Preventable drug-related hospital admissions

被引:193
作者
Winterstein, AG
Sauer, BC
Hepler, CD
Poole, C
机构
[1] Univ Florida, Coll Pharm, Dept Pharm Hlth Care Adm, Gainesville, FL 32610 USA
[2] Univ N Carolina, Sch Publ Hlth, Dept Epidemiol, Chapel Hill, NC USA
关键词
adverse drug events; adverse effects; meta-analysis;
D O I
10.1345/aph.1A225
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
OBJECTIVE: To estimate the prevalence of preventable drug-related hospital admissions (PDRAs) and to explore if selected study characteristics affect prevalence estimates. METHODS: Keyword search of MEDLINE (1966-December 1999), International Pharmaceutical Abstracts (1970-December 1999), and hand search. Two reviewers independently selected studies published in peer-reviewed journals and extracted crude prevalence estimates and study characteristics. Trials had to specifically address consequences of drug therapy requiring hospital admission and include a quantitative preventability assessment. Stratified analysis and meta-regression were used to explore the association between study characteristics and prevalence estimates, DATA SYNTHESIS: Fifteen studies reported a median PDRA prevalence of 4.3% (interquartile range [IQR] 3.1-9.5%). The median preventability rate of drug-related admissions was 59% (IQR 50-73%). No evidence of publication bias related to study size could be determined. Because the individual study results were highly heterogeneous (Cochran's Q = 176, df = 14: p < 0.001), no metaanalytic summary estimate was computed. Stratified analysis suggested an association between prevalence estimates and 3 study characteristics: exclusion of first admissions (readmission studies: average PDRA prevalence of 14.0 %, estimated prevalence OR =: 3.7); mean age of admissions >70 (OR = 2.1); and inclusion of "indirect" drug-related morbidity, such as omission errors or therapeutic failure (OR = 1.9). There was little evidence of other associations with prevalence estimates, such as selection of specific hospital units, exclusion/inclusion of planned admissions, country, and specified methods of PDRA case ascertainment. CONCLUSIONS: Drug-related morbidity is a significant healthcare problem, and a great proportion is preventable. Study methods in prevalence reports vary and should be considered when interpreting findings or planning future research.
引用
收藏
页码:1238 / 1248
页数:11
相关论文
共 52 条
[1]   An empirical assessment of the validity of explicit and implicit process-of-care criteria for quality assessment [J].
Ashton, CM ;
Kuykendall, DH ;
Johnson, ML ;
Wray, NP .
MEDICAL CARE, 1999, 37 (08) :798-808
[2]   INCIDENCE OF ADVERSE DRUG EVENTS AND POTENTIAL ADVERSE DRUG EVENTS - IMPLICATIONS FOR PREVENTION [J].
BATES, DW ;
CULLEN, DJ ;
LAIRD, N ;
PETERSEN, LA ;
SMALL, SD ;
SERVI, D ;
LAFFEL, G ;
SWEITZER, BJ ;
SHEA, BF ;
HALLISEY, R ;
VANDERVLIET, M ;
NEMESKAL, R ;
LEAPE, LL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (01) :29-34
[3]   OPERATING CHARACTERISTICS OF A BANK CORRELATION TEST FOR PUBLICATION BIAS [J].
BEGG, CB ;
MAZUMDAR, M .
BIOMETRICS, 1994, 50 (04) :1088-1101
[4]   CHARACTERIZATION OF GERIATRIC DRUG-RELATED HOSPITAL READMISSIONS [J].
BERO, LA ;
LIPTON, HL ;
BIRD, JA .
MEDICAL CARE, 1991, 29 (10) :989-1003
[5]   ASSESSING THE PREVENTABILITY OF EMERGENCY HOSPITAL ADMISSIONS - A METHOD FOR EVALUATING THE QUALITY OF MEDICAL-CARE IN A PRIMARY CARE FACILITY [J].
BIGBY, J ;
DUNN, J ;
GOLDMAN, L ;
ADAMS, JB ;
JEN, P ;
LANDEFELD, CS ;
KOMAROFF, AL .
AMERICAN JOURNAL OF MEDICINE, 1987, 83 (06) :1031-1036
[6]  
Brennan T A, 2000, Tex Med, V96, P13
[7]   HOSPITAL CHARACTERISTICS ASSOCIATED WITH ADVERSE EVENTS AND SUBSTANDARD CARE [J].
BRENNAN, TA ;
HEBERT, LE ;
LAIRD, NM ;
LAWTHERS, A ;
THORPE, KE ;
LEAPE, LL ;
LOCALIO, AR ;
LIPSITZ, SR ;
NEWHOUSE, JP ;
WEILER, PC ;
HIATT, HH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (24) :3265-3269
[8]  
*COMM QUAL HLTH CA, 1999, ERR HUM BUILD SAF HL
[9]  
Courtman Barbara J., 1995, Canadian Journal of Hospital Pharmacy, V48, P161
[10]   THE INCIDENT REPORTING SYSTEM DOES NOT DETECT ADVERSE DRUG EVENTS - A PROBLEM FOR QUALITY IMPROVEMENT [J].
CULLEN, DJ ;
BATES, DW ;
SMALL, SD ;
COOPER, JB ;
NEMESKAL, AR ;
LEAPE, LL .
JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT, 1995, 21 (10) :541-548