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Which Adverse Events and Which Drugs Are Implicated in Drug-Related Hospital Admissions? A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12041320. [PMID: 36835854 PMCID: PMC9963366 DOI: 10.3390/jcm12041320] [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: 12/05/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Adverse drug events (ADEs) and adverse drug reactions (ADRs) are leading causes of iatrogenic injury, which can result in emergency department (ED) visits or admissions to inpatient wards. The aim of this systematic review and meta-analysis was to provide up-to-date estimates of the prevalence of (preventable) drug-related ED visits and hospital admissions, as well as the type and prevalence of implicated ADRs/ADEs and drugs. A literature search of studies published between January 2012 and December 2021 was performed in PubMed, Medline, EMBASE, Cochrane Library, and Web of Science. Retrospective and prospective observational studies investigating acute admissions to EDs or inpatient wards due to ADRs or ADEs in the general population were included. Meta-analyses of prevalence rates were conducted using generalized linear mixed models (GLMM) with the random-effect method. Seventeen studies reporting ADRs and/or ADEs were eligible for inclusion. The prevalence rates of ADR- and ADE-related admissions to EDs or inpatient wards were estimated at 8.3% ([95% CI, 6.4-10.7%]) and 13.9% ([95% CI, 8.1-22.8%]), respectively, of which almost half (ADRs: 44.7% [95% CI: 28.1; 62.4]) and more than two thirds (ADEs: 71.0% [95% CI, 65.9-75.6%]) had been classified as at least possibly preventable. The ADR categories most frequently implicated in ADR-related admissions were gastrointestinal disorders, electrolyte disturbances, bleeding events, and renal and urinary disorders. Nervous system drugs were found to be the most commonly implicated drug groups, followed by cardiovascular and antithrombotic agents. Our findings demonstrate that ADR-related admissions to EDs and inpatient wards still represent a major and often preventable health care problem. In comparison to previous systematic reviews, cardiovascular and antithrombotic drugs remain common causes of drug-related admissions, while nervous system drugs appear to have become more commonly implicated. These developments may be considered in future efforts to improve medication safety in primary care.
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Serre A, Eiden C, Gourhant V, Laureau M, Perier D, Giraud I, Sebbane M, Peyrière H. [Involvement of addictovigilance in emergency department for the detection of abuse and dependence cases: 3 years of experience]. Therapie 2018; 73:501-509. [PMID: 30017376 DOI: 10.1016/j.therap.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Due to the increase of hospitalization at emergency department (ED) related to psychoactive substances use (PSU), the addictovigilance center of Montpellier has been integrated into the URGEIM program for the detection of iatrogenic events at the ED. The objective of the present work was to analyze spontaneous reports (SR) collected via the URGEIM program. METHODS Analysis of spontaneous reports related to PSU at the ED of the Montpellier University Hospital, collected through the URGEIM program, between January 2014 and December 2016. RESULTS During the study period, 160 SR were collected through the URGEIM program on 1118 SR collected by the Addictovigilance center over the period: 40SR/342 in 2014, 46 SR/303 in 2015 and 74 SR/473 in 2016. Most patients were male (70%) and the mean age at admission was 33 years old. A total of 240 psychoactive substances were identified with 160 illicit substances (66.6%) [cocaine 38.1%, cannabis 30.6%] and 80 medications (33.3%) [buprenorphine 22.5%, benzodiazepines 20% and methadone 18.8%]. Mental and behavioral disorders (20.0%), general health problems associated with substance use (17.5%), cardiovascular diseases (13.1%) and infectious diseases (12.5%) were the main reported effects. The duration of emergency stay was inferior to 12hours in 63.1% of cases and greater than 24hours in 12.5% of cases. In 69.4% of cases, the event was considered as serious. The outcome was unknown for 6.9% of patients. CONCLUSION The number of SR from ED has increased over the study period, with the notification of serious and worrying cases, and the possibility of setting up actions. The deployment of addictovigilance within clinical services is a significant factor for notification and quality of care.
