Abstract
Objective
: To describe the frequency and types of drug-related problems (DRPs) in hospitalised patients, and to identify risk factors for DRPs and the drugs most frequently causing them.
Methods
From May to December 2002, 827 patients from six internal medicine and two rheumatology departments in five hospitals in Norway were included in this study. We recorded demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors, i.e. reduced renal function, reduced liver function, heart failure, diabetes, compliance problems, drugs with a narrow therapeutic index and drug allergy. DRPs were documented after reviewing medical records and participation in multidisciplinary team discussions. An independent quality assessment team retrospectively assessed the DRPs in a randomly selected number of the study population.
Results
Of the patients, 81% had DRPs, and an average of 2.1 clinically relevant DRPs was recorded per patient. The DRPs most frequently recorded were dose-related problems (35.1% of the patients) followed by need for laboratory tests (21.6%), non-optimal drugs (21.4%), need for additional drugs (19.7%), unnecessary drugs (16.7%) and medical chart errors (16.3%). The patients used an average of 4.6 drugs at admission. A multivariate analysis showed that the number of drugs at admission and the number of clinical/pharmacological risk factors were both independent risk factors for the occurrence of DRPs, whereas age and gender were not. The drugs most frequently causing a DRP were warfarin, digitoxin and prednisolone, with calculated risk ratios 0.48, 0.42 and 0.26, respectively. The drug groups causing most DRPs were B01A-antithrombotic agents, M01A-non-steroidal anti-inflammatory agents, N02A-opioids and C09A-angiotensin converting enzyme inhibitors, with risk ratios of 0.22, 0.49, 0.21 and 0.35, respectively.
Conclusions
The majority of hospitalised patients in our study had DRPs. The number of drugs used and the number of clinical/pharmacological risk factors significantly and independently influenced the risk for DRPs. Procedures for identification of, and intervention on, actual and potential DRPs, along with awareness of drugs carrying a high risk for DRPs, are important elements of drug therapy and may contribute to diminishing drug-related morbidity and mortality.
References
Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Bruke JP (1997) Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 277:301–306
Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL (1997) The costs of adverse drug events in hospitalized patients. Adverse drug events prevention study group. JAMA 277:307–311
Ernst FR, Grizzle AJ (2001) Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash) 41:192–199
Lagnaoui R, Moore N, Fach J, Longy-Boursier M, Begaud B (2000) Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability. Eur J Clin Pharmacol 56:181–186
Winterstein AG, Sauer BC, Hepler CD, Poole C (2002) Preventable drug-related hospital admissions. Ann Pharmacother 36:1238–1248
Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients: a meta- analysis of prospective studies. JAMA 279:1200–1205
McDonnell PJ, Jacobs MR (2002) Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother 36:1331–1336
Hanlon JT, Schmader KE, Ruby CM, Weinberger M (2001) Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 49:200–209
Hanlon JT, Fillenbaum GG, Schmader KE, Kuchibhatla M, Horner RD (2000) Inappropriate drug use among community-dwelling elderly. Pharmacotherapy 20:575–582
Dhall J, Larrat EP, Lapane KL (2002) Use of potentially inappropriate drugs in nursing homes. Pharmacotherapy 22:88–96
Norsk legemiddelhåndbok for helsepersonell (2001) Oslo
WHO Collaborating Centre for Drug Statistics Methodology (2002) ATC index with DDDs. WHO Collaborating Centre, Oslo
van Mil Consultancy (2002) Pharmaceutical care network Europe. DRP-classification V3.01
Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD (1990) Drug-related problems: their structure and function. DICP 24:1093–1097
Spigset O, Krumsvik IL (2002) Legemiddelinteraksjoner. Felleskatalogen 1e-78
Hansten PD, Horn JR (2000) Drug interactions. Analysis and management. Facts and comparisons, St. Louis
Hansten PD, Horn JR, Hazlet TK (2001) ORCA: OpeRational ClassificAtion of drug interactions. J Am Pharm Assoc (Wash) 41:161–165
Sjöquist F (2001) Interaktion mellan läkemedel. I:FASS 2001. Stockholm:Linfo AS:1574–1653
Hallas J, Harvald B, Gram LF, Grodum E, Brosen K, Haghfelt T, Damsbo N (1990) Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med 228:83–90
Venulet J, TenHam M (1996) Methods for monitoring and documenting adverse drug reactions. Int J Clin Pharmacol Ther 34:112–129
Lesar TS, Briceland L, Stein DS (1997) Factors related to errors in medication prescribing. JAMA 277:312–317
Lipton HL, Bero LA, Bird JA, McPhee SJ (1992) The impact of clinical pharmacists’ consultations on physicians’ geriatric drug prescribing. A randomized controlled trial. Med Care 30:646–658
Alderman CP, Farmer C (2001) A brief analysis of clinical pharmacy interventions undertaken in an Australian teaching hospital. J Qual Clin Pract 21:99–103
Barber ND, Batty R, Ridout DA (1997) Predicting the rate of physician-accepted interventions by hospital pharmacists in the United Kingdom. Am J Health Syst Pharm 54:397–405
Bart BA, Gattis WA, Diem SJ, O’Connor CM (1997) Reasons for underuse of angiotensin-converting enzyme inhibitors in patients with heart failure and left ventricular dysfunction. Am J Cardiol 79:1118–1120
Gattis WA, Larsen RL, Hasselblad V, Bart BA, O’Connor CM (1998) Is optimal angiotensin-converting enzyme inhibitor dosing neglected in elderly patients with heart failure? Am Heart J 136:43–48
Gambassi G, Forman DE, Lapane KL, Mor V, Sgadari A, Lipsitz LA, Bernabei R (2000) Management of heart failure among very old persons living in long-term care: has the voice of trials spread? The SAGE study group. Am Heart J 139:85–93
Oborne CA, Hooper R, Li KC, Swift CG and Jackson SH (2002) An indicator of appropriate neuroleptic prescribing nursing homes. Age Ageing 31(6):435–439
Flaherty JH, Perry HM, Lynchard GS and Morley JE (2000) Polypharmacy and hospitalization among older home care patients. J Gerontol A Biol Sci Med Sci 55(10):554–559
Gilbert AL, Roughead EE, Beilby J, Mott K, Barratt JD (2002) Collaborative medication management services: improving patient care. Med J Aust 177:189–192
Furniss L, Craig SK, Burns A (1998) Medication use in nursing homes for elderly people. Int J Geriatr Psychiatry 13:433–439
Gurwitz JH, Rochon P (2002) Improving the quality of medication use in elderly patients: a not-so- simple prescription. Arch Intern Med 162:1670–1672
Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151:1825–1832
Samsa GP, Hanlon JT, Schmader KE, Weinberger M, Clipp EC, Uttech KM, Lewis IK, Landsman PB, Cohen HJ (1994) A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol 47:891–896
Thomas EJ, Brennan TA (2000) Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ 320:741–744
Carbonin P, Pahor M, Bernabei R, Sgadari A (1991) Is age an independent risk factor of adverse drug reactions in hospitalized medical patients? J Am Geriatr Soc 39:1093–1099
Acknowledgements
We thank Frank Jørgensen and members of the health teams in the participating departments. The study was supported by grants from “The Norwegian Community Pharmacy Foundation” and “The Norwegian Pharmacy Associations’ Foundation”, both are independent foundations for pharmacy research and development and they have no connection to the pharmaceutical industry.
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Blix, H.S., Viktil, K.K., Reikvam, Å. et al. The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol 60, 651–658 (2004). https://doi.org/10.1007/s00228-004-0830-4
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DOI: https://doi.org/10.1007/s00228-004-0830-4