Skip to main content

Advertisement

SpringerLink
Log in

Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Adverse drug events (ADEs) lead to adverse clinical outcomes such as hospitalization. There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy. This study aimed to evaluate (i) the prevalence of ADEs at the time of admission to hospital, (ii) the causality, severity, and preventability of the ADEs, and (iii) the clinical and pharmacological characteristics associated with the ADEs.

Methods

This is a prospective cross-sectional study (county of Osona, Catalonia, Spain). We included patients who required palliative care as identified by the NECPAL CCOMS-ICO tool who were hospitalized in an acute geriatric unit (AGU). A system of alerts (trigger tool) was used together with a multidisciplinary review for the detection of the ADEs.

Results

Over the course of 10 months, 235 patients were recruited. Seventy-six ADEs affecting 24.68 % of the sample were identified, and of these, 23 (30.26 % of the ADEs; 8.51 % of the sample) were directly related to hospitalization. The multivariate logistic regression analysis identified the following risk factors: presence of extreme polypharmacy (≥10 medications) (OR = 3.02; 95 % CI = 1.48–6.19), anticholinergic burden according to the Anticholinergic Drug Scale (ADS) (OR = 2.32; 95 % CI = 1.13–4.78), and treatment complexity according to the Medication Regimen Complexity Index (MRCI) scale (OR = 2.90; 95 % CI = 1.44–5.83). The vast majority (94.45 %) of the ADEs were considered to be preventable. There were no differences in the survival of the patients.

Conclusions

ADEs are common, largely preventable, and implicated in the hospitalization of patients who require palliative care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Davies EA, O’Mahony MS (2015) Adverse drug reactions in special populations—the elderly. Br J Clin Pharmacol 80:796–807

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Pedrós C, Formiga F, Corbella X, Arnau JM (2016) Adverse drug reactions leading to urgent hospital admission in an elderly population: prevalence and main features. Eur J Clin Pharmacol 72:219–226

    Article  PubMed  Google Scholar 

  3. Somers A, Robays H, Vander Stichele R, et al. (2010) Contribution of drug related problems to hospital admission in the elderly. J Nutr Health Aging 14:477–482

    Article  CAS  PubMed  Google Scholar 

  4. Marcum ZA, Pugh MJV, Amuan ME, et al. (2012) Prevalence of potentially preventable unplanned hospitalizations caused by therapeutic failures and adverse drug withdrawal events among older veterans. J Gerontol A Biol Sci Med Sci 67:867–874

    Article  PubMed  PubMed Central  Google Scholar 

  5. Conforti A, Costantini D, Zanetti F, et al. (2012) Adverse drug reactions in older patients: an Italian observational prospective hospital study. Drug Healthc Patient Saf 4:75–80

    Article  PubMed  PubMed Central  Google Scholar 

  6. Beijer HJM, de Blaey CJ (2002) Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 24:46–54

    Article  CAS  PubMed  Google Scholar 

  7. Bates DW, Spell N, Cullen DJ, et al. (1997) The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 277:307–311

    Article  CAS  PubMed  Google Scholar 

  8. Pirmohamed M, James S, Meakin S, et al. (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329:15–19

    Article  PubMed  PubMed Central  Google Scholar 

  9. Charlesworth CJ, Smit E, Lee DSH, et al. (2015) Polypharmacy among adults aged 65 years and older in the United States: 1988-2010. Journals Gerontol Ser A Biol Sci Med Sci 70:989–995

    Article  Google Scholar 

  10. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T (2015) The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010. BMC Med 13:1–10

    Article  CAS  Google Scholar 

  11. Garcia Molina O, Olmos Jimenz R, Castellote de Varona FJ, et al. (2014) Polypharmacy related to increased risk of hip fracture in elderly patients. Eur J Clin Pharm 16:117–123

    Google Scholar 

  12. Maher RL, Hanlon J, Hajjar ER, Manuscript A (2014) Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 13:57–65

    Article  PubMed  Google Scholar 

  13. Sehgal V, Bajwa SJS, Sehgal R, et al. (2013) Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital. J Fam Med Prim care 2:194–199

    Article  Google Scholar 

  14. Hedna K, Hakkarainen KM, Gyllensten H, et al. (2015) Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study. Eur J Clin Pharmacol 71:1525–1533

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Tangiisuran B, Davies JG, Wright JE, Rajkumar C (2012) Adverse drug reactions in a population of hospitalized very elderly patients. Drugs Aging 29:669–679

    PubMed  Google Scholar 

  16. Hamilton H, Gallagher P, Ryan C, et al. (2011) Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 171:1013–1019

    Article  PubMed  Google Scholar 

  17. Budnitz DS, Lovegrove MC, Shehab N, Richards CL (2011) Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 365:2002–2012

    Article  CAS  PubMed  Google Scholar 

  18. Marcum ZA, Amuan ME, Hanlon JT, et al. (2012) Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc 60:34–41

    Article  PubMed  Google Scholar 

  19. Schenker Y, Arnold R (2015) The next era of palliative care. JAMA 314:1565–1566

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Halpern SD (2015) Toward evidence-based end-of-life care. N Engl J Med 373:2001–2003

