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Background Medication-related hospital admissions (MRAs) are frequently used to measure outcomes in studies involving medication reviews. The process of identifying MRAs is subjective and time-consuming, and practical, validated alternatives are required. Objective The aim of this study was to develop and validate a practical tool to identify MRAs. Setting Uppsala University Hospital, Sweden. Method We reviewed existing literature on methods to identify MRAs. The tool AT-HARM10 was developed using an iterative process including content validity and feasibility testing. The tool’s inter-rater reliability (IRR) and criterion-related validity (CRV) were assessed: four pairs of either final-year undergraduate or postgraduate pharmacy students applied the tool to one of two batches of 50 older patients’ hospital admissions. Assessment of the same 100 admissions by two experienced clinicians acted as gold standard. Main outcome measure Cohen’s and Fleiss’ kappa for IRR, and sensitivity, specificity, and positive and negative predictive value for CRV. Results AT-HARM10 consists of ten closed questions to distinguish between admissions that are unlikely to be and those that are possibly medication-related. The IRR was moderate to substantial (Cohen’s kappa values were 0.45–0.75 and Fleiss’ kappa values were 0.46 and 0.58). The sensitivity and specificity values were 70/86% and 74/70%, positive and negative predictive values were 73/74% and 71/83% respectively. Both AT-HARM10 and the gold standard identified approximately 50% of the admissions as MRAs. Conclusion AT-HARM10 has been developed as a practical tool to identify MRAs and the tool is valid for use in older patients by final-year undergraduate and postgraduate pharmacy students.
Supplementary material 1 (DOCX 36 kb)11096_2018_768_MOESM1_ESM.docx
Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag. 2005;1(1):39–48.
Strand L, Morely P, Cipolle R, Ramsey R, Lamsam G. Drug-related problems: their structure and function. Ann Pharmacother. 1990;24(11):1093–7.
Chan M, Nicklason F, Vial JH. Adverse drug events as a cause of hospital admission in the elderly. Intern Med J. 2001;31(4):199–205.
McLachlan CYL, Yi M, Ling A, Jardine DL. Adverse drug events are a major cause of acute medical admission. Intern Med J. 2014;44(7):633–8.
Howard RL. Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study. Qual Saf Heal Care. 2003;12(4):280–5.
Ahern F, Sahm LJ, Lynch D, McCarthy S. Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: a cross-sectional study. Emerg Med J. 2014;31(1):24–9.
Winterstein AG, Sauer BC, Hepler CD, Poole C, Suárez EC, Kaiser JM. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36(7–8):1238–48.
Cunningham G, Dodd TR, Grant DJ, McMurdo ME, Richards RM. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age Ageing. 1997;26(5):375–82.
Graabaek T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol. 2013;112(6):359–73.
Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.
Hellström LM, Bondesson Å, Höglund P, Midlöv P, Holmdahl L, Rickhag E, et al. Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits. Eur J Clin Pharmacol. 2011;67(7):741–52.
Beuscart JB, Knol W, Cullinan S, Schneider C, Dalleur O, Boland B, et al. International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. BMC Med. 2018;16(1):21.
Mjörndal T, Boman MD, Hägg S, Bäckström M, Wiholm B-E, Wahlin A, et al. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf. 2002;11(1):65–72.
Gustafsson M, Sjölander M, Pfister B, Jonsson J, Schneede J, Lövheim H. Pharmacist participation in hospital ward teams and hospital readmission rates among people with dementia: a randomized controlled trial. Eur J Clin Pharmacol. 2017;73(7):827–35.
Hammond F, Malec J, Buschbader R. Handbook for clinical research: design, statistics, and implementation. New York: Demos Medical Publishing; 2014. p. 180–91.
Hoonpongsimanont W, Sahota PK, Ng NN, Farooqui MJ, Chakravarthy B, Patel BLS. Research Associates Program: expanding clinical research productivity with undergraduate students. SAGE Open Med. 2017;5:1–7.
Streiner D, Norman G. Health measurement scales: a practical guide to their development and use. Oxford: Oxford Scholarship Online; 2008. p. 1–37.
Peat J, Barton B, Elliot E. Statistics workbook for evidence-based health care. 1st ed. Hoboken: Wiley; 2009. p. 147–53.
Gallagher RM, Kirkham JJ, Mason JR, Bird KA, Williamson PR, Nunn AJ, et al. Development and inter-rater reliability of the Liverpool adverse drug reaction causality assessment tool. PLoS ONE. 2011;6(12):e28096.
Kramer MS, Leventhal JM, Hutchinson TA, Feinstein AR. An algorithm for the operational assessment of adverse drug reactions: I. Background, description, and instructions for use. JAMA. 1979;242(7):623–32.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.
Hallas J, Gram L, Grodum E, Damsbo N, Brosen K, Haghfelt T, et al. Drug related admissions to medical wards: a population based survey. Br J Clin Pharmacol. 1992;33(1):61–8.
The Uppsala Monitoring Centre. The use of the WHO-UMC system for standardised case causality assessment. 2016 [cited 2017 Dec 20]. http://www.who.int/medicines%0A/areas/quality_safety/safety_efficacy/WHOcausality%0A_assessment.pdf.
