Abstract
Introduction: Drug-related problems (DRPs) that cause hospital admission are a major cause of morbidity and pose a substantial burden on limited healthcare resources. Risks of DRPs have been highlighted in policy documents worldwide.
Aim: The overall aim of this study was to examine the natures of DRPs that lead to hospital admissions in terms of prevalence, risk factors, and medications. The DRPs in this study included adverse drug events (ADEs), adverse drug reactions (ADRs), non-adherence to medication (NA) and medication errors (MEs).
Methods: A prospective observational study was conducted in 10 hospitals in the Lower Northern Region of Thailand over 3 months. A review of medical records of patients admitted to medical units was undertaken by pharmacists supplemented by patient interview to detect DRPs. All DRPs were clinically assessed to determine contribution to hospital admissions, causality, severity and preventability. The main outcome measures included the proportion of screened hospital admissions that were due to overall DRPs, ADEs, ADRs, NA, and MEs. All statistical analyses were performed using STATA version 9.
Results: A total of 4112 patients were screened of whom 1999 patients were elderly, and of these, 56 admissions (2.8%) were due to causal DRPs. The corresponding number of hospital admissions associated with ADEs and ADRs was 47 (2.4%) and 46 (2.3%). NA was responsible for 18 (0.9%) of admissions. Nearly half of hospital admissions associated with causal DRPs (44.0%) were judged to be preventable. When classified by type of DRPs, nearly one third of hospital admissions associated with causal ADEs [22 (31.4%)] including causal ADRs [20 (29.4%)] were preventable; 90.6% of hospital admissions associated with causal NA were preventable. Most casual drug related problems (98.9%) were of moderate severity. Risk factors of hospital admissions associated with the study population including 60% of the elderly patients were patient age, receiving new medications within 1 month, polypharmacy (≥ 5 medications). Other risk factors identified in the study population included receiving medications from private clinics, receiving medications from drugstores, education, alcohol drinking, and family. Harm to patients from hospital admissions associated with drug related problems were often hypoglycaemia, hypokalemia, gastrointestinal/intracerebral haemorrhage, hyperglycaemia, hypertensive urgency/ascites, COPD exacerbation and drowsiness. Medications targeting the endocrine, cardiovascular and central nervous systems were the drug classes most frequently involving hospital admissions associated with ADEs including ADRs. Medications involving the endocrine, cardiovascular and respiratory systems were frequently involved in hospital admissions associated with non-adherence.
Conclusion: Hospital admissions associated with drug-related problems in elderly Thais are common. Effective risk management programmes and interventions for reducing risk from DRPs are needed for ensuring safety in medication use in the elderly.
