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Pharmacy World and Science

, Volume 22, Issue 2, pp 62–66 | Cite as

Risk factors for the development of adverse drug events in hospitalized patients

  • P.M.L.A. van den Bemt
  • A.C.G. Egberts
  • A.W. Lenderink
  • J.M. Verzijl
  • K.A. Simons
  • W.S.C.J.M. van der Pol
  • H.G.M. Leufkens
Article

Abstract

Adverse drug events in hospitalized patients lead to increased morbidity, mortality and costs. Early detection of adverse drug events could aid in the prevention of these adverse outcomes. A cost‐effective system for the early detection of adverse drug events should focus on high risk patients. A study was set up with the primary aim to identify characteristics that are associated with the development of adverse drug events (ADEs) in hospitalized patients.ADE reports were gathered from physicians and nurses (spontaneous reports) and from patients after intensive ward interviews by hospital pharmacists. All patients admitted to the internal medicine wards of two Dutch hospitals, during a two month period, were included.The following characteristics were analyzed for their potential relationship to the occurence of ADEs: age (categorized), gender, number of drugs prescribed during hospital stay, types of drugs used and changes in drug use on admission.Age was found to be inversely associated with the development of ADEs (OR 0.36, CI 0.21‐0.61 for age category > 80 years; OR 0.56; CI 0.31‐1.02 for age category 75‐80 years and OR 0.69; CI 0.42‐1.11 for age category 60‐74 years). Furthermore, statistically significant associations were found for the number of drugs prescribed per hospitalized patient (for the class of 4‐6 drugs per patient OR 2.61, CI 1.32‐5.18), for newly prescribed drugs (OR 6.65, CI 2.63‐16.81) and for the cessation of drugs on hospital admission (OR 1.50, CI 1.02‐2.20). The use of gastrointestinal drugs (OR 2.13, CI 1.32‐3.45), central nervous system drugs (OR 1.66, CI 1.07‐2.57) and antibiotics (OR 2.44, CI 1.65‐3.60) were associated with the development of ADEs, when compared to all other drugs taken by the patients.In this study, the most important risk factors are the number of drugs used per patient and the starting of a new drug during hospitalization. As most hospitalized patients start new drug therapies while in hospital, this seems an inappropriate focus. However, careful monitoring of patients using more than 7 drugs at a time may be possible in a cost‐effective system for the early detection of ADEs.

Adverse drug events Hospitalized patients Risk factors Pharmacoepidemiology 

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References

  1. 1.
    Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991;324:377-84.Google Scholar
  2. 2.
    Classen DC, Pestotnik SL, Scott Evans R, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. JAMA 1997;277:301-6.Google Scholar
  3. 3.
    Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug events in hospitalized patients. A meta-analysis of prospective studies. JAMA 1998;279:1200-05.Google Scholar
  4. 4.
    Anonymous. International monitoring of adverse reactions to drugs. Adverse reaction terminology. Uppsala: WHO Collaborating Centre for International Drug Monitoring, 1995.Google Scholar
  5. 5.
    Anonymous. Anatomical Therapeutic Chemical (ATC) classification index. Oslo: WHO Collaborating Centre for Drug Statistics Methodology, 1994.Google Scholar
  6. 6.
    Mitchell AS, Henry DA, Sanson-Fisher R, O'Connell DL. Patients as a direct source of information on adverse drug events. BMJ 1988;297:891-3.Google Scholar
  7. 7.
    Hoigné R, Lawson DH, Weber E. Risk factors for adverse drug events-epidemiological approaches. Eur J Clin Pharmacol 1990;39:321-5.Google Scholar
  8. 8.
    Brawn LA, Castleden CM. Adverse drug events-an overview of special considerations in the management of the elderly patient. Drug Safety 1990;5:421-35.Google Scholar
  9. 9.
    Denham MJ. Adverse drug events. Br Med Bull 1990;46:53-62.Google Scholar
  10. 10.
    Lamy PP. Adverse drug effects. Clin Geriatr Med 1990;6:293-307.Google Scholar
  11. 11.
    Gurwitz JH, Avorn J. The ambiguous relation between aging and adverse drug events. Ann Intern Med 1991;114:956-66.Google Scholar
  12. 12.
    Lindley CM, Tully MP, Paramsothy V, Tallis RC. Inappropriate medication is a major cause of adverse drug events in elderly patients. Age and Ageing 1992;21:294-300.Google Scholar
  13. 13.
    Atkin PA, Shenfield GM. Medication-related adverse reactions and the elderly: a literature review. Adverse Drug React Toxicol Rev 1995;14:175-91.Google Scholar
  14. 14.
    Holland EG, Degruy FV. Drug-induced disorders. Am Family Physician 1997;56:178-88.Google Scholar
  15. 15.
    D'Arcy PF. Adverse drug events in hospital and in the community. Adverse Drug React Toxicol Rev 1997;16:95-101.Google Scholar
  16. 16.
    Carbonin P, Pahor M, Bernabei R, Sgadari A. Is age an independent risk factor of adverse drug events in hospitalized medical patients? J Am Geriatr Soc 1991;39:1093-99.Google Scholar
  17. 17.
    Moore N, Lecointre D, Noblet C, Mabille M. Frequency and cost of serious adverse drug events in a department of general medicine. Br J Clin Pharmacol 1998;45:301-8.Google Scholar
  18. 18.
    Mann RD, Rawlins MD, Fletcher P, Wood SM. Age and the spontaneous reporting of adverse reactions in the United Kingdom. Pharmacoepidemiology and Drug Safety 1992;1:19-23.Google Scholar
  19. 19.
    Kando JC, Yonkers KA, Cole JO. Gender as a risk factor for adverse events to medications. Drugs 1995;50:1-6.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • P.M.L.A. van den Bemt
    • 1
    • 2
  • A.C.G. Egberts
    • 1
    • 3
  • A.W. Lenderink
    • 1
  • J.M. Verzijl
    • 1
  • K.A. Simons
    • 1
  • W.S.C.J.M. van der Pol
    • 2
  • H.G.M. Leufkens
    • 3
  1. 1.Hospital Pharmacy Midden-BrabantTilburgThe Netherlands/
  2. 2.Hospital Pharmacy Diagnostisch Centrum SSDZ DelftThe Netherlands
  3. 3.Utrecht Institute for Pharmaceutical Sciences Dept. of Pharmacoepidemiology & PharmacotherapyUniversity of UtrechtNetherlands

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