Percentage of Patients with Preventable Adverse Drug Reactions and Preventability of Adverse Drug Reactions – A Meta-Analysis

BACKGROUND: Numerous observational studies suggest that preventable adverse drug reactions are a significant burden in healthcare, but no meta-analysis using a standardised definition for adverse drug reactions exists. The aim of the study was to estimate the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions in adult outpatients and inpatients. METHODS: Studies were identified through searching Cochrane, CINAHL, EMBASE, IPA, Medline, PsycINFO and Web of Science in September 2010, and by hand searching the reference lists of identified papers. Original peer-reviewed research articles in English that defined adverse drug reactions according to WHO's or similar definition and assessed preventability were included. Disease or treatment specific studies were excluded. Meta-analysis on the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions was conducted. RESULTS: Data were analysed from 16 original studies on outpatients with 48797 emergency visits or hospital admissions and from 8 studies involving 24128 inpatients. No studies in primary care were identified. Among adult outpatients, 2.0% (95% confidence interval (CI): 1.2-3.2%) had preventable adverse drug reactions and 52% (95% CI: 42-62%) of adverse drug reactions were preventable. Among inpatients, 1.6% (95% CI: 0.1-51%) had preventable adverse drug reactions and 45% (95% CI: 33-58%) of adverse drug reactions were preventable. CONCLUSIONS: This meta-analysis corroborates that preventable adverse drug reactions are a significant burden to healthcare among adult outpatients. Among both outpatients and inpatients, approximately half of adverse drug reactions are preventable, demonstrating that further evidence on prevention strategies is required. The percentage of patients with preventable adverse drug reactions among inpatients and in primary care is largely unknown and should be investigated in future research

Characterization of Drug-Related Problems in Elderly Patients on Admission to a Medical Ward

ABSTRACTThe incidence, types, avoidability and risk factors associated with drug-related problems (DRPs) in geriatric patients on admission to a medical ward of the Toronto Hospital were assessed. The admission note and laboratory data of 150 consecutive admissions were reviewed for the presence of an adverse drug reaction, inappropriate dose, non-compliance, drug interaction, or lack of required medication. The avoidability (avoidable, possibly avoidable, or unavoidable) and contribution to hospitalization (major reason, contributing or non contributing) of each DRP was characterized.On admission, 41 % of patients had a DRP identified, of which most were potentially avoidable (96.8%) and involved commonly prescribed drugs. The DRP was the major or contributing reason for admission in 31 % of cases.Polypharmacy was a statistically significant risk factor for a DRP, particularly for male patients (p=0.0010). In this elderly population, DRPs were not statistically correlated to age greater than 65 years, gender, renal function, native language, or duration of hospital stay.The incidence of DRPs and hospitalizations in the elderly can potentially be reduced by improving medication use. Enhanced communication, particularly between hospital and community pharmacists and their patients, may be a key mechanism.RÉSUMÉOn a évalué, chez les personnes âgées qui étaient admises à une unité de soins médicale du Toronto Hospital, l'incidence et les types de problèmes d'origine médicamenteuse (POM), ainsi que le caractère évitable et les facteurs de risque associés à ces derniers. Les dossiers d'admission et les données de laboratoires concernant 150 patients admis de façon consécutive ont été passés en revue. On recherchait les réactions indésirables à un médicament, les doses inappropriées, le manque de fidélité au régime non-observance thérapeutique, les interactions médicamenteuses ou la sous-médication. Le caractère évitable (évitable, possiblement évitable, inévitable) et le facteur de contribution à l'hospitalisation (majeur, présent, absent) de chaque POM ont été spécifiés.À l'admission, 41 % des patients présentaient un POM qui, dans la majorité de ces cas, soit (96.8 %) était évitable et associé à un médicament d'ordonnance courant. Dans 31 % des cas, le POM était un facteur de contribution majeur ou présent à l'hospitalisation.La polypharmacie constituait un facteur de risque de POM statistiquement significatif, particulièrement chez les hommes (p = 0,0010). Dans cette population, il n'a pas été possible d'établir de corrélation statistique entre les POM et l'âge supérieur à 65 ans, le sexe, l'état de la fonction rénale, la langue maternelle ou la durée de l'hospitalisation.L'incidence des POM et de l'hospitalisation chez les personnes âgées pourrait être réduite en rationalisant l'utilisation des médicaments. Une meilleure communication, particulièrement entre les hôpitaux, d'une part, et les pharmaciens communautaires et leurs patients, d'autre part, serait tout probablement une solution clé

Medication use in the context of everyday living as understood by seniors

Recognizing that older adults are among the biggest consumers of medication, and the demographic group most likely to suffer an adverse drug reaction (ADR), this paper details the findings from a recent study on how older adults come to understand medication and its related use. Using a qualitative content analysis method, semi-structured interviews were conducted with 21 individuals from British Columbia, Canada. Study participants ranged in age from 65 to 89 years (male = 9, female = 11). Using NVIVO® 7 software, data were subjected to comparative thematic content analysis in an effort to capture the role of medication use in the context of everyday living as understood by older adults. While there was variability in how older adults come to understand their medication use, an overarching theme was revealed whereby most participants identified their prescription medications as being life-sustaining and prolonging. Deeper thematic content analysis of participant narratives drew attention to three key areas: (A) medications are viewed as a necessary, often unquestioned, aspect of day-to-day life (B) a relationship is perceived to exist between the amount of medications taken and ones current state of health (C) the overall medication experience is positively or negatively influenced by the doctor patient relationship and the assumption that it is the physicians role to communicate medication information that will support everyday living. The article concludes that medical authority and the complexities surrounding medication use need to undergo significant revision if community dwelling older adults are to experience greater success in safely managing their health and medication-related needs

Education, cognition, health knowledge, and health behavior

Using data from NLSY97 we analyze the impact of education on health behavior. Controlling for health knowledge does not influence the impact of education on health behavior, supporting the productive efficiency hypothesis. Accounting for cognitive ability does not significantly alter the relationship between education and health behavior. Similarly, the impact of education on health behavior is the same between those with and without a learning disability, suggesting that cognition is not likely to be a significant factor in explaining the impact of education on health behavior