Trends of adverse drug reactions related-hospitalizations in Spain (2001-2006)

<p>Abstract</p> <p>Background</p> <p>Adverse drug reactions (ADR) are a substantial cause of hospital admissions. We conducted a nationwide study to estimate the burden of hospital admissions for ADRs in Spain during a six-year period (2001-2006) along with the associated total health cost.</p> <p>Methods</p> <p>Data were obtained from the national surveillance system for hospital data (Minimum Basic Data Set) maintained by the Ministry of Health and Consumer Affairs, and covering more than 95% of Spanish hospitals. From these admissions we selected all hospitalization that were code as drug-related (ICD-9-CM codes E), but intended forms of overdoses, errors in administration and therapeutics failure were excluded. The average number of hospitalizations per year, annual incidence of hospital admissions, average length of stay in the hospital, and case-fatality rate, were calculated.</p> <p>Results</p> <p>During the 2001-2006 periods, the total number of hospitalized patients with ADR diagnosis was 350,835 subjects, 1.69% of all acute hospital admissions in Spain. The estimated incidence of admissions due to ADR decreased during the period 2001-2006 (p < 0.05). More than five percent of patients (n = 19,734) died during an ADR-related hospitalization. The drugs most commonly associated with ADR-related hospitalization were antineoplastic and immunosuppressive drugs (n = 75,760), adrenal cortical steroids (n = 47,539), anticoagulants (n = 26,546) and antibiotics (n = 22,144). The costs generated by patients in our study increased by 19.05% between 2001 and 2006.</p> <p>Conclusions</p> <p>Approximately 1.69% of all acute hospital admissions were associated with ADRs. The rates were much higher for elderly patients. The total cost of ADR-related hospitalization to the Spanish health system is high and has increased between 2001 and 2006. ADRs are an important cause of admission, resulting in considerable use of national health system beds and a significant number of deaths.</p

Cost-effectiveness of ward-based pharmacy care in surgical patients: protocol of the SUREPILL (Surgery & Pharmacy In Liaison) study

<p>Abstract</p> <p>Background</p> <p>Preventable adverse drug events (pADEs) are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison) study is initiated.</p> <p>Methods/Design</p> <p>A multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care.</p> <p>The primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-)medical costs and indirect non-medical costs, extra costs per prevented ADE, number and type of pharmacy interventions, length of hospital stay, complications registered in a national complication registration system for surgery, number of readmissions within three months after initial admission (follow-up), quality of life and number of non-institutionalized days during follow-up.</p> <p>Discussion</p> <p>This study will assess the cost-effectiveness of ward-based pharmacy care on preventable adverse drug events in surgical patients from a societal perspective, using a comparative study design.</p> <p>Trial registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2258">NTR2258</a></p

Improvement in Oral Diabetes Medication Adherence after a Comprehensive Wellness Assessment in a Dual Eligible Population

Medication adherence is often lower among disadvantaged patients. Drivers of medication adherence may include the quality of communications between patient and medical caregiver. The research objective is to assess whether an annual Comprehensive Wellness Assessment (CWA) is associated with improved medication adherence. The CWA targeted primarily dual eligible Special Needs Plan (SNP) enrollees in a Medicare Advantage plan. This retrospective panel study used administrative claims data and member-month level data for members who were newly diagnosed with diabetes in 2010, allowing for up to 5 years of follow-up. The intervention of interest is whether the member received a CWA in the past 12 months. Multivariate regression models were estimated using pooled member-month data and a difference-in-difference type approach to assess whether CWA visits improve oral diabetes medication (ODM) adherence among SNP enrollees. Twenty-six percent of pooled member-month observations are from SNP enrollees. Average monthly ODM adherence is 77.5%. Approximately 31% of SNP enrollees had a CWA in the last 12 months, compared to 5% of regular enrollees. Regression results show SNP enrollees with a CWA on average had higher monthly adherence by 3.9 percentage points ( P  < 0.01), and were 7% more likely to meet the threshold of at least 80% adherence ( P  < 0.01). Adherence is even higher for the subsample of African American SNP enrollees with CWA. CWA appears to be effective in improving ODM adherence among SNP patients. Care models with components like wellness assessments that include medication review and education may improve medication adherence as well as Medicare Advantage plan star ratings

Adverse Drug Events (ADEs): a novel RFID device for a safe and strong match between patients and their medications

The Adverse Drug Events (ADEs) can be defined as errors in therapy that are not desirable, not intentional and foreseeable, that can cause or lead to an inappropriate use of the medication or to a danger for the patient. In this work it is shown the design, engineering and realization of a prototype device for the safe and secure administration of pharmacological therapy using RFID. In particular, the redesign of the prototype antenna is addressed, with a focus on its enhanced performance