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European Journal of Clinical Pharmacology

, Volume 70, Issue 1, pp 79–87 | Cite as

Negative clinical outcomes of medication resulting in emergency department visits

  • María Isabel Baena
  • Paloma C. Fajardo
  • Antonio Pintor-Mármol
  • M. José Faus
  • Rosario Marín
  • Antonio Zarzuelo
  • José Martínez-Olmos
  • Fernando Martínez-Martínez
Pharmacoepidemiology and Prescription

Abstract

Purpose

The results of analyses of patients’ health problems related to medication use have been highly variable due to various factors, such as different study methodology, diverse variables determined, fields of study. The aim of our study was to determine the prevalence and preventability of negative clinical outcomes of medication (NCOMs).

Methods

This was a cross-sectional study performed in the emergency departments (EDs) of nine Spanish hospitals during a 3-month period. A two-stage probabilistic sampling method was used , and a systematic appraisal tool was used to identify the NCOMs based on information gathered through patient interview and review of the medical records. Case evaluations were conducted in two phases by pharmacists and physicians. The prevalence and preventability of NCOM were calculated. A homogeneity test was performed to assess potential differences in the prevalence for each hospital.

Results

A total of 4,611 patients were included in the study. The overall prevalence of NCOMs was 35.7 % [95 % confidence interval (CI) 33.3–38.1]. These NCOMs could be divided into three categories: ineffectiveness (18.2 %; 95 % CI 16.2–20.1), necessity (14.9 %; 95 % CI 13.4–16.6), and lack of safety (2.4 %; 95 % CI 1.9–2.8). About 81 % (95 % CI 80.1–82.3) of the NCOMs could have been prevented.

Conclusions

NCOMs provoked approximately one-third of visits to the EDs, and a high percentage of these were preventable. Implementation of strategies for patient safety and pharmaceutical care could help to prevent these problems and optimize the use of medications.

Keywords

Emergency department Treatment outcomes Medication Prevalence Preventability 

Notes

Acknowledgments

The authors would like to thank Dr. Ricardo Ocaña Riola, Andalusian School of Public Health, Granada, Spain, for his statistical support. The authors would also like to thank all contributing pharmacists and especially researchers of the participating hospitals: Concepción Alvarez del Vayo Benito (University Hospital of Virgen del Rocio, Sevilla), Jose Miguel Sotoca (University Hospital Clínic of Barcelona, Barcelona), Miguel Ángel Calleja Hernández (University Hospital of Reina Sofia, Córdoba), Isabel María Muñoz Castillo (University Hospital of Carlos Haya), Rosa María Simó Martínez (University Hospital Central of Asturias, Oviedo), María Antonia Mangues Baffalluy (Hospital Santa Creu I Sant Pau, Barcelona), Montserrat Alonso Díez (Cruces University Hospital, Barakaldo), Esther Durán-García (Gregorio Marañón University Hospital, Madrid) and Beatriz Fuentes Caparrós (Infanta Margarita Hospital, Cabra, Córdoba).

This study was supported by a Research Grant from Spain’s Health Research Fund (Fondo de Investigación Sanitaria—FIS)

