Risk Factors for Adverse Drug Events Among Older Adults in the Ambulatory Setting

Field, Terry S.; Gurwitz, Jerry H.; Harrold, Leslie R.; Rothschild, Jeffrey M.; DeBellis, Kristin R.; Seger, Andrew C.; Auger, Jill C.; Garber, Leslie A.; Cadoret, Cynthia A.; Fish, Leslie S.; Garber, Lawrence; Kelleher, Michael J.; Bates, David W.

doi:10.1111/j.1532-5415.2004.52367.x

Cited by 254 publications

(205 citation statements)

References 27 publications

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“…In the current study antipsychotics had an ADR incidence of 333 per 1000 population and antihypertensive had incidence of 128/1000. This implies that the more drugs with these effects that the elderly patients are exposed to (number and dose), the poorer will be their quality of life and they will be more prone to ADRs, as evident from the results of the current study that those elderly patients who were positive of polypharmacy had 2.3 times more risk of developing ADRs [23].…”

Section: Discussionsupporting

confidence: 57%

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

Ahmed

Nanji

Patel

2015

International Journal of Epidemiology

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Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ''concurrent use of five or more different prescription medication''. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center.

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Section: Discussionsupporting

confidence: 57%

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

Ahmed

Nanji

Patel

2015

International Journal of Epidemiology

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“…Na tenta tiva de emprego da gravidade como variável de ajuste, foram extraídas do prontuário informações sobre patologias préexistentes ou diagnosticadas na internação. O Índice de Charlson 21 , método para classificação de gravidade usando dados de comorbidades, vem sendo aplicado para o ajuste de risco e foi demonstrada sua associação com a ocor rência de EAMs em pacientes ambulatoriais com idade igual ou superior a 65 anos 22 . A determinação do Índice de Charlson não é condição indispensável para a aplicação da técnica; entretanto, é uma alternativa possível para o ajuste de risco.…”

Section: Virtudes E Limitaçõesunclassified

Vigilância de eventos adversos a medicamentos em hospitais: aplicação e desempenho de rastreadores

Giordani

Rozenfeld

Oliveira

et al. 2012

Rev. bras. epidemiol.

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Os eventos adversos a medicamentos (EAMs) são causa importante de comprometimento da qualidade da atenção ao paciente hospitalizado e, por isso, devem ser identificados e caracterizados. Para tanto surgiram listas de rastreadores, entre elas a proposta pelo Institute for Healthcare Improvement. Aqui é apresentado o processo da aplicação dos rastreadores e o seu desempenho em um hospital de ensino. As informações sobre os rastreadores e os EAM foram coletadas por meio de revisão retrospectiva dos prontuários de pacientes com alta hospitalar de janeiro a junho de 2008. Foram identificados 497 rastreadores em 177 prontuários, onde cada prontuário apresentou, em média, 2,33 (DP = 2,7) rastreadores. Os encontrados com mais frequência foram: "antiemético" (72,1/100 prontuários), "interrupção abrupta da medicação" (70,0/100 prontuários) e "sedação excessiva, sonolência, torpor, letargia, queda e hipotensão" (34,6/100 prontuários). Os mais eficientes na captura de EAM (rendimento), isto é, aqueles que uma vez identificados sinalizaram possíveis eventos foram "antagonista de benzodiazepínico", "antidiarréicos" e "rash cutâneo". Os EAM mais encontrados foram relacionados aos rastreadores "interrupção abrupta da medicação" (8,3/100 prontuários), "antiemético" (4,6/100 prontuários) e "rash cutâneo" (2,1/100 prontuários). Essas considerações apontam para a utilidade do emprego da lista de rastreadores e podem contribuir para decidir sobre ajustes na sua aplicação.

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“…Adult studies have demonstrated that higher cumulative medication exposures are associated with an increased frequency of ADEs. [7][8][9] Complicating the issue, because the underlying disease processes comprising CCCs are rare and heterogeneous, clinicians may use riskier medications without reliable information to identify, guide, and subsequently monitor drug therapies. 28 Even for routine medications frequently used in the treatment of children with CCCs, such as proton pump inhibitors or antihistamines, there is little evidence to guide best practice in children with CCCs.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] Many of these characteristics are shared by the pediatric population comprising children with CCCs, who have a chronic or life spanshortening disease process, require lifelong medical care, and often rely on supportive technology (such as tracheostomy, ventilator, or gastrostomy tube) and multiple prescription medications. 11 Children with CCCs may be exposed to multiple concurrent medications in the inpatient 3 and ambulatory settings, potentially increasing their risk of developing ADEs.…”

mentioning

confidence: 99%

Adverse Drug Event-Related Emergency Department Visits Associated With Complex Chronic Conditions

2014

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WHAT'S KNOWN ON THIS SUBJECT: Children who experience outpatient adverse drug events represent 0.5% of pediatric emergency department visits. The subset of children with complex chronic conditions often take multiple medications, but the incidence and severity of adverse drug events in these children is unknown. WHAT THIS STUDY ADDS:Children with complex chronic conditions have a higher risk of emergency department visits related to adverse drug events, compared with other children. The implicated drugs with the highest rates include psychotropic agents, antimicrobial agents, anticonvulsants, hormones/steroids, and analgesics. abstract BACKGROUND AND OBJECTIVES: Outpatient adverse drug events (ADEs) can result in serious outcomes requiring emergency department (ED) visits and hospitalizations. The incidence and severity of ADEs in children with complex chronic conditions (CCCs), who often take multiple medications, is unknown. We sought to describe the characteristics of ADE-related ED visits, including association with CCC status; determine the implicated medications; and determine if CCC status increased the risk of ADE-related admission. METHODS:Retrospective cohort study of ED visits by patients aged 0 to 18 years using a national sample. ADEs were identified by external cause of injury codes; cases with overdose, wrongful administration, self-harm, or diagnosis of malignancy were excluded. Multivariable logistic regression was used to test outcomes of having an ADE-related ED visit and of subsequent admission. All statistics accounted for the complex survey design. RESULTS:Of 144 million ED visits, 0.5% were associated with ADEs. Adjusting for age, gender, insurance type, day of week, and location of hospital, ADEs were associated with the presence of a CCC (odds ratio 4.76; 95% confidence interval: 4.45-5.10). The implicated medications differed significantly by CCC status. Adjusting for the same variables, ADEs were associated with subsequent inpatient admission (odds ratio 2.18; 95% confidence interval: 2.04-2.32) for all children; an interaction between ADE and CCC status was not significant.CONCLUSIONS: ED visits associated with ADEs were more likely to occur for children with CCCs, and the implicated drugs differed, but ADE-related admissions were not differentially affected by CCC status.

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Risk Factors for Adverse Drug Events Among Older Adults in the Ambulatory Setting

Abstract: Prevention efforts to reduce ADEs should be targeted toward older adults with multiple medical conditions or taking multiple medications, nonopioid analgesics, anticoagulants, diuretics, and antiseizure medications.

Cited by 254 publications

References 27 publications

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

Vigilância de eventos adversos a medicamentos em hospitais: aplicação e desempenho de rastreadores

Adverse Drug Event-Related Emergency Department Visits Associated With Complex Chronic Conditions

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