Methodological issues in research on drug‐related admissions: A meta‐epidemiological review with focus on causality assessments

Abstract

Aim: To investigate methodological aspects potentially related to the diverging scientific literature on the prevalence of drug-related hospitalisations, focusing on causality assessments.Methods: Original studies contributing data to a recent meta-analysis were reviewed.Methodological aspects, in particular those related to causality assessments, were extracted and compiled.Results: Thirteen studies provided data on the prevalence of drug-related admissions.Seven studies focused on adverse drug reactions (prevalences 1.3-10%), and six studies used the broader concept of drug-related problems (prevalences 4.5-41%). In 10 out of 13 studies, causality between the drug and the specified problem was assessed. One study required a probable causal relationship; the remaining studies merely required a possible causal relationship. Five studies assessed the association between the problem assumed to be related to drug therapy and the admission, at one end requiring the former to be demonstrated as the underlying cause and, at the other, merely requiring a temporal relationship between drug intake and admission.Three out of eight studies involving multiple assessors for all/some cases reported the inter-rater agreement, ranging from none to almost perfect. Physicians were involved in the assessments in five studies, reporting prevalences of 3.2% to 4.5%, while studies without such medical input reported prevalences of 8.8% to 41%.Conclusions: This review illustrates that methodological issues contribute to the diverse literature on drug-related admissions. We provide suggestions for harmonisation of research, including explicitly assessing the drug-problem-admission relationships from a medical perspective, focusing on problems where the drug treatment is the probable culprit.

Drug-Related Hospital Admissions via the Department of Emergency Medicine: A Cross-Sectional Study From the Czech Republic

“…However, at the same time, safer alternatives are being used in clinical practice, high-risk medications are being withdrawn from the market, and preventative measures are being implemented in clinical practice. The prevalence of DRAs differs due to inconsistencies in the definitions and methods of DRA identification ( Leendertse et al, 2010 ; Linkens et al, 2020 ; Laatikainen et al, 2021 ), the selected threshold of causality assessment ( Wallerstedt et al, 2021 ), patient population ( Beijer and de Blaey, 2002 ; Leendertse et al, 2010 ; Laatikainen et al, 2021 ) and whether the denominator includes all admissions, only acute admissions, or specific wards ( Leendertse et al, 2010 ). When comparing the prevalence of DRAs, one has to take all these things into account.…”

“…Recently, it was suggested that the widespread use of a signal detection cut-off in descriptive prevalence studies may have contributed to the perception that harmful drug treatment is the major problem of health care ( Wallerstedt et al, 2021 ). Therefore, it should be underlined that medications often pose a risk in certain situations and many ADEs are multifactorial in nature.…”

Drug-related hospital admissions and emergency department visits: a feasibility study and an updated version of the AT-HARM10 assessment tool

“…It does not require a clinical expert panel, which previous studies on drug-related hospital visits have had to rely on. Wallerstedt et al have raised common methodological issues in research on DRAs and provided suggestions for future research [11]. In line with these suggestions, we need to adress that AT-HARM10 only distinguishes between visits that are unlikely to be and those that are possibly drug-related.…”

“…Two recent systematic reviews on drug-related hospital admissions (DRAs) report an average prevalence of 15% and 21% of which at least a third seems preventable [3,9]. DRAs are therefore an important outcome in research areas with a strong link to pharmacotherapy, such as clinical pharmacy [10,11]. However, great heterogeneity in methods to measure DRAs exist and validated methods are lacking [3,11].…”

“…DRAs are therefore an important outcome in research areas with a strong link to pharmacotherapy, such as clinical pharmacy [10,11]. However, great heterogeneity in methods to measure DRAs exist and validated methods are lacking [3,11]. Methods often include assessments by an expert panel of experienced clinicians, making it time-consuming and costly.…”