Drugs causing adverse events in patients aged 45 or older: a randomised survey of Australian general practice patients

Abstract

ObjectiveTo determine prevalence of adverse drug events (ADEs) in patients aged 45 years or older presenting to Australian general practitioners (GPs) and identify drug groups related to ADEs, their severity and manifestation.DesignSubstudy of the Bettering the Evaluation and Care of Health continuous survey of Australian GP clinical activity in which randomly selected GPs collected survey data from patients. Data are reported with 95% CIs.SettingGeneral practice in Australia.Main outcome measuresPrevalence in the preceding 6 months, type, implicated drugs, severity (including hospitalisation) and manifestation of ADEs.ParticipantsFrom three survey samples, January–October 2007, and two samples, January–March 2010, responses were received from 482 GPs about 7561 patients aged 45 years or older.ResultsOf a final sample of 7518 patients (after duplicate patients removed), 871 (11.6%) reported ADEs in the previous 6 months. The type of ADE was recognised side effect (75.8%, 95% CI 72.0 to 79.7), drug sensitivity (9.9%, 95% CI 7.2 to 12.7) and drug allergy (7.4%, 95% CI 4.7 to 10.1). Drug interaction (1.0%, 95% CI 0.1 to 1.8), overdose (0.8%, 95% CI 0.0 to 1.5) and contraindications (0.2%, 95% CI 0.0 to 0.6) were very infrequent. A severity rating was provided for 846 patients. Almost half (45.9%, 95% CI 42.0 to 49.7) were rated as ‘mild’ events, 42.2% (95% CI 38.8 to 45.6) ‘moderate’, 11.8% (95% CI 9.5 to 14.1) severe and 5.4% (95% CI 3.8 to 7.0) had been hospitalised as a result of the most recent ADE. Thirteen commonly prescribed drug groups accounted for 58% of all ADEs, opioids being the group most often implicated.ConclusionADEs in patients aged 45 or older are frequent and are associated with significant morbidity. Most of ADEs result from commonly prescribed drugs at therapeutic dosage. The list of causative agents bears little relationship to published lists of ‘inappropriate medications’.

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“…Miller et al [40] reported 11.6% of people had at least one AE in the preceding six months, most of which were mild to moderate; 11.8 were severe and 5.4% required a hospital admission as a result of using 13 commonly prescribed medicines not on lists such as BEERS Criteria [15,16]. These tools were developed to aid medicine prescribing decisions, not replace reasoned clinical decision-making.…”

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“…• about a quarter of patients at encounters and 16.2% of people in the population had six or more diagnosed chronic conditions 65 106 Of the 11,181 patients aged 65+ in our sample, the average number of diagnosed chronic conditions among them was 4.2 (median = 4) and ranged from 0 to 21. Prevalence and management of chronic conditions Table 14.1 shows the prevalence and management rates of common chronic conditions among patients aged 65+.…”

“…Readers interested in adverse drug events will find more detailed information from the BEACH program in Drugs causing adverse events in patients aged 45 or older: a randomised survey of general practice patients. 65 …”

“…65 As a result of multimorbidity and associated use of multiple medications, patients aged 65 and older are at a significant risk of suffering an adverse drug event and consequent hospital care.…”

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“…76 Readers interested in adverse drug events will find more detailed information from the BEACH program in Drugs causing adverse events in patients aged 45 or older: a randomised survey of general practice patients. 77 …”