Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission

作者：Sevilla Sanchez Daniel; Molist Brunet Nuria; Amblas Novellas Jordi; Roura Poch Pere; Espaulella Panicot Joan; Codina Jane Carles

来源：European Journal of Clinical Pharmacology, 2017, 73(1): 79-89.

DOI：10.1007/s00228-016-2136-8

• Adverse drug events
• Palliative care
• Polypharmacy
• Hospital admission
• End-of-life
• Chronic disease

Adverse drug events (ADEs) lead to adverse clinical outcomes such as hospitalization. There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy. This study aimed to evaluate (i) the prevalence of ADEs at the time of admission to hospital, (ii) the causality, severity, and preventability of the ADEs, and (iii) the clinical and pharmacological characteristics associated with the ADEs.
This is a prospective cross-sectional study (county of Osona, Catalonia, Spain). We included patients who required palliative care as identified by the NECPAL CCOMS-ICO tool who were hospitalized in an acute geriatric unit (AGU). A system of alerts (trigger tool) was used together with a multidisciplinary review for the detection of the ADEs.
Over the course of 10 months, 235 patients were recruited. Seventy-six ADEs affecting 24.68 % of the sample were identified, and of these, 23 (30.26 % of the ADEs; 8.51 % of the sample) were directly related to hospitalization. The multivariate logistic regression analysis identified the following risk factors: presence of extreme polypharmacy (ae10 medications) (OR = 3.02; 95 % CI = 1.48-6.19), anticholinergic burden according to the Anticholinergic Drug Scale (ADS) (OR = 2.32; 95 % CI = 1.13-4.78), and treatment complexity according to the Medication Regimen Complexity Index (MRCI) scale (OR = 2.90; 95 % CI = 1.44-5.83). The vast majority (94.45 %) of the ADEs were considered to be preventable. There were no differences in the survival of the patients.
ADEs are common, largely preventable, and implicated in the hospitalization of patients who require palliative care.

• 出版日期2017-1