Negative clinical outcomes of medication resulting in emergency department visits
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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).
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.
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.
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.
KeywordsEmergency department Treatment outcomes Medication Prevalence Preventability
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)
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