissions: a method for evaluating the quality of medical care in a primary care facility; citation_author=J Bigby, J Dunn, L Goldman; citation_volume=83; citation_issue=6; citation_publication_date=1987; citation_pages=1031-6; citation_doi=10.1016/0002-9343(87)90938-7; citation_id=CR7
citation_journal_title=N Engl J Med; citation_title=A computer-assisted management program for antibiotics and other antiinfective agents; citation_author=RS Evans, SL Pestotnik, DC Classen; citation_volume=338; citation_issue=4; citation_publication_date=1998; citation_pages=232-8; citation_doi=10.1056/NEJM199801223380406; citation_id=CR8
citation_journal_title=Drug Saf; citation_title=Incidence and costs of adverse drug reactions during hospitalisation: computerised monitoring versus stimulated spontaneous reporting; citation_author=H Dormann, U Muth-Selbach, S Krebs; citation_volume=22; citation_issue=2; citation_publication_date=2000; citation_pages=161-8; citation_doi=10.2165/00002018-200022020-00007; citation_id=CR9
citation_journal_title=J Am Med Inform Assoc; citation_title=Reducing the frequency of errors in medicine using information technology; citation_author=DW Bates, M Cohen, LL Leape; citation_volume=8; citation_issue=4; citation_publication_date=2001; citation_pages=299-308; citation_doi=10.1136/jamia.2001.0080299; citation_id=CR10
citation_journal_title=J Am Med Inform Assoc; citation_title=Using computerized data to identify adverse drug events in outpatients; citation_author=B Honigman, J Lee, J Rothschild; citation_volume=8; citation_issue=3; citation_publication_date=2001; citation_pages=254-66; citation_doi=10.1136/jamia.2001.0080254; citation_id=CR11
citation_journal_title=Pharmacoepidemiol Drug Saf; citation_title=Identifying hospital admissions due to adverse drug events using a computer-based monitor; citation_author=AK Jha, GJ Kuperman, E Rittenberg; citation_volume=10; citation_issue=2; citation_publication_date=2001; citation_pages=113-9; citation_doi=10.1002/pds.568; citation_id=CR12
citation_title=Computerised advice on drug dosage to improve prescribing practice. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 1; citation_inbook_title=Oxford Update Software; citation_publication_date=2001; citation_id=CR13; citation_author=RT Walton; citation_author=E Harvey; citation_author=S Dovey
citation_journal_title=J Am Med Inform Assoc; citation_title=Detecting adverse effects using information technology; citation_author=DW Bates, RS Evans, H Murff; citation_volume=10; citation_publication_date=2003; citation_pages=115-28; citation_doi=10.1197/jamia.M1074; citation_id=CR14
citation_journal_title=Aliment Pharmacol Ther; citation_title=Adverse drug reactions in patients with gastroenterological diseases: does age increase the risk?; citation_author=H Dormann, S Krebs, U Muth-Selbach; citation_volume=15; citation_issue=2; citation_publication_date=2001; citation_pages=171-80; citation_doi=10.1046/j.1365-2036.2001.00922.x; citation_id=CR15
citation_journal_title=J Chronic Dis; citation_title=A new method of classifying prognostic comorbidity in longitudinal studies: development and validation; citation_author=ME Charlson, P Pompei, KL Ales; citation_volume=40; citation_issue=5; citation_publication_date=1987; citation_pages=373-83; citation_doi=10.1016/0021-9681(87)90171-8; citation_id=CR16
Bundesverband der pharmazeutischen Industrie e.V. (BPI) VfAeVV BdAeVB, Verband aktiver Pharmaunternehmer e.V. (VAP). Zusammenstellung von Gegenanzeigen, Anwendungsbeschränkungen, Neben- Wechselwirkungen und Intoxikationen. Rote Liste Service GmbH; 2000
citation_journal_title=Lancet; citation_title=Adverse drug reactions: definitions, diagnosis, and management; citation_author=IR Edwards, JK Aronson; citation_volume=356; citation_issue=9237; citation_publication_date=2000; citation_pages=1255-9; citation_doi=10.1016/S0140-6736(00)02799-9; citation_id=CR18
citation_journal_title=Clin Pharmacol Ther; citation_title=A method for estimating the probability of adverse drug reactions; citation_author=CA Naranjo, U Busto, EM Sellers; citation_volume=30; citation_issue=2; citation_publication_date=1981; citation_pages=239-45; citation_doi=10.1038/clpt.1981.154; citation_id=CR19
citation_journal_title=Hosp Pharm; citation_title=Focusing on the preventability of adverse drug reactions [letter]; citation_author=GT Schumock, JP Thornton; citation_volume=27; citation_issue=6; citation_publication_date=1992; citation_pages=538; citation_id=CR20