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Affiliation(s)
- Anaïs Serre
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Céline Eiden
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Vincent Gourhant
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Marion Laureau
- Département de pharmacie clinique et dispensation, pharmacie, centre hospitalier universitaire, 34295 Montpellier, France
| | - Damien Perier
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Isabelle Giraud
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Mustapha Sebbane
- Département des urgences, centre hospitalier universitaire, 34295 Montpellier, France
| | - Hélène Peyrière
- Département de pharmacologie médicale et toxicologie, centre d'addictovigilance, hôpital Lapeyronie, centre hospitalier universitaire, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Flamme-Obry F, Belaiche S, Hazzan M, Ramdan N, Noël C, Odou P, Décaudin B. [Clinical pharmacist and medication reconciliation in kidney transplantation]. Nephrol Ther 2018; 14:91-98. [PMID: 29477279 DOI: 10.1016/j.nephro.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Drug related problems (DRP) can lead to severe consequences in kidney recipients. The aim of the study was to assess the impact of the clinical pharmacist interventions on the incidence of DRP. METHOD The number of DRP were evaluated according to 3periods: Without intervention, with medication reconciliation at admission, and with medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge. RESULTS Patients concerned were mainly men, 55years old (median age), stage3 of CKD, transplanted for less than 3months or more than 1year, with cardiovascular risk factors and receiving an average of 9drugs/day. Among the DRP, 20% were avoidable and severe in most cases. In period1, 27.7% patients had at least 1DRP, in period2, 21.3% patients had at least 1DRP, and in period3, 17.4% of patients had at least 1DRP (P=0.03). One hundred and ten patients had medication reconciliation at admission with a mean of 0.6unintentional discrepancies per patient (omission in 81% of cases). The main drugs involved concerned the digestive-metabolic (24.5%), cardiovascular (23%), and nervous (23%) system. Sixty-eight interviews at discharge were realized and revealed self-medication habits. CONCLUSION Our study shows that medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge can help to reduce DRP in kidney recipients. Further studies are needed to confirm our results.
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Affiliation(s)
| | - Stéphanie Belaiche
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France.
| | - Marc Hazzan
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Nassima Ramdan
- EA 2694, santé publique : épidémiologie et qualité des soins, CHRU de Lille, University Lille, 59000 Lille, France
| | - Christian Noël
- Service de néphrologie, CHRU de Lille, 59000 Lille, France; Inserm U995, Lille Inflammation Research International Center (LIRIC), University Lille, 59000 Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
| | - Bertrand Décaudin
- Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France
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Prevalence of Drug-Related Emergency Department Visits at a Teaching Hospital in Malaysia. Drugs Real World Outcomes 2015; 2:387-395. [PMID: 26689834 PMCID: PMC4674517 DOI: 10.1007/s40801-015-0045-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Data on the prevalence of adverse drug event (ADE)-related emergency department (ED) visits in developing countries are limited. Malaysia is located in South-East Asia, and, to our knowledge, no information exists on ADE-related ED visits. OBJECTIVE The objective of this study was to determine the prevalence, preventability, severity, and outcome of drug-related ED visits. METHODOLOGY A cross-sectional study was conducted in consenting patients who visited the ED of Hospital Universiti Sains Malaysia over a 6-week period. The ED physician on duty determined whether or not the visit was drug related according to set criteria. Other relevant information was extracted from the patient's medical folder by a clinical pharmacist. RESULTS Of the 434 consenting patients, 133 (30.6 %; 95 % confidence interval [CI] 26-35 %) visits were determined to be ADE related; 55.5 % were considered preventable, 11.3 % possibly preventable, and 33.1 % not preventable. Severity was classed as mild in 1.5 %, moderate in 67.7 %, and severe in 30.8 %. The most common ADEs reported were drug therapeutic failure (55.6 %) and adverse drug reactions (32.3 %). The most frequently implicated drugs were antidiabetics (n = 31; 23.3 %), antihypertensives (n = 28; 21.1 %), antibiotics (n = 13; 9.8 %), and anti-asthmatics (n = 11; 8.3 %). A total of 93 patients (69.9 %) were admitted to the ED for observation, 25 (18.8 %) were discharged immediately after consultation, and 15 (11.3 %) were admitted to the ward through the ED. CONCLUSION The prevalence of ADE-related ED visits was high; more than one-half of the events were considered preventable and one-third was classed as severe. As such, preventive measures will minimize future occurrences and increase patient safety.
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Roulet L, Ballereau F, Lapeyre-Mestre M, Joris-Frasseren M, Asseray N. [Developing a terminology in the French language for clinical practice and research in drug safety]. Therapie 2014; 70:283-92. [PMID: 25534521 DOI: 10.2515/therapie/2014215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 10/08/2014] [Indexed: 01/18/2023]
Abstract
While several attempts have been made to clarify the English terminology of drug-related iatrogeny, a consensus has still not been reached in the French language. We set up a multidisciplinary task force to propose a terminology that differs from the one used in pharmacovigilance and risk management. We prefer the term "adverse drug event" (ADE) over "adverse drug reaction", and recommend avoiding the term "adverse event", which is too general. We propose to classify ADEs as "direct drug effect" or "drug involvement in a multifactorial pathological condition", taking into account the close relationship commonly found between drug and non-drug etiologies of a pathology. The consistent association between the notions "error" and "preventability" is also questionable, and we suggest assessing the "ameliorability" of ADEs rather than their "preventability". "Misuse" (i.e., the non-respect by the patient of the drug label) must be distinguished from "off-label use or substance abuse".
