Which drugs cause preventable admissions to hospital? A systematic review.
Journal: 2007/May - British Journal of Clinical Pharmacology
ISSN: 0306-5251
Abstract:
OBJECTIVE
Previous systematic reviews have found that drug-related morbidity accounts for 4.3% of preventable hospital admissions. None, however, has identified the drugs most commonly responsible for preventable hospital admissions. The aims of this study were to estimate the percentage of preventable drug-related hospital admissions, the most common drug causes of preventable hospital admissions and the most common underlying causes of preventable drug-related admissions.
METHODS
Bibliographic databases and reference lists from eligible articles and study authors were the sources for data. Seventeen prospective observational studies reporting the proportion of preventable drug-related hospital admissions, causative drugs and/or the underlying causes of hospital admissions were selected. Included studies used multiple reviewers and/or explicit criteria to assess causality and preventability of hospital admissions. Two investigators abstracted data from all included studies using a purpose-made data extraction form.
RESULTS
From 13 papers the median percentage of preventable drug-related admissions to hospital was 3.7% (range 1.4-15.4). From nine papers the majority (51%) of preventable drug-related admissions involved either antiplatelets (16%), diuretics (16%), nonsteroidal anti-inflammatory drugs (11%) or anticoagulants (8%). From five studies the median proportion of preventable drug-related admissions associated with prescribing problems was 30.6% (range 11.1-41.8), with adherence problems 33.3% (range 20.9-41.7) and with monitoring problems 22.2% (range 0-31.3).
CONCLUSIONS
Four groups of drugs account for more than 50% of the drug groups associated with preventable drug-related hospital admissions. Concentrating interventions on these drug groups could reduce appreciably the number of preventable drug-related admissions to hospital from primary care.
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Br J Clin Pharmacol 63(2): 136-147

Which drugs cause preventable admissions to hospital? A systematic review

Nottingham Primary Care Research Partnership, Broxtowe & Hucknall PCT, Hcknall Health Centre, Nottingham, UK
Division of Primary Care, University of Nottingham, Nottingham, UK
Radboud University, Nijmegen, the Netherlands
Primary Care, University of Nottingham at Derby Graduate Entry Medical School, Derby, Liverpool, UK
Clinical Pharmacology and Consultant Physician University of Liverpool, Liverpool, UK
Correspondence Mrs Rachel Howard, Nottingham Primary Care Research Partnership, Broxtowe & Hucknall PCT, Hucknall Health Centre, Nottingham NG8 1HT, UK. Tel: +44(0)115 8590770 Fax: +44(0)115 8590772 E-mail: ku.shn.tcp-llankcuhewotxorb@drawoh.lehcar
Nottingham Primary Care Research Partnership, Broxtowe & Hucknall PCT, Hcknall Health Centre, Nottingham, UK
Received 2006 Jan 30; Accepted 2006 Apr 12.

Abstract

Aims

Previous systematic reviews have found that drug-related morbidity accounts for 4.3% of preventable hospital admissions. None, however, has identified the drugs most commonly responsible for preventable hospital admissions. The aims of this study were to estimate the percentage of preventable drug-related hospital admissions, the most common drug causes of preventable hospital admissions and the most common underlying causes of preventable drug-related admissions.

Methods

Bibliographic databases and reference lists from eligible articles and study authors were the sources for data. Seventeen prospective observational studies reporting the proportion of preventable drug-related hospital admissions, causative drugs and/or the underlying causes of hospital admissions were selected. Included studies used multiple reviewers and/or explicit criteria to assess causality and preventability of hospital admissions. Two investigators abstracted data from all included studies using a purpose-made data extraction form.

Results

From 13 papers the median percentage of preventable drug-related admissions to hospital was 3.7% (range 1.4–15.4). From nine papers the majority (51%) of preventable drug-related admissions involved either antiplatelets (16%), diuretics (16%), nonsteroidal anti-inflammatory drugs (11%) or anticoagulants (8%). From five studies the median proportion of preventable drug-related admissions associated with prescribing problems was 30.6% (range 11.1–41.8), with adherence problems 33.3% (range 20.9–41.7) and with monitoring problems 22.2% (range 0–31.3).

Conclusions

Four groups of drugs account for more than 50% of the drug groups associated with preventable drug-related hospital admissions. Concentrating interventions on these drug groups could reduce appreciably the number of preventable drug-related admissions to hospital from primary care.

Keywords: adverse effects, drug safety, drug therapy, drug toxicity, medication errors, systematic review
Abstract

DRA, Drug-related admissions; ADR, adverse drug reaction; PDRA, preventable drug-related admission.

Acknowledgments

This systematic review was undertaken with NHS Research & Development funding.

Acknowledgments

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