citation_journal_title=Drug Saf; citation_title=Adverse reactions to drugs as a cause of admissions to a general teaching hospital in Hong Kong; citation_author=TY Chan, JC Chan, B Tomlinson; citation_volume=7; citation_issue=3; citation_publication_date=1992; citation_pages=235-40; citation_doi=10.2165/00002018-199207030-00008; citation_id=CR21
citation_journal_title=Int J Clin Pharmacol Ther; citation_title=Adverse drug reactions resulting in hospital admission; citation_author=M Huic, V Mucolic, B Vrhovac; citation_volume=32; citation_issue=12; citation_publication_date=1994; citation_pages=675-82; citation_id=CR22
citation_journal_title=Scand J Gastroenterol; citation_title=Drug-related admissions to a department of medical gastroenterology: the role of self-medicated and prescribed drugs; citation_author=J Hallas, KB Jensen, E Grodum; citation_volume=26; citation_issue=2; citation_publication_date=1991; citation_pages=174-80; citation_doi=10.3109/00365529109025028; citation_id=CR23
citation_journal_title=J Gen Intern Med; citation_title=Drug complications in outpatients; citation_author=TK Gandhi, HR Burstin, EF Cook; citation_volume=15; citation_issue=3; citation_publication_date=2000; citation_pages=149-54; citation_doi=10.1046/j.1525-1497.2000.04199.x; citation_id=CR24
citation_journal_title=JAMA; citation_title=Incidence of adverse drug events and potential adverse drug events: implications for prevention. ADE Prevention Study Group; citation_author=DW Bates, DJ Cullen, N Laird; citation_volume=274; citation_issue=1; citation_publication_date=1995; citation_pages=29-34; citation_doi=10.1001/jama.1995.03530010043033; citation_id=CR25
citation_journal_title=Arch Intern Med; citation_title=Preventable medical injuries in older patients; citation_author=JM Rothschild, DW Bates, LL Leape; citation_volume=160; citation_issue=18; citation_publication_date=2000; citation_pages=2717-28; citation_doi=10.1001/archinte.160.18.2717; citation_id=CR26
citation_journal_title=Am J Med; citation_title=Incidence and preventability of adverse drug events in nursing homes; citation_author=JH Gurwitz, TS Field, J Avorn; citation_volume=109; citation_issue=2; citation_publication_date=2000; citation_pages=87-94; citation_doi=10.1016/S0002-9343(00)00451-4; citation_id=CR27
citation_journal_title=Ann Intern Med; citation_title=Studies on the epidemiology of adverse drug reactions: V. clinical factors influencing susceptibility; citation_author=JW Smith, LG Seidl, LE Cluff; citation_volume=65; citation_issue=4; citation_publication_date=1966; citation_pages=629-40; citation_id=CR28
citation_journal_title=Arch Intern Med; citation_title=Patient risk factors for adverse drug events in hospitalized patients: ADE Prevention Study Group; citation_author=DW Bates, EB Miller, DJ Cullen; citation_volume=159; citation_issue=21; citation_publication_date=1999; citation_pages=2553-60; citation_doi=10.1001/archinte.159.21.2553; citation_id=CR29
citation_journal_title=Int J Clin Pharmacol Ther; citation_title=Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use; citation_author=GI Kohler, SM Bode-Boger, R Busse; citation_volume=38; citation_issue=11; citation_publication_date=2000; citation_pages=504-13; citation_id=CR30
citation_journal_title=Lancet; citation_title=Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital; citation_author=M Gosney, R Tallis; citation_volume=II; citation_issue=8402; citation_publication_date=1984; citation_pages=564-7; citation_doi=10.1016/S0140-6736(84)90775-X; citation_id=CR31
citation_journal_title=Medicine (Baltimore); citation_title=Computer-assisted adult medical diagnosis: subject review and evaluation of a new microcomputer-based system; citation_author=HS Waxman, WE Worley; citation_volume=69; citation_issue=3; citation_publication_date=1990; citation_pages=125-36; citation_id=CR32
Reducing doctors’ errors. BMJ 1977; 1 (6073): 1412
citation_journal_title=N Engl J Med; citation_title=Protocol-based computer reminders, the quality of care and the non-perfectability of man; citation_author=CJ McDonald; citation_volume=295; citation_issue=24; citation_publication_date=1976; citation_pages=1351-5; citation_doi=10.1056/NEJM197612092952405; citation_id=CR34