Abstract
Background Studies of self-administered medications associated with hospital admissions are limited. Objective This study aimed to identify drug-related hospital admissions among elderly patients with diabetes, hypertension and chronic obstructive pulmonary disease and its association with self-administered medications. Method This was a prospective study of 335 patients admitted to a district hospital in Thailand from October 2018 to April 2019. The patients were divided into two groups: one with self-administered medication and the other with caregiver-administered medication. Pharmaceutical Care Network Europe V8.02-defined drug-related problems were identified. Those that conformed to the Hallas contribution and causality criteria were deemed drug-related hospital admissions and causes of the problems were examined. Main outcome measure An association between self-administration of medications and hospital admission was determined using a multivariable logistic regression analysis. Results The prevalence of drug-related hospital admissions was 20.6% (95% confidence interval, CI 16.4–25.3%) as an overall and was significantly higher in the self-administration group (25.4%) than in the caregiver administration group (12.7%). Among the drug-related hospital admissions in the self-administration and caregiver administration groups respectively, 71.7 and 62.5% were preventable, 63.2 and 37.7% were caused by patient themselves, and 26.3 and 37.5% were from adverse drug reactions. Medical conditions frequently caused by the patients included the exacerbation of chronic obstructive pulmonary disease due to using inhalers less than prescribed or administering drugs in the wrong manner in the self-administration group and hypoglycemia due to a long interval between insulin injection and meal consumption in the caregiver administration group. Compared to caregiver-administered medications, self-administration of medications increased the odds of hospital admission by approximately two-fold (adjusted odds ratio, OR 2.24, 95% CI 1.13–4.43). Other independent risk factors included the use of five or more medications a day (OR 2.65, 95% CI 1.16–6.07), the presence of underlying chronic obstructive pulmonary disease (OR 2.11, 95% CI 1.05–4.23) and self-medication (OR 2.59, 95% CI 1.12–5.99). Conclusion Self-administered medication was associated with hospital admissions in elderly patients with chronic diseases. To prevent problems, priority should be given to interventions to ensure the appropriate administration of inhaled medications for chronic obstructive pulmonary disease and antihyperglycemic agents.
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References
Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM, HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6.
Leendertse AJ, Van Den Bemt PM, Poolman JB, Stoker LJ, Egberts AC, Postma MJ. Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study. Value Health. 2011;14(1):34–40.
Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of hospitalization resulting from medicine-related problems in adult patients. Br J Clin Pharmacol. 2014;78(2):202–17.
Sköldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging. 2015;32(8):671–8.
Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012;60(1):34–41.
Oscanoa TJ, Lizaraso F, Carvajal A. Hospital admissions due to adverse drug reactions in the elderly: a meta-analysis. Eur J Clin Pharmacol. 2017;73(6):759–70.
Gustafsson M, Sjölander M, Pfister B, Jonsson J, Schneede J, Lövheim H. Drug-related hospital admissions among old people with dementia. Eur J Clin Pharmacol. 2016;72(9):1143–53.
Singh H, Kumar BN, Sinha T, Dulhani N. The incidence and nature of drug-related hospital admission: a 6-month observational study in a tertiary health care hospital. J Pharmacol Pharmacother. 2011;2(1):17–20.
Alghamdy MS, Randhawa MA, Al-Wahhas MH, Al-Jumaan MA. Admissions for drug-related problems at the emergency department of a university hospital in the kingdom of Saudi Arabia. J Fam Commun Med. 2015;22(1):44–8.
World Health Organization. Older population and health system: a profile of Thailand [Internet]. 2003. http://www.who.int/ageing/projects/intra/phase_one/alc_intra1_cp_thailand.pdf. Accessed 31 Aug 2020.
Strategy and Planning Division, Ministry of Public Health. Thailand Regional Health Profile 2012–2017 [Internet]. 2018. http://bps.moph.go.th/new_bps/monitoringandevaluation. Accessed 31 Aug 2020.
Lam P, Elliott RA, George J. Impact of a self-administration of medications programme on elderly inpatients’ competence to manage medications: a pilot study. J Clin Pharm Ther. 2011;36(1):80–6.
Richardson SJ, Brooks HL, Bramley G, Coleman JJ. Evaluating the effectiveness of Self-Administration of Medication (SAM) schemes in the hospital setting: a systematic review of the literature. PLoS ONE. 2014;9(12):e113912.
Dechanont S, Jedsadayanmata A, Butthum B, Kongkaew C. Hospital admissions associated with medication-related problems in Thai older patients: a multicenter prospective observational study. J Patient Saf. 2019. https://doi.org/10.1097/PTS.0000000000000627.
Ayalew MB, Tegegn HG, Abdela OA. Drug related hospital admissions: a systematic review of the recent literatures. Bull Emerg Trauma. 2019;7(4):339–46.
Foundation Pharmaceutical Care Network Europe. The PCNE classification V 8.02. 2017 [Internet]. 2017. https://www.pcne.org/upload/files/230_PCNE_classification_V8-02.pdf. Accessed 31 Aug 2020.
Hallas J, Harvald B, Gram LF, Grodum E, Brøsen K, Haghfelt T, et al. Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med. 1990;228(2):83–90.
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533–43.
Parameswaran Nair N, Chalmers L, Peterson GM, Bereznicki BJ, Castelino RL, Bereznicki LR. Hospitalization in older patients due to adverse drug reactions -the need for a prediction tool. Clin Interv Aging. 2016;11:497–505.
Kongkaew C, Hann M, Mandal J, Williams SD, Metcalfe D, Noyce PR, et al. Risk factors for hospital admissions associated with adverse drug events. Pharmacotherapy. 2013;33(8):827–37.
Olivier P, Bertrand L, Tubery M, Lauque D, Montastruc JL, Lapeyre-Mestre M. Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging. 2009;26(6):475–82.
Lea M, Mowe M, Mathiesen L, Kvernrød K, Skovlund E, Molden E. Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward. PLoS ONE. 2019;14(7):e0220071.
Jin H, Kim Y, Rhie SJ. Factors affecting medication adherence in elderly people. Patient Prefer Adherence. 2016;10:2117–25.
National Health Security Office. Fund management manual [Internet]. 2019. https://www.nhso.go.th/frontend/page-contentdetail.aspx?CatID=MTMxMA==. Accessed 31 Aug 2020.
Health Data Center. Ministry of Public Health. COPD Service Plan indicators [Internet]. 2020. https://hdcservice.moph.go.th/hdc/reports/page.php?cat_id=03b912ab9ccb4c07280a89bf05e5900e. Accessed 31 Aug 2020.
Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag. 2019;15:461–72.
Zhong H, Ni XJ, Cui M, Liu XY. Evaluation of pharmacist care for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Clin Pharm. 2014;36(6):1230–40.
Acknowledgements
We acknowledge the support from all doctors, nurses, and pharmacists at the study hospital and the individuals who participated in the study. We would like to thank Miss Kunrada Thammatacharee for providing English editing assistance.
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This study was funded by Health Systems Research Institute, Thailand.
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Ratanadadas, J., Rattanachotphanit, T. & Limwattananon, C. Self-administration of medications for chronic diseases and drug-related hospital admissions in elderly patients at a Thai hospital. Int J Clin Pharm 43, 864–871 (2021). https://doi.org/10.1007/s11096-020-01186-y
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DOI: https://doi.org/10.1007/s11096-020-01186-y