    Article  CAS  PubMed  Google Scholar 

  21. Otero-López M, Castaño-Rodríguez B, Pérez-Encinas M, et al. (2008) Actualización de la clasificación de errores de medicación del grupo Ruiz-Jarabo 2000. Farm Hosp 32:38–52

    Article  PubMed  Google Scholar 

  22. Gómez-Batiste X, Martínez-Muñoz M, Blay C, et al. (2014) Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Palliat Med 28:302–311

    Article  PubMed  Google Scholar 

  23. Gomez-Batiste X, Martinez-Munoz M, Blay C, et al. (2012) Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care 3:300–308

    Article  PubMed  Google Scholar 

  24. The Gold Standards Framework (2010) The GSF prognostic indicator guidance. End Life Care 4:62–64

    Google Scholar 

  25. Handler SM, Hanlon JT (2010) Detecting adverse drug events using a nursing home specific trigger tool. Ann Longterm Care 18:17–22

    PubMed  PubMed Central  Google Scholar 

  26. Marcum ZA, Arbogast KL, Behrens MC, et al. (2013) Utility of an adverse drug event trigger tool in veterans affairs nursing homes. Consult Pharm 28:99–109

    Article  PubMed  PubMed Central  Google Scholar 

  27. Handler SM, Hanlon JT, Perera S, et al. (2008) Consensus list of signals to detect potential adverse drug reactions in nursing homes. J Am Geriatr Soc 56:808–815

    Article  PubMed  PubMed Central  Google Scholar 

  28. Klopotowska JE, Wierenga PC, Stuijt CCM, et al. (2013) Adverse drug events in older hospitalized patients: results and reliability of a comprehensive and structured identification strategy. PLoS One 8:e71045

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Otero-López M, Dominguez-Gil A (2000) Acontecimientos Adversos por Medicamentos: una patología emergente. Farm Hosp 24:258–266

    Google Scholar 

  30. Naranjo CA, Busto U, Sellers EM, et al. (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245

    Article  CAS  PubMed  Google Scholar 

  31. Hallas J, Harvald B, Gram LF, et al. (1990) Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention. J Intern Med 228:83–90

    Article  CAS  PubMed  Google Scholar 

  32. Schumock GT, Thornton JP (1992) Focusing on the preventability of adverse drug reactions. Hosp Pharm 27:538

    CAS  PubMed  Google Scholar 

  33. Griffin FA, Resar RK (2009) IHI global trigger tool for measuring adverse events (second edition). IHI Innovation Series white paper. Cambridge, Massachusetts: Institue for Healthcare Improvement

  34. O’Mahony D, O’Sullivan DP, Byrne S, et al. (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218

    Article  PubMed  Google Scholar 

  35. Hanlon JT, Schmader KE, Samsa GP (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  CAS  PubMed  Google Scholar 

  36. Hilmer SN, Mager DE, Simonsick EM, et al. (2007) A drug burden index to define the functional burden of medications in older people. Arch Intern Med 167:781–787

    Article  PubMed  Google Scholar 

  37. Carnahan RM, Lund BC, Perry PJ, et al. (2006) The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol 46:1481–1486

    Article  CAS  PubMed  Google Scholar 

  38. George J, Phun Y-T, Bailey MJ, et al. (2004) Development and validation of the medication regimen complexity index. Ann Pharmacother 38:1369–1376

    Article  PubMed  Google Scholar 

  39. Reisberg B (2007) Global measures: utility in defining and measuring treatment response in dementia. Int Psychogeriatr 19:421–456

    Article  PubMed  Google Scholar 

  40. Wade DT, Collin C (1988) The Barthel ADL Index: a standard measure of physical disability. Int Disabil Stud 10:64–67

    Article  CAS  PubMed  Google Scholar 

  41. Laroche M-L, Charmes J-P, Nouaille Y, et al. (2007) Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 63:177–186

    Article  PubMed  Google Scholar 

  42. Howard RL, Avery AJ, Slavenburg S, et al. (2007) Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol 63:136–147

    Article  CAS  PubMed  Google Scholar 

  43. Franceschi M, Scarcelli C, Niro V, et al. (2008) Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf 31:545–556

    Article  PubMed  Google Scholar 

  44. O’Mahony D, O’Connor MN (2011) Pharmacotherapy at the end-of-life. Age Ageing 40:419–422

    Article  PubMed  Google Scholar 

  45. Molist Brunet N, Espaulella Panicot J, Sevilla-Sánchez D, et al. (2015) A patient-centered prescription model assessing the appropriateness of chronic drug therapy in older patients at the end of life. Eur Geriatr Med 6:565–569