References

  1. 1.
    Baena MI, Faus MJ, Fajardo PC, Luque FM, Sierra F, Martinez-Olmos J et al (2006) Medicine-related problems resulting in emergency department visits. Eur J Clin Pharmacol 62:387–393PubMedCrossRefGoogle Scholar
  2. 2.
    Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F et al (2001) Medication errors and adverse drug events in pediatric inpatients. JAMA 285:2114–2120PubMedCrossRefGoogle Scholar
  3. 3.
    Franceschi M, Scarcelli C, Niro V, Seripa D, Pazienza AM, Pepe G et al (2008) Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf 31:545–556PubMedCrossRefGoogle Scholar
  4. 4.
    Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 279:1200–1205PubMedCrossRefGoogle Scholar
  5. 5.
    De Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA (2008) The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 17:216–223PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Budnitz DS, Pollock DA, Mendelsohn AB, Weidenbach KN, McDonald AK, Annest JL (2005) Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance system. Ann Emerg Med 45:197–206PubMedCrossRefGoogle Scholar
  7. 7.
    Hohl CM, Robitaille C, Lord V, Dankoff J, Colacone A, Pham L et al (2005) Emergency physician recognition of adverse drug-related events in elder patients presenting to an emergency department. Acad Emerg Med 12:197–205PubMedCrossRefGoogle Scholar
  8. 8.
    Trifirò G, Calogero G, Ippolito FM, Cosentino M, Giuliani R, Conforti A et al (2005) Adverse drug events in emergency department population: a prospective Italian study. Pharmacoepidemiol Drug Saf 14:333–340PubMedCrossRefGoogle Scholar
  9. 9.
    Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR et al (2008) Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 178:1563–1569PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Cohen AL, Budnitz DS, Weidenbach KN, Jernigan DB, Schroeder TJ, Shehab N et al (2008) National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents. J Pediatr 152:416–421PubMedCrossRefGoogle Scholar
  11. 11.
    Leendertse AJ, Egberts ACG, Stoker LJ, Van den Bemt PMLA (2008) Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 168:1890–1896PubMedGoogle Scholar
  12. 12.
    García V, Marquina I, Olabarri A, Miranda G, Rubiera G, Baena MI (2008) Negative results associated with medication in the emergency department of a hospital. Farm Hosp 32:157–162PubMedCrossRefGoogle Scholar
  13. 13.
    Queneau P, Bannwarth B, Carpentier F, Guliana J-M, Bouget J, Trombert B et al (2007) Emergency department visits caused by adverse drug events: results of a French survey. Drug Saf 30:81–88PubMedCrossRefGoogle Scholar
  14. 14.
    Ramos Linares S, Díaz Ruiz P, Mesa Fumero J, Núñez Díaz S, Suárez González M, Callejón Callejón G et al (2010) Incidence rate of adverse drug effects in a hospital emergency unit and its associated factors. Farm Hosp 34:271–278PubMedCrossRefGoogle Scholar
  15. 15.
    Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA et al (1991) The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324:377–384PubMedCrossRefGoogle Scholar
  16. 16.
    Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD (1995) The Quality in Australian Health Care Study. Med J Aust 163:458–471PubMedGoogle Scholar
  17. 17.
    Thomas EJ, Studdert DM, Newhouse JP, Zbar BI, Howard KM, Williams EJ et al (1999) Costs of medical injuries in Utah and Colorado. Inquiry 36:255–264PubMedGoogle Scholar
  18. 18.
    Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S (2002) Adverse events in New Zealand public hospitals I: occurrence and impact. N Z Med J 115:U271PubMedGoogle Scholar
  19. 19.
    Schiøler T, Lipczak H, Pedersen BL, Mogensen TS, Bech KB, Stockmarr A et al (2001) Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskr Laeger 163:5370–5378PubMedGoogle Scholar
  20. 20.
    Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review. BMJ 322:517–519PubMedCrossRefGoogle Scholar
  21. 21.
    Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J et al (2004) The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 170:1678–1686PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Michel P, Quenon JL, Djihoud A, Tricaud-Vialle S, De Sarasqueta AM (2007) French national survey of inpatient adverse events prospectively assessed with ward staff. Qual Saf Health Care 16:369–377PubMedCrossRefGoogle Scholar
  23. 23.
    Aranaz-Andrés JM, Aibar-Remón C, Vitaller-Murillo J, Ruiz-López P, Limón-Ramírez R, Terol-García E (2008) Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events. J Epidemiol Community Health 62:1022–1029PubMedCrossRefGoogle Scholar
  24. 24.
    Patel KJ, Kedia MS, Bajpai D, Mehta SS, Kshirsagar NA, Gogtay NJ (2007) Evaluation of the prevalence and economic burden of adverse drug reactions presenting to the medical emergency department of a tertiary referral centre: a prospective study. BMC Clin Pharmacol 7:8PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Pintor-Mármol A, Baena MI, Fajardo PC, Sabater-Hernández D, Sáez-Benito L, García-Cárdenas MV et al (2012) Terms used in patient safety related to medication: a literature review. Pharmacoepidemiol Drug Saf 21:799–809PubMedCrossRefGoogle Scholar
