Factors associated with adverse drug reactions in older inpatients in teaching hospital
Autor(a) principal: | |
---|---|
Data de Publicação: | 2017 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/44006 |
Resumo: | Objective Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients. Design A nested case–control study. Setting A medical centre located in north Taiwan. Participants 539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected. Exposure Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses. Primary and secondary outcome measures ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes. Results The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively. Conclusions The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient’s safety improvement in geriatric care. |
id |
UFMG_59d1875f2cdc279b3753a8ef08d2d931 |
---|---|
oai_identifier_str |
oai:repositorio.ufmg.br:1843/44006 |
network_acronym_str |
UFMG |
network_name_str |
Repositório Institucional da UFMG |
repository_id_str |
|
spelling |
2022-08-05T17:46:20Z2022-08-05T17:46:20Z201739467968510.1007/s11096-017-0473-z2210-7703http://hdl.handle.net/1843/44006Objective Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients. Design A nested case–control study. Setting A medical centre located in north Taiwan. Participants 539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected. Exposure Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses. Primary and secondary outcome measures ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes. Results The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively. Conclusions The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient’s safety improvement in geriatric care.Objetivo Pacientes mais velhos são propensos a ter maior complexidade da doença e mais prescrições de medicamentos que estão associadas a uma maior incidência de reações adversas a medicamentos (RAM). Este estudo teve como objetivo investigar fatores associados à ocorrência de RAM, prognóstico e gastos médicos em pacientes idosos internados. Desenho Um estudo de caso-controle aninhado. Cenário Um centro médico localizado no norte de Taiwan. Participantes 539 casos relatados de RAM de uma coorte de pacientes contendo 108 548 pacientes idosos internados foram coletados de 2006 a 2012. Havia 1.854 controles pareados sem RAM; um máximo de 1:5 pareado por idade, sexo e diagnóstico principal foram coletados. Exposição A polifarmácia, o número de medicamentos prescritos, as comorbidades e o setor de internação foram fatores associados às RAMs, assim como o prognóstico desfavorável posterior, tempo de internação e despesas médicas. Medidas de desfecho primário e secundário A ocorrência de RAM e mau prognóstico (mortalidade, alta contra orientação médica em condições críticas ou internação em unidade de terapia intensiva) foram os desfechos primários. Despesas médicas adicionais e tempo de internação foram os desfechos secundários. Resultados O setor de internação, o número de comorbidades e o número de prescrições de medicamentos antes das RAM foram associados à ocorrência de RAM entre os idosos internados. A gravidade da RAM foi um fator prognóstico significativo entre os casos de RAM. O OR ajustado multivariado de 1,63 (IC 95% 1,36 a 1,95) para mau prognóstico foi encontrado à medida que o número de comorbidades aumentou. Os pacientes prescritos ≥11 medicamentos, incluindo psicoativos, apresentaram prognóstico 2,45 vezes (95% IC 1,40 a 4,28) pior do que outros pacientes. As RAMs causaram o acréscimo de US$ 1.803,8, US$ 360,8 e 5,6 dias no total de despesas médicas, despesas com medicamentos e tempo de permanência entre os pacientes idosos afetados, respectivamente. Conclusões O número de comorbidades e a polifarmácia, incluindo o uso de psicofármacos, tem impactos significativos na ocorrência e prognóstico de RAM entre os idosos internados. Os resultados fornecem pistas para futuras modificações de prescrição e melhoria da segurança do paciente em cuidados geriátricos.engUniversidade Federal de Minas GeraisUFMGBrasilFAR - DEPARTAMENTO DE PRODUTOS FARMACÊUTICOSInternational Journal of Clinical PharmacyReações Adversas a MedicamentosPrognósticoGastosPacientes IdososFactors associated with adverse drug reactions in older inpatients in teaching hospitalFatores associados a reações adversas a medicamentos em idosos internados em hospital universitárioinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://bmjopen.bmj.com/content/9/5/e026771Tácita Piresde FigueiredoRonara Camila de Souza GroiaSoraya Coelho Costa BarrosoMariana Martins Gonzaga do NascimentoAdriano Max Moreira Reisapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/44006/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINAL2017_Factors associated with adverse drug reactions in older inpatients in teaching hospital.pdf2017_Factors associated with adverse drug reactions in older inpatients in teaching hospital.pdfapplication/pdf581690https://repositorio.ufmg.br/bitstream/1843/44006/2/2017_Factors%20associated%20with%20adverse%20drug%20reactions%20in%20older%20inpatients%20in%20teaching%20hospital.pdff92feffa7c82767f8144c7184b8a5cb9MD521843/440062022-08-05 14:46:20.548oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-08-05T17:46:20Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
dc.title.alternative.pt_BR.fl_str_mv |
Fatores associados a reações adversas a medicamentos em idosos internados em hospital universitário |
title |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
spellingShingle |
Factors associated with adverse drug reactions in older inpatients in teaching hospital Tácita Piresde Figueiredo Reações Adversas a Medicamentos Prognóstico Gastos Pacientes Idosos |
title_short |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
title_full |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
title_fullStr |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
title_full_unstemmed |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
title_sort |
Factors associated with adverse drug reactions in older inpatients in teaching hospital |
author |
Tácita Piresde Figueiredo |
author_facet |
Tácita Piresde Figueiredo Ronara Camila de Souza Groia Soraya Coelho Costa Barroso Mariana Martins Gonzaga do Nascimento Adriano Max Moreira Reis |
author_role |
author |
author2 |
Ronara Camila de Souza Groia Soraya Coelho Costa Barroso Mariana Martins Gonzaga do Nascimento Adriano Max Moreira Reis |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Tácita Piresde Figueiredo Ronara Camila de Souza Groia Soraya Coelho Costa Barroso Mariana Martins Gonzaga do Nascimento Adriano Max Moreira Reis |
dc.subject.other.pt_BR.fl_str_mv |
Reações Adversas a Medicamentos Prognóstico Gastos Pacientes Idosos |
topic |
Reações Adversas a Medicamentos Prognóstico Gastos Pacientes Idosos |
description |
Objective Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients. Design A nested case–control study. Setting A medical centre located in north Taiwan. Participants 539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected. Exposure Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses. Primary and secondary outcome measures ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes. Results The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively. Conclusions The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient’s safety improvement in geriatric care. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017 |
dc.date.accessioned.fl_str_mv |
2022-08-05T17:46:20Z |
dc.date.available.fl_str_mv |
2022-08-05T17:46:20Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/44006 |
dc.identifier.doi.pt_BR.fl_str_mv |
10.1007/s11096-017-0473-z |
dc.identifier.issn.pt_BR.fl_str_mv |
2210-7703 |
identifier_str_mv |
10.1007/s11096-017-0473-z 2210-7703 |
url |
http://hdl.handle.net/1843/44006 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
International Journal of Clinical Pharmacy |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
FAR - DEPARTAMENTO DE PRODUTOS FARMACÊUTICOS |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
instname_str |
Universidade Federal de Minas Gerais (UFMG) |
instacron_str |
UFMG |
institution |
UFMG |
reponame_str |
Repositório Institucional da UFMG |
collection |
Repositório Institucional da UFMG |
bitstream.url.fl_str_mv |
https://repositorio.ufmg.br/bitstream/1843/44006/1/License.txt https://repositorio.ufmg.br/bitstream/1843/44006/2/2017_Factors%20associated%20with%20adverse%20drug%20reactions%20in%20older%20inpatients%20in%20teaching%20hospital.pdf |
bitstream.checksum.fl_str_mv |
fa505098d172de0bc8864fc1287ffe22 f92feffa7c82767f8144c7184b8a5cb9 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 |
repository.name.fl_str_mv |
Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG) |
repository.mail.fl_str_mv |
|
_version_ |
1803589405961617408 |