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.
Larazou J, Pomeranz B, Corey P. Incidence of adverse drug reactions in hospitalized patients. JAMA 1998; 279: 1200–5CrossRefGoogle Scholar
Imbs J, Pouyanne P, Haramburu F, et al. Iatrogenie médicamenteuse: estimation de sa prévalence dans les hôpitaux publics français. Thérapie 1999; 54: 21–7PubMedGoogle Scholar
Ministère de l’Emploi et de la Solidarité. Annuaire des Statistiques Sanitaires et Sociales. 1998 ed. Paris: SESI, 1999Google Scholar
Pokras R, Kozak L, McCarthy E, et al. Trends in Hospital Utilization, 1965-86. Am J Public Health 1990; 80: 488–90PubMedCrossRefGoogle Scholar
Klein U, Klein M, Sturm H, et al. The frequency of adverse drug reactions as dependent upon age, sex, and duration of hospitalization. Int J Clin Pharmacol 1976; 13: 187–95Google Scholar
Weigelt J, Dryer D, Haley R. The necessity and efficiency of wound surveillance after discharge. Arch Surg 1992; 127: 77–82PubMedCrossRefGoogle Scholar
Iezzoni L, Mackiernan Y, Chalane M, et al. Screening inpatient quality using post-discharge events. Med Care 1999; 37: 384–98PubMedCrossRefGoogle Scholar
Valleron A, Garnerin P. Computer networking as a tool for public health surveillance: the French experiment. MMWR Morb Mortal Wkly Rep 1992; 41: 101–10PubMedGoogle Scholar
Keissler D. Introducing MEDWatch: a new approach to reporting medication and device adverse effects and product problems. JAMA 1993; 269: 2765–8CrossRefGoogle Scholar
Benichou C. Imputability of unexpected or toxic drug reactions. In: Benichou C, Bouche P, Caron J, et al., editors. Adverse drug reactions. A practical guide to diagnosis and management. New York (NY): J Wiley & Sons, 1994: 271–5Google Scholar
Imbs JL, Pletan Y, Spriet A. Evaluation de la iatrogènese médicamenteuse évitable: méthodologie. Thérapie 1998; 53: 365–70PubMedGoogle Scholar
Vidal dictionary. 76th ed. Paris: Editions du Vidal, 2000Google Scholar
Gardner M, Altman D. Statistics with confidence: confidence intervals and statistical guidelines. London: BMJ Books, 1989: 116–8Google Scholar
Spino M, Sellers E, Kaplan H, et al. Adverse biochemical and clinical consequences of furosemide administration. Can Med Assoc J 1978; 118: 1513–8PubMedGoogle Scholar
Pillans P, Coulter D, Black P. Angiooedema and urticaria with angiotensin converting inhibitors. Eur J Clin Pharmacol 1996; 51: 123–6PubMedCrossRefGoogle Scholar
Skjelbred P. The effects of acetylsalicylic acid on swelling, pain and other events after surgery. Br J Clin Pharmacol 1984; 17: 379–84PubMedCrossRefGoogle Scholar
van Kraaij DJ, Jansen R, Bouwels L, et al. Furosemide withdrawal in elderly heart failure patients with preserved left ventricular systolic function. Am J Cardiol 2000; 85: 1461–6PubMedCrossRefGoogle Scholar
Dukes M. Meyler’s side effects of drugs. 13th ed. Amsterdam: Elsevier Science Publishers, 1996Google Scholar
McAreavey D, Robertson J. Angiotensin converting enzyme inhibitors and moderate hypertension. Drugs 1990; 40: 326–45PubMedCrossRefGoogle Scholar
The European atrial fibrillation trial study group. Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med 1995; 333: 5–10Google Scholar
Fava M, Rosenbaum J, Hoog S, et al. Fluoxetine versus sertraline and paroxetine in major depression: tolerability and efficacy in anxious depression. J Affect Disord 2000; 59: 119–26PubMedCrossRefGoogle Scholar
Bocksberger J, Gex-Fabry M, Gauthey L, et al. Clomipramine therapy in the geriatric drug monitoring. Ther Drug Monit 1994; 16: 113–9PubMedCrossRefGoogle Scholar
Egbert A, Parks L, Short L, et al. Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men. Arch Intern Med 1990; 150: 1897–903PubMedCrossRefGoogle Scholar
United Kingdom Prospective Diabetes Study Group. United Kingdom prospective diabetes study (UKPDS) 13: relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ 1995; 310: 83–8Google Scholar
Ytterberg S, Mahowald M, Woods S. Codeine and oxycodone use in patients with chronic rheumatic disease pain. Arthritis Rheum 1998; 41: 1603–2PubMedCrossRefGoogle Scholar
Kjaersgaard-Andersen P, Nafei A, Skov O, et al. Codeine plus paracetamol versus paracetamol in longer-term treatment of chronic pain due to osteoarthritis of the hip: a randomised, double-blind, multi-centre study. Pain 1990; 43: 309–18PubMedCrossRefGoogle Scholar
Wilton L, Pearce G, Mann R. A comparison of ciprofloxacin, norfloxacine, ofloxacine, azithromycin and cefixime examined by observational cohort studies. Br J Clin Pharmacol 1996; 41: 277–84PubMedCrossRefGoogle Scholar
Frykman E, Bystrom M, Jansson U, et al. Side effects of iron supplements in blood donors: Superior tolerance of heme iron. J Lab Clin Med 1994; 123: 561–4PubMedGoogle Scholar
Perry M, Eaton W, Propert K, et al. Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med 1987; 316: 912–8PubMedCrossRefGoogle Scholar
Crawford J, Ozer H, Stoller R, et al. Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 1991; 325: 164–70PubMedCrossRefGoogle Scholar
Miremont G, Haramburu F, Begaud B, et al. Adverse drug reactions: physicians’ opinions versus a causality assessment method. Eur J Clin Pharmacol 1994; 46: 285–9PubMedCrossRefGoogle Scholar
Kellaway GS. Intensive monitoring for adverse drug effects in patients discharged from acute medical wards. NZ Med J 1973; 78: 525–8Google Scholar
Moride Y, Haramburu F, Requejo A, et al. Under-reporting of adverse drug reactions in general practice. Br J Clin Pharmacol 1997; 43: 177–81PubMedCrossRefGoogle Scholar
Frankl S, Breeling J, Goldman L. Preventability of emergent hospital readmission. Am J Med 1991; 90: 667–74PubMedGoogle Scholar
Hewitt J. Drug-related unplanned readmissions to hospital. Aust J Hosp Pharm 1995; 25: 400–3Google Scholar
Mouquet M, Joubert M, Tudeau L. Les pathologies prises en charge à l’hôpital. Direction de la Recherche, des Etudes et de l’Evaluation et des Statistiques, Ministère de l’Emploi et de la Solidarité. Etudes et résultats 1999; 41: 1–8Google Scholar
Moore N, Lecointre D, Noblet C, et al. Frequency and cost of serious adverse drug reactions in a department of general medicine. Br J Clin Pharmacol 1998; 45: 301–8PubMedCrossRefGoogle Scholar