Original Research Article

Drug Safety

, Volume 24, Issue 10, pp 781-792

Postdischarge Adverse Drug Reactions in Primary Care Originating from Hospital Care in France

A Nationwide Prospective Study
  • Laurent LetrilliartAffiliated withINSERM Unit 444, WHO Collaborating Centre for Electronic Disease Surveillance, National Institute for Health and Medical Research (INSERM), Université Paris 6
  • , Thomas HanslikAffiliated withDepartment of Internal Medicine, Ambroise-Paré Hospital, Boulogne-Billancourt, and Université Paris 5
  • , Michel BiourAffiliated withRegional Centre for Pharmacovigilance and Drug Information, Saint-Antoine Hospital
  • , Jean-Paul FagotAffiliated withINSERM Unit 444, WHO Collaborating Centre for Electronic Disease Surveillance, National Institute for Health and Medical Research (INSERM), Université Paris 6
  • , Marguerite GuiguetAffiliated withINSERM Unit 444, WHO Collaborating Centre for Electronic Disease Surveillance, National Institute for Health and Medical Research (INSERM), Université Paris 6
  • , Antoine FlahaultAffiliated withINSERM Unit 444, WHO Collaborating Centre for Electronic Disease Surveillance, National Institute for Health and Medical Research (INSERM), Université Paris 6 Email author 

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Abstract

Objective: To describe and estimate the incidence and preventability of postdischarge adverse drug reactions (ADRs) detected in primary care in France.

Design: Prospective study of patients referred to hospital by participating general practitioners (GPs). These GPs reported all cases of an adverse reaction to a drug instituted in hospital among patients who consulted them within 30 days of discharge.

Setting: 305 general practices from all French regions.

Patients: 7540 patients referred by GPs to private or public hospitals.

Main outcome measures: The incidence for postdischarge ADRs in primary care, and their preventability.

Results: 30 cases of postdischarge ADR were detected in 29 re-consulting patients, yielding a minimal incidence for France of 0.4 per 100 admissions (95% confidence interval 0.3 to 0.6). The ADRs were assessed as serious in 60% of cases. The main drug classes implicated were cardiovascular drugs (8 ADRs), oral anticoagulants (6), psychoactive drugs (4), antidiabetics (3), and opioid analgesics (3). Patients experiencing a postdischarge ADR were older than patients not experiencing one (median age: 77 vs 68 years; p = 0.004). Detected ADRs were considered preventable in 59% of cases.

Conclusions: Physicians and patients should be aware of the possible occurrence of postdischarge ADRs. Patient information in hospital, close postdischarge follow-up of patients at risk, and appropriate transmission of information between hospital physicians and GPs can help to prevent them.