Lack of Awareness of Community-Acquired Adverse Drug Reactions Upon Hospital Admission

Dormann, Harald; Criegee-Rieck, Manfred; Neubert, Antje; Egger, Tobias; Geise, Arnim; Krebs, Sabine; Schneider, Thomas; Levy, Micha; Hahn, Eckhart G.; Brune, Kay

doi:10.2165/00002018-200326050-00004

Cited by 73 publications

(42 citation statements)

References 32 publications

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“…Commonly used scales include Hallas et al, 54 Schumock and Thornton, 44 Dormann et al, 214 Ducharme et al 215 and Olivier et al 216 The Ferner and Aronson 25 systematic review identified eight different approaches to assessing avoidability. They suggested an approach to preventability based on analysis of the mechanisms of ADRs and their clinical manifestations.…”

Section: Discussionmentioning

confidence: 99%

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

Smyth

Peak

Turner

et al. 2014

Programme Grants for Applied Research

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AimsTo comprehensively investigate the incidence, nature and risk factors of adverse drug reactions (ADRs) in a hospital-based population of children, with rigorous assessment of causality, severity and avoidability, and to assess the consequent impact on children and families. We aimed to improve the assessment of ADRs by development of new tools to assess causality and avoidability, and to minimise the impact on families by developing better strategies for communication.Review methodsTwo prospective observational studies, each over 1 year, were conducted to assess ADRs in children associated with admission to hospital, and those occurring in children who were in hospital for longer than 48 hours. We conducted a comprehensive systematic review of ADRs in children. We used the findings from these studies to develop and validate tools to assess causality and avoidability of ADRs, and conducted interviews with parents and children who had experienced ADRs, using these findings to develop a leaflet for parents to inform a communication strategy about ADRs.ResultsThe estimated incidence of ADRs detected in children on admission to hospital was 2.9% [95% confidence interval (CI) 2.5% to 3.3%]. Of the reactions, 22.1% (95% CI 17% to 28%) were either definitely or possibly avoidable. Prescriptions originating in the community accounted for 44 out of 249 (17.7%) of ADRs, the remainder originating from hospital. A total of 120 out of 249 (48.2%) reactions resulted from treatment for malignancies. Off-label and/or unlicensed (OLUL) medicines were more likely to be implicated in an ADR than authorised medicines [relative risk (RR) 1.67, 95% CI 1.38 to 2.02;p < 0.001]. When medicines used for the treatment of oncology patients were excluded, OLUL medicines were not more likely to be implicated in an ADR than authorised medicines (RR 1.03, 95% CI 0.72 to 1.48;p = 0.830). For children who had been in hospital for > 48 hours, the overall incidence of definite and probable ADRs based on all admissions was 15.9% (95% CI 15.0 to 16.8). Opiate analgesic drugs and drugs used in general anaesthesia (GA) accounted for > 50% of all drugs implicated in ADRs. The odds ratio of an OLUL drug being implicated in an ADR compared with an authorised drug was 2.25 (95% CI 1.95 to 2.59;p < 0.001). Risk factors identified were exposure to a GA, age, oncology treatment and number of medicines. The systematic review estimated that the incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children [pooled estimate of 2.9% (95% CI 2.6% to 3.1%)] and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. New tools to assess causality and avoidability of ADRs have been developed and validated. Many parents described being dissatisfied with clinician communication about ADRs, whereas parents of children with cancer emphasised confidence in clinician management of ADRs and the way clinicians communicated about medicines. The accounts of children and young people largely reflected parents’ accounts. Clinicians described using all of the features of communication that parents wanted to see, but made active decisions about when and what to communicate to families about suspected ADRs, which meant that communication may not always match families’ needs and expectations. We developed a leaflet to assist clinicians in communicating ADRs to parents.ConclusionThe Adverse Drug Reactions In Children (ADRIC) programme has provided the most comprehensive assessment, to date, of the size and nature of ADRs in children presenting to, and cared for in, hospital, and the outputs that have resulted will improve the management and understanding of ADRs in children and adults within the NHS. Recommendations for future research: assess the values that parents and children place on the use of different medicines and the risks that they will find acceptable within these contexts; focusing on high-risk drugs identified in ADRIC, determine the optimum drug dose for children through the development of a gold standard practice for the extrapolation of adult drug doses, alongside targeted pharmacokinetic/pharmacodynamic studies; assess the research and clinical applications of the Liverpool Causality Assessment Tool and the Liverpool Avoidability Assessment Tool; evaluate, in more detail, morbidities associated with anaesthesia and surgery in children, including follow-up in the community and in the home setting and an assessment of the most appropriate treatment regimens to prevent pain, vomiting and other postoperative complications; further evaluate strategies for communication with families, children and young people about ADRs; and quantify ADRs in other settings, for example critical care and neonatology.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