Alexopoulou A, Dourakis SP, Mantzoukis D, Pitsariotis T, Kandyli A, Deutsch M, et al. Adverse drug reactions as a cause of hospital admissions: a 6-month experience in a single center in Greece. Eur J Intern Med. 2008;19(7):505–10.
Singh H, Kumar BN, Sinha T, Dulhani N. The incidence and nature of drug-related hospital admission: a 6-month observational study in a tertiary health care hospital. J Pharmacol Pharmacother. 2011;2(1):17–20.
Thevelin S, Spinewine A, Beuscart J, Boland B, Marien S, Vaillant F, et al. Development of a standardized chart review method to identify drug-related hospital admissions in older people. Br J Clin Pharmacol. 2018;84(11):2600–14.
Kempen TGH, Bertilsson M, Lindner K-J, Sulku J, Nielsen EI, Högberg A, et al. Medication Reviews Bridging Healthcare (MedBridge): study protocol for a pragmatic cluster-randomised crossover trial. Contemp Clin Trials. 2017;61:126–32.
Schneeweiss S, Hasford J, Göttler M, Hoffmann A, Riethling AK, Avorn J. Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol. 2002;58(4):285–91.
Marcum ZA, Pugh MJV, Amuan ME, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans. J Gerontol Ser A Biol Sci Med Sci. 2012;67 A(8):867–74.
Rogers S, Wilson D, Wan S, Griffin M, Rai G, Farrell J. Medication-related admissions in older people. Drugs Aging. 2012;26(11):951–61.
Meier F, Maas R, Sonst A, Patapovas A, Muller F, Plank-Kiegele B, et al. Adverse drug events in patients admitted to an emergency department: an analysis of direct costs. Pharmacoepidemiol Drug Saf. 2014;24(2):176–86.
Bonnet-Zamponi D, D’Arailh L, Konrat C, Delpierre S, Lieberherr D, Lemaire A, et al. Drug-related readmissions to medical units of older adults discharged from acute geriatric units: results of the optimization of medication in AGEd multicenter randomized controlled trial. J Am Geriatr Soc. 2013;61(1):113–21.
Davies EC, Green CF, Mottram DR, Rowe PH, Pirmohamed M. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol. 2010;70(5):749–55.
Juntti-Patinen L, Kuitunen T, Pere P, Neuvonen PJ. Drug-related visits to a district hospital emergency room. Basic Clin Pharmacol Toxicol. 2006;98(2):212–7.
Dormann H, Sonst A, Müller F, Vogler R, Patapovas A, Pfistermeister B, et al. Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int. 2013;110(13):213–9.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9.
Kongkaew C, Hann M, Mandal J, Williams SD, Metcalfe D, Noyce PR, et al. Risk factors for hospital admissions associated with adverse drug events. Pharmacotherapy. 2013;33(8):827–37.
Leendertse AJ, Egberts ACG, Stoker LJ, van den Bemt PMLA, HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6.
Somers A, Robays H, Vander Stichele R, Van Maele G, Bogaert M, Petrovic M. Contribution of drug related problems to hospital admission in the elderly. J Nutr Heal Aging. 2010;14(6):477–82.
Dormann H, Neubert A, Criegee-Rieck M, Egger T, Radespiel-Tröger M, Azaz-Livshits T, et al. Readmissions and adverse drug reactions in internal medicine: the economic impact. J Intern Med. 2004;255(6):653–63.
Leendertse AJ, De Koning FHP, Goudswaard AN, Jonkhoff AR, Van Den Bogert SCA, De Gier HJ, et al. Preventing hospital admissions by reviewing medication (PHARM) in primary care: design of the cluster randomised, controlled, multi-centre PHARM-study. BMC Health Serv Res. 2011;11:4.
Wilbur K, Hazi H, El-Bedawi A. Drug-related hospital visits and admissions associated with laboratory or physiologic abnormalities—a systematic-review. PLoS ONE. 2013;8(6):e66803.
Bürkle T, Müller F, Patapovas A, Sonst A, Pfistermeister B, Plank-Kiegele B, et al. A new approach to identify, classify and count drug-related events. Br J Clin Pharmacol. 2013;76(S1):56–68.
Warlé-van Herwaarden MF, Kramers C, Sturkenboom MC, van den Bemt PMLA, De Smet PAGM. Targeting outpatient drug safety: recommendations of the Dutch HARM-Wrestling Task Force. Drug Saf. 2012;35(3):245–59.
Nivya K, Sri Sai Kiran V, Ragoo N, Jayaprakash B, Sonal Sekhar M. Systemic review on drug related hospital admissions—a pubmed based search. Saudi Pharm J. 2015;23(1):1–8.
Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, et al. Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol. 2007;63(2):136–47.
Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012;60(1):34–41.
Bowyer P, Lee J, Kramer J, Taylor R, Kielhofner G. Determining the clinical utility of the Short Child Occupational Profile (SCOPE). Br J Occup Ther. 2012;1:19–26.
Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76(5):378–82.
- Assessment tool for hospital admissions related to medications: development and validation in older patients
Thomas G. H. Kempen
- Springer International Publishing
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