Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study

Zed, Peter J.; Abu‐Laban, Riyad B.; Balen, Robert M.; Loewen, Peter; Hohl, Corinne M.; Brubacher, Jeffrey R.; Wilbur, Kerry; Wiens, Matthew O.; Samoy, Leslie J.; Lacaria, Katie; Purssell, Roy

doi:10.1503/cmaj.071594

Cited by 252 publications

(264 citation statements)

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“…Prospective analyses and chart reviews of ED visits from across the country have found consistent results in the incidence of ADRs and presentation to ED. [19,20] An important weakness with the retrospective analysis of administrative databases is that we are not able to identify which specific drug was the cause for ED visits or the inpatient admissions.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

2012

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Background: The rapid rise in the availability and use of pharmaceutical agents, and particularly polypharmacy, directly increases the risk for patients to experience adverse drug reactions (ADRs). There are few studies on the overall incidence and costs of ADRs.Objective: The aim of this study was to estimate the incidence and costs of emergency department (ED) visits related to ADRs for patients greater than 65 years of age using administrative data, and to describe risk factors for experiencing severe ADRs.Methods: We employed a retrospective cohort design based on population-based healthcare administrative clinical databases. Identification of ADR-related ED visits from the administrative database was based on International Classification of Diseases, 10th Revision-Canadian Enhancement (ICD-10-CA) codes for each ED visit. The incidence and costs of ADR-related ED visits and subsequent hospital admissions were estimated for all adults aged 66 years and above for the period April 2003–March 2008. Costs were standardized and reported in 2008 Canadian dollars. Logistic regression was used to detect risk factors for severe ADRs.Results: Approximately 0.75% of total annual ED visits among adults aged 66 years and above were found to be ADR-related, and among these patients 21.6% were hospitalized. In 2007, the cost of ADR-related visits was $333 per ED visit and $7528 per hospitalization for a total annual cost of $13.6 million in Ontario, or an estimated $35.7 million in Canada. Severe ADRs were associated with sex, age, comorbid disease burden, multiple drugs, multiple pharmacies, newly prescribed drugs, recent ED visit, recent hospitalization and long-term care (LTC) residence.Conclusions: ADRs are an important public health issue that threaten the safety of drug therapy and results in significant economic burden to the healthcare system. ED visits related to ADRs may be underestimated in retrospective studies using administrative data compared with prospective studies. Further research is needed to better understand the risk of experiencing severe ADRs among LTC residents.

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Section: Discussionmentioning

confidence: 99%

“…[24] A recent Canadian study reported that 12.0% (122/1017) of the ED visits were judged as drug-related, while the most common reason for drug-related visits were ADRs (39.3%). [25]…”

Section: Discussionmentioning

confidence: 99%

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

2012

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“…It is important to stress that the term PRM is more extensive and complete than ARMs (adverse reactions to medications) or AEMs (adverse events to medications) [4]. There are numerous classifications of PRMs; one of them described by Zed et al [6] which appears referenced next (Table 1).…”

Section: Problems Related To Medicationmentioning

confidence: 99%

Safety of the Patient from the Medication

Casallas¹

2017

JPP

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Currently, more than 7% of admissions to acute care hospitals are related with AEMs (adverse events to medications). AEMs are the sixth cause of death, causing a cost of over $5.6 million dollars (USD) per hospital per year. There is an estimate that between 19% and 23% of hospitalized patients will have an adverse effect within the first 30 days after being discharged, 14.3% will be re-admitted and 70% of these events will be related to a medication prescription. Fortunately, at least 58% of these AEMs are preventable, since they result from a lack of information on the medication, prescription and dosage errors and from the abuse and underuse of the same. Polymedicated patients, especially the elderly with multiple pathologies and/or chronic patients that need to be admitted into the hospital more frequently, usually to internal medicine, neurology, psychiatry, rehabilitation and intensive care, are precisely the most liable to suffer from medication errors. It must be the objective to aim for the increase in the patient safety standards when it comes to medications.

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“…2 In a recent Canadian prospective observational study, 12.0% (95% confidence interval [CI] 10.1%-14.2%) of emergency department visits were drug-related, and 68.0% of these visits (95% CI 59.0%-76.2%) were deemed preventable. 3 Furthermore, patients visiting the emergency department because of drug-related problems were more likely to be admitted to hospital and had a longer length of stay than those visiting the emergency department for nondrug reasons. 3 In an economic analysis conducted at one of the larger emergency departments in the United States, between $4.68 and $16.70 was saved for every dollar spent on a pharmacist.…”

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confidence: 99%

“…3 Furthermore, patients visiting the emergency department because of drug-related problems were more likely to be admitted to hospital and had a longer length of stay than those visiting the emergency department for nondrug reasons. 3 In an economic analysis conducted at one of the larger emergency departments in the United States, between $4.68 and $16.70 was saved for every dollar spent on a pharmacist. 4 Therefore, because of the enormous economic burden associated with adverse drug events, it may be highly cost-effective to use the high-level expertise of a clinical pharmacist in the emergency department.…”

mentioning

confidence: 99%