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Affiliation(s)
- Lucien Roulet
- Service de pharmacie, Hôpital du Valais, Sion, Suisse
| | | | | | | | - Nathalie Asseray
- Service des maladies infectieuses et tropicales, CHU de Nantes, Nantes, France
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Charfi R, El Aïdli S, Zaïem A, Kastalli S, Sraïri S, Daghfous R, Lakhal M. Adverse Drug Reactions in Older Adults: a Retrospective Study from Pharmacovigilance. Therapie 2012; 67:471-6. [DOI: 10.2515/therapie/2012059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/12/2012] [Indexed: 11/20/2022]
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Adam M, Coffinet C, Corbière C, Berthe A, Beauruelle C, Doucet J. Iatrogénèse des médicaments génériques en gériatrie. Therapie 2011; 66:459-60. [DOI: 10.2515/therapie/2011050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 05/24/2011] [Indexed: 11/20/2022]
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Taché SV, Sönnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systematic review. Ann Pharmacother 2011; 45:977-89. [PMID: 21693697 DOI: 10.1345/aph.1p627] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Most medications are prescribed, dispensed, and administered in ambulatory care settings, yet little information exists on the adverse effects of drugs in this setting. This review was conducted to estimate the prevalence of adverse drug events (ADEs) and the proportion of preventable ADEs in ambulatory care settings; compare data for different age groups including children, adults, and elderly patients; and review drug classes most commonly associated with ADEs. DATA SOURCES Four electronic databases-PubMed (1966-March 2011), International Pharmaceutical Abstracts (1970-March 2011), EMBASE (1980-March 2011), and the Cochrane Database of Systematic Reviews (1993-March 2011)-were systematically searched for published data. Bibliographies of retrieved articles were searched individually for additional relevant studies. STUDY SELECTION A standardized definition of an ADE was used to select studies in populations living in the community, with medical visits to primary care facilities, nonspecialty ambulatory care facilities, and/or admissions to a hospital for medication-related adverse events. DATA EXTRACTION Data were extracted using a standardized table. Forty-three studies met our inclusion criteria. DATA SYNTHESIS The median ADE prevalence rate for retrospective studies was 3.3% (interquartile range [IQR] 2.3-7.1%) vs 9.65% (IQR 3.3-17.35%) for prospective studies. Median preventable ADE rates in ambulatory care-based studies were 16.5%, and 52.9% for hospital-based studies. Median prevalence rates by age group ranged from 2.45% for children to 5.27% for adults, 16.1% for elderly patients, and 3.45% for studies including all ages. CONCLUSIONS Despite a recent increase in publications on ADEs in the ambulatory care setting, most studies remain hospital based. Notable differences in prevalence rates by age groups and by responsible drug categories provide guidance on how to direct attention toward effective targets for improvement of medication safety in ambulatory care settings.
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Affiliation(s)
- Stephanie V Taché
- Department of Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
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Ventelou B, Rolland S. Évaluation de l'implication des médecins généralistes libéraux dans le bon usage des médicaments. SANTE PUBLIQUE 2009; 21:129-38. [DOI: 10.3917/spub.092.0129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Laroche ML, Boqueho S, Vallejo C, Nouaille Y, Godard S, Merle L. Effets indésirables médicamenteux aux urgences : une étude prospective au CHU de Limoges. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.jeur.2008.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Trinh-Duc A, Doucet J, Bannwarth B, Trombert-Paviot B, Carpentier F, Bouget J, Queneau P. [Admissions of elderly to French emergency departments related to adverse drug events]. Therapie 2008; 62:437-41. [PMID: 18206105 DOI: 10.2515/therapie:2007063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/05/2007] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the characteristics of adverse drug events (ADE) causing emergency medical admissions in the elderly. METHODS Data were obtained from two prospective cross sectional studies with similar experimental design which were carried out in seven French emergency departments in 1999 and 2003. The proportion of ADE leading to admission, their severity and preventability were assessed in patients aged > or =70 (group A) and compared to those of patients < 70 years (group B). RESULTS Out of a total of 2907 patients, 1158 (39.8%) were > or =70 years of age. Among these, 17.1% were admitted as a result of an ADE vs. 13.2% in group B (p = 0.004). ADE appeared to be more severe in group A than in group B. The part of preventable ADE did not significantly differ between the two groups (48.9% vs. 43.7%, respectively). CONCLUSION ADE are a common preventable cause of unplanned admissions, especially in the elderly.
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Affiliation(s)
- Albert Trinh-Duc
- Service d'Accueil des Urgences, Centre Hospitalier d'Agen, Agen, France.
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Granjon C, Beyens MN, Frederico D, Blanc P, Gonthier R. Existe-t-il un sur-risque d’accidents médicamenteux chez les sujets âgés atteints de troubles cognitifs ? ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1627-4830(06)75270-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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