Smyth

Peak

Turner

et al. 2014

Programme Grants for Applied Research

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“…Poor recognition could account for the low estimate of the incidence of ADR-related ED visits as noted in a German study that more than half of the pre-existing ADRs were not recognized by either the admitting or the attending physician. [5] Finally, we note that there is likely to be facility-level variability in identification and coding of ADRs in the CIHI databases used in this analysis. Although we do not believe such variability would be a confounding factor in the present analysis, future work could investigate such variability.…”

Section: Discussionmentioning

confidence: 99%

“…With far lower rates than those found in prospective or trial-based results, our study suggests that ED visits related to ADRs are not well identified or coded in emergency settings. Since early identification of an ADR is the predominant factor in preventability,[5] effective interventions aimed at improving ADR identification are warranted.…”

Section: Discussionmentioning

confidence: 99%

“…While some pharmacosurveillance studies include multicentre[3] or national hospital data,[4] most studies on ADRs have been conducted within a single hospital[5] or even a single medical department,[6] making it difficult to confidently extrapolate results to a general population. [7] As well, ADRs occur more commonly in community-dwelling patients[3] where data is not well documented and more difficult to obtain.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

2012

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Background: The rapid rise in the availability and use of pharmaceutical agents, and particularly polypharmacy, directly increases the risk for patients to experience adverse drug reactions (ADRs). There are few studies on the overall incidence and costs of ADRs.Objective: The aim of this study was to estimate the incidence and costs of emergency department (ED) visits related to ADRs for patients greater than 65 years of age using administrative data, and to describe risk factors for experiencing severe ADRs.Methods: We employed a retrospective cohort design based on population-based healthcare administrative clinical databases. Identification of ADR-related ED visits from the administrative database was based on International Classification of Diseases, 10th Revision-Canadian Enhancement (ICD-10-CA) codes for each ED visit. The incidence and costs of ADR-related ED visits and subsequent hospital admissions were estimated for all adults aged 66 years and above for the period April 2003–March 2008. Costs were standardized and reported in 2008 Canadian dollars. Logistic regression was used to detect risk factors for severe ADRs.Results: Approximately 0.75% of total annual ED visits among adults aged 66 years and above were found to be ADR-related, and among these patients 21.6% were hospitalized. In 2007, the cost of ADR-related visits was $333 per ED visit and $7528 per hospitalization for a total annual cost of $13.6 million in Ontario, or an estimated $35.7 million in Canada. Severe ADRs were associated with sex, age, comorbid disease burden, multiple drugs, multiple pharmacies, newly prescribed drugs, recent ED visit, recent hospitalization and long-term care (LTC) residence.Conclusions: ADRs are an important public health issue that threaten the safety of drug therapy and results in significant economic burden to the healthcare system. ED visits related to ADRs may be underestimated in retrospective studies using administrative data compared with prospective studies. Further research is needed to better understand the risk of experiencing severe ADRs among LTC residents.

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“…5 % der medikamentös behandelten Patienten UAW auf (5). Bei ungefähr 3-6 % aller Patienten, die stationär aufgenommen werden, ist eine UAW Ursache für die Aufnahme (5-12), die vom aufnehmenden Arzt allerdings häufig nicht erkannt wird (11). Ungefähr 40 % der UAW, die zu einer stationären Aufnahme führen, werden als vermeidbar eingestuft (11;13;14).…”

Section: Epidemiologie Und öKonomische Bedeutungunclassified

Erfahrungsdatenbank Phytopharmaka - eine onlinebasierte Erhebung

Ravens¹,

Mösges²,

Meng³

et al. 2012

Z Phytother

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Lack of Awareness of Community-Acquired Adverse Drug Reactions Upon Hospital Admission

Cited by 73 publications

References 32 publications

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

ADRIC: Adverse Drug Reactions In Children – a programme of research using mixed methods

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

Erfahrungsdatenbank Phytopharmaka - eine onlinebasierte Erhebung

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