  26. 26.
    Fernández-Llimós F, Tuneu L, Baena MI, Garcia-Delgado A, Faus MJ (2004) Morbidity and mortality associated with pharmacotherapy. Evolution and current concept of drug-related problems. Curr Pharm Des 10:3947–3967PubMedCrossRefGoogle Scholar
  27. 27.
    Fernandez-Llimos F, Faus MJ (2005) From “drug-related problems” to “negative clinical outcomes”. Am J Health Syst Pharm 62(2348):2350Google Scholar
  28. 28.
    Tipping B, Kalula S, Badri M (2006) The burden and risk factors for adverse drug events in older patients—a prospective cross-sectional study. S Afr Med J 96:1255–1259PubMedGoogle Scholar
  29. 29.
    Juntti-Patinen L, Kuitunen T, Pere P, Neuvonen PJ (2006) Drug-related visits to a district hospital emergency room. Basic Clin Pharmacol Toxicol 98:212–217PubMedCrossRefGoogle Scholar
  30. 30.
    Van Doormaal JE, Mol PGM, Van den Bemt PMLA, Zaal RJ, Egberts ACG, Kosterink JGW et al (2008) Reliability of the assessment of preventable adverse drug events in daily clinical practice. Pharmacoepidemiol Drug Saf 17:645–654PubMedCrossRefGoogle Scholar
  31. 31.
    Pharmaceutical Care Research Group, University of Granada (2006) Pharmacotherapy follow-up: the Dáder method (3rd rev.; 2005). Pharm Pract 4:44–53Google Scholar
  32. 32.
    Committee of Consensus (2007) Third Consensus of Granada on Drug Related Problems (DRP) and Negative Outcomes associated with Medication (NOM). Ars Pharm 48:5–17Google Scholar
  33. 33.
    Baena MI, Fajardo P, Luque F, Marín R, Arcos A (2001) Problemas relacionados con los medicamentos en usuarios de un servicio de urgencias hospitalario: resultados de la validación de un cuestionario. Pharm Care Esp 3:345–357Google Scholar
  34. 34.
    Baena MI, Marín R, Martínez J, Fajardo P, Vargas J, Faus M (2002) Nuevos criterios para determinar la evitabilidad de los problemas relacionados con los medicamentos. Pharm Care Esp 4:393–396Google Scholar
  35. 35.
    Madurga M, De Abajo F, Martín-Serrano G, Montero D (1998) El sistema Español de farmacovigilancia. In: Nuevas perpectivas de la farmacovigilancia en España y en la Unión Europea. Grupo ISFAS, Madrid, pp 37–62Google Scholar
  36. 36.
    Landis JR, Koch GG (1997) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  37. 37.
    Amariles P, Sabater-Hernández D, García-Jiménez E, Rodríguez-Chamorro MÁ, Prats-Más R, Marín-Magán F et al (2012) Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial. J Manag Care Pharm 18:311–323PubMedGoogle Scholar
  38. 38.
    Gastelurrutia P, Benrimoj SI, Espejo J, Tuneu L, Mangues MA, Bayes-Genis A (2011) Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: impact of a pharmacist in a multidisciplinary HF clinic. J Card Fail 17:217–223PubMedCrossRefGoogle Scholar
  39. 39.
    Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D et al (2007) Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med 146:714–725PubMedCrossRefGoogle Scholar
  40. 40.
    Lee JK, Grace KA, Taylor AJ (2006) Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 296:2563–2571PubMedCrossRefGoogle Scholar
  41. 41.
    Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL (2006) National surveillance of emergency department visits for outpatient adverse drug events. JAMA 296:1858–1866PubMedCrossRefGoogle Scholar
  42. 42.
    Raschetti R, Morgutti M, Menniti-Ippolito F, Belisari A, Rossignoli A, Longhini P et al (1999) Suspected adverse drug events requiring emergency department visits or hospital admissions. Eur J Clin Pharmacol 54:959–963PubMedCrossRefGoogle Scholar
  43. 43.
    Zhang M, Holman CDJ, Price SD, Sanfilippo FM, Preen DB, Bulsara MK (2009) Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study. BMJ 338:a2752PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Courtman BJ, Stallings SB (1995) Characterization of drug-related problems in elderly patients on admission to a medical ward. Can J Hosp Pharm 48:161–166PubMedGoogle Scholar
  45. 45.
    Krämer SD, Testa B (2009) The biochemistry of drug metabolism--an introduction: part 7. Intra-individual factors affecting drug metabolism. Chem Biodivers 6:1477–1660PubMedCrossRefGoogle Scholar
  46. 46.
    Kroon LA (2007) Drug interactions with smoking. Am J Health Syst Pharm 64:1917–1921PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • María Isabel Baena
    • 1
  • Paloma C. Fajardo
    • 1
  • Antonio Pintor-Mármol
    • 1
  • M. José Faus
    • 1
  • Rosario Marín
    • 2
  • Antonio Zarzuelo
    • 1
  • José Martínez-Olmos
    • 1
  • Fernando Martínez-Martínez
    • 1
  1. 1.Pharmaceutical Care Research GroupUniversity of GranadaGranadaSpain
  2. 2.University Hospital of Puerta del MarCadizSpain

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