Drug‐Associated Hospital Admissions in Older Medical Patients

Grymonpre, Ruby; Mitenko, Paul A.; Sitar, Daniel S.; Aoki, Fred Y.; Montgomery, Patrick R.

doi:10.1111/j.1532-5415.1988.tb04395.x

Cited by 268 publications

(136 citation statements)

References 19 publications

(38 reference statements)

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“…There are numerous contributing causes of the overall adverse event rates, including errors in dispensing, monitoring and adherence to medications (Avery et al 2002). They may drive up to a quarter of all hospital admissions (Grymonpre et al 1988;Hurwitz 1969;Ives et al 1987;May et al 1977), and this problem will likely be magnified by the increasing prevalence of chronic comorbidities in an increasingly aged population who also live in a culture of widespread over-the-counter medication use and acceptance of polypharmacy.…”

Section: The Challengementioning

confidence: 99%

Inappropriate Prescribing Practices: The Challenge and Opportunity for Patient Safety

Taylor

Kawasumi²,

Bartlett³

et al. 2005

hcq

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Adverse clinical events related to inappropriate prescribing practices are an important threat to patient safety. Avoidance of inappropriate prescribing in community settings, where the majority of prescriptions are written, offers a major area of opportunity to improve quality of care and outcomes. Electronic medication order entry systems, with automated clinical risk screening and online alerting capabilities, appear as particularly promising enabling tools in such settings. The Medical Office of the Twenty First Century (MOXXI-III) research group is currently utilizing such a system that integrates identification of dosing errors, adverse drug interactions, drug-disease and allergy contraindications and potential toxicity or contraindications based on patient age. This paper characterizes the spectrum of alerts in an urban community of care involving 28 physicians and 32 pharmacies. Over a consecutive nine-month period, alerts were generated in 29% of 22,419 prescriptions, resulting in revised prescriptions in 14% of the alert cases. Drug-disease contraindications were the most common driver of alerts, accounting for 41% of the total and resulting in revised prescriptions in 14% of cases. In contrast, potential dosing errors generated only 8% of all alerts, but resulted in revised prescriptions 23% of the time. Overall, online evidence-based screening and alerting around prescription of medications in a community setting demands confirmation in prescribers' clinical decision making in almost one-third of prescriptions and leads to changed decisions in up to onequarter of some prescribing categories. Its ultimate determination of clinical relevance to patient safety may, however, have to await more detailed examination of physician response to alerts and patient outcomes as a primary measure of utility.Patient safety is an increasingly recognized challenge and opportunity for stakeholders in improving health care delivery. It involves many issues, including delayed diagnosis and treatment, as well as inappropriate undertreatment and overtreatment. The common denominators, however, are that care and outcomes could be better, and there is a role for patients, providers and policy makers in making improvements.

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Section: The Challengementioning

confidence: 99%

Inappropriate Prescribing Practices: The Challenge and Opportunity for Patient Safety

Taylor

Kawasumi²,

Bartlett³

et al. 2005

hcq

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show abstract

“…They may present with harmful outcomes, resulting in about 2.8% of all hospitalizations in older patients and an estimated cost of more than U$1 billion per year, to government exchequer health care systems [1][2][3]. Previous studies [4,5] which were mainly centered around patients of emergency departments and hospital wards showed that the cardiovascular drugs were the most common culprits to cause DDIs.…”

Section: Introductionmentioning

confidence: 99%

Potential Drug - Drug Interactions among Medications Prescribed to Hypertensive Patients

Kothari

Ganguly

2014

JCDR

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“…Any medication switch at the same time also constitutes an opportunity to review medications used by a patients which may result in a reduction in the number of drugs used simultaneously that is known to be the strongest risk factor for adverse events [14,15].…”

Section: Clinical Rationale For Rdps: Therapeutic Substitutionmentioning

confidence: 99%

Reference drug programs: Effectiveness and policy implications

Schneeweiß¹

2007

Health Policy

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In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP.In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering them. This paper summarizes the mechanism and rationale of RDPs, presents evidence of their economic effectiveness and clinical safety, and concludes with some practical implications of implementing RDP policies.

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Drug‐Associated Hospital Admissions in Older Medical Patients

Cited by 268 publications

References 19 publications

Inappropriate Prescribing Practices: The Challenge and Opportunity for Patient Safety

Inappropriate Prescribing Practices: The Challenge and Opportunity for Patient Safety

Potential Drug - Drug Interactions among Medications Prescribed to Hypertensive Patients

Reference drug programs: Effectiveness and policy implications

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