    Article  Google Scholar 

  46. Payne RA, Abel GA, Avery AJ, et al. (2014) Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol 77:1073–1082

    Article  PubMed  PubMed Central  Google Scholar 

  47. Payne RA, Avery AJ, Duerden M, et al. (2014) Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol 70:575–581

    Article  CAS  PubMed  Google Scholar 

  48. Gnjidic D, Hilmer SN, Blyth FM, et al. (2012) Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 65:989–995

    Article  PubMed  Google Scholar 

  49. Dipoto JP, Buckley MS, Kane-Gill SL (2015) Evaluation of an automated surveillance system using trigger alerts to prevent adverse drug events in the intensive care unit and general ward. Drug Saf 38:311–317

    Article  CAS  PubMed  Google Scholar 

  50. Singh R, McLean-Plunckett EA, Kee R, et al. (2009) Experience with a trigger tool for identifying adverse drug events among older adults in ambulatory primary care. Qual Saf Health Care 18:199–204

    Article  CAS  PubMed  Google Scholar 

  51. Carnevali L, Krug B, Amant F, et al. (2013) Performance of the adverse drug event trigger tool and the global trigger tool for identifying adverse drug events: experience in a Belgian hospital. Ann Pharmacother 47:1414–1419

    Article  PubMed  Google Scholar 

  52. Ruiter R, Visser LE, Rodenburg EM, et al. (2012) Adverse drug reaction-related hospitalizations in persons aged 55 years and over. Drugs Aging 29:225–232

    Article  PubMed  Google Scholar 

  53. Moroni M, Zocchi D, Bolognesi D, et al. (2014) The “surprise” question in advanced cancer patients: a prospective study among general practitioners. Palliat Med 28:959–964

    Article  PubMed  Google Scholar 

  54. Yee JL, Hasson NK, Schreiber DH (2005) Drug-related emergency department visits in an elderly veteran population. Ann Pharmacother 39:1990–1995

    Article  PubMed  Google Scholar 

  55. Kolandaivelu K, Leiden BB, O’Gara PT, Bhatt DL (2014) Non-adherence to cardiovascular medications. Eur Heart J 35:3267–3276

    Article  CAS  PubMed  Google Scholar 

  56. Chowdhury R, Khan H, Heydon E, et al. (2013) Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J 34:2940–2948

    Article  CAS  PubMed  Google Scholar 

  57. Cullinan S, O’Mahony D, O’Sullivan D, Byrne S (2016) Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients. Age Ageing 45:115–120

    Article  PubMed  Google Scholar 

  58. Molist Brunet N, Sevilla-Sánchez D, Amblàs Novellas J, et al. (2014) Optimizing drug therapy in patients with advanced dementia: a patient-centered approach. Eur Geriatr Med 5:66–71

    Article  Google Scholar 

  59. Kogan AC, Wilber K, Mosqueda L (2016) Person-centered care for older adults with chronic conditions and functional impairment: a systematic literature review. J Am Geriatr Soc 64:e1–e7

    Article  PubMed  Google Scholar 

  60. Holmes HM, Hayley DC, Alexander GC, Sachs GA (2006) Reconsidering medication appropriateness for patients late in life. Arch Intern Med 166:605–609

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank all the nurses, patients, and caregivers who have participated and collaborated in the study.

Author information

Authors and Affiliations

  1. Hospital Universitari de Vic, Hospital de la Santa Creu de Vic, Vic, Barcelona, Spain

    Daniel Sevilla-Sanchez, Núria Molist-Brunet, Jordi Amblàs-Novellas, Pere Roura-Poch, Joan Espaulella-Panicot & Carles Codina-Jané

Authors
  1. Daniel Sevilla-Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Núria Molist-Brunet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jordi Amblàs-Novellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pere Roura-Poch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joan Espaulella-Panicot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carles Codina-Jané
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Sevilla-Sanchez.

Ethics declarations

Funding

This study was partially supported by a PhD Research Fellowship granted by “Consultori Bayes.” The funders had no role in the design, execution, analysis, interpretation, or writing of the study.

Conflict of interests

Sevilla-Sánchez D, Molist-Brunet N, Amblàs-Novellas J, Roura-Poch P, Espaulella-Panicot J, and Codina-Jane C declare that they have no conflict of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

This study was approved by the local ethics committee (ID number PR82-2014852). All procedures performed in this study met the ethical standards of the committee and the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all of the participants included in the study.

Electronic supplementary material

Online Resource 1

(PDF 64 kb)

Online Resource 2

(PDF 115 kb)

Online Resource 3

(PDF 117 kb)

Online Resource 4

(PDF 66 kb)

Online Resource 5

(PDF 77 kb)

Online Resource 6

(PDF 67 kb)

Online Resource 7

(PDF 112 kb)

Online Resource

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sevilla-Sanchez, D., Molist-Brunet, N., Amblàs-Novellas, J. et al. Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission. Eur J Clin Pharmacol 73, 79–89 (2017). https://doi.org/10.1007/s00228-016-2136-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-016-2136-8

Keywords

Search

Navigation