Prospective identification versus administrative coding of adverse drug reaction‐related hospitalizations in the elderly: A comparative analysis

Abstract

Purpose To compare prospective identification of adverse drug reaction (ADR)‐related hospital admissions in the elderly with administrative coding using the International Classification of Diseases 10th Revision Australian Modification (ICD‐10‐AM) coding system. Methods We linked the records of 768 enrolled patients from an earlier study, where clinical pharmacists identified ADRs using prospective data collection, to hospital administrative data. We identified patients in the study whose admissions were coded as ADRs using ICD‐10‐AM codes. We then compared the prevalence and characteristics of ADR‐related hospital admissions identified by the two approaches. Results According to ICD‐10‐AM coding, 2.7% of patients were admitted due to ADRs, while 15.0% of patients were deemed to have been admitted due to ADRs based on prospective identification by clinical pharmacists. Most (85.7%) patients coded as having an ADR‐related hospital admission were also identified as such prospectively. Hematological (23.1%) and metabolic reactions (23.1%) were frequent causes of ADRs identified by coding, whereas cardiovascular ADRs (27.8%) were more common causes of ADRs identified prospectively by pharmacists. Antidepressants (16.7%) and cardiac glycosides (16.7%) were the most commonly implicated drug groups in ADRs identified by coding, whereas diuretics (28.8%) and renin‐angiotensin system inhibitors (17.0%) were frequently implicated as causes of ADRs identified prospectively by pharmacists. Conclusions Reliance on administrative coding potentially underestimates the extent of the problem of ADRs as a cause of hospitalization in the elderly, and more detailed prospective analysis of admissions provides additional targets for strategies to prevent ADRs. The types of ADRs identified also differ between the two approaches.

Drug-Related Hospital Admissions via the Department of Emergency Medicine: A Cross-Sectional Study From the Czech Republic

“…The main limitation of this study is the retrospective data collection process. The gold standard method is a prospective evaluation of patient medical records, laboratory tests, and interviews with patients and care providers ( Parameswaran Nair et al, 2018 ). The limitation related to retrospective data collection includes the absence of medication reconciliation, patient interview, medication adherence confirmation.…”

Medical students as junior adverse drug event managers facilitating reporting of ADRs

“…Compared with other ADR reporting initiatives, such as administrative or computerized coding systems, the J‐ADEM team approach is probably more sensitive in detecting ADRs. 28 By gathering prospective detailed ADR information from the electronic patient record, assisting healthcare professionals in accurate ADR diagnosis and occasionally advising on ADR management/treatment, the J‐ADEM team is a real clinical support team rather than merely an administrative solution.…”

Detection of serious adverse drug reactions using diagnostic codes in the International Statistical Classification of Diseases and Related Health Problems

“…Other researchers have compared prospective and retrospective approaches to detect ADRs. Parameswaran Nair et al 20 analysed 118 ADRs leading to admission in elderly patients, of which 82.2% were identified prospectively, 2.5% were identified retrospectively on the basis of coding with ICD-10-Australian Modification and 15.3% were identified by both approaches. Bellis et al 21 retrospectively analysed, for a selection of paediatric charts, the coding of ADRs identified prospectively.…”

“…The 70 serious ADRs identified in our analysis had a range of ratings according to the Naranjo score (Table 2). Parameswaran Nair et al 20 also used the Naranjo algorithm to assess the association between an adverse effect and a suspected drug. Of the 115 ADRs evaluated, 81% were deemed to be probable ADRs and 19% were deemed to be definite ADRs.…”