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Hospital Admissions Related to Medication HARMstudy

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polypharmacy, cognitive dysfunction, non-compliance and renal function. results ... moment of admission (polypharmacy) HR. medication related characteristics ... – PowerPoint PPT presentation

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Title: Hospital Admissions Related to Medication HARMstudy


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Hospital Admissions Related to Medication(HARM-st
udy)
  • Patricia van den Bemt
  • Anne Leendertse
  • Toine Egberts

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90.000 preventable admissions a year
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literature
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literature
  • little information on Dutch situation
  • often retrospectively
  • often one hospital
  • little information on risk factors

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HARM
  • prospective
  • multicenter
  • all admissions (no selection of wards)
  • representative
  • all types of hospitals
  • from all Dutch regions

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aim
costs
risk factors
frequency and potential preventability
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methods
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related to medication
  • medication error preventable
  • dosage
  • drug-drug interaction
  • contra-indication
  • non-compliance
  • adverse drug reaction
  • not preventable

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admissions
elective surgery
acute admissions
No-HARM
HARM
preventable
not preventable
cases
controls
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methodsdata collection
  • cases and controls
  • medical record
  • community pharmacy
  • laboratory data
  • informed consent

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HARM causality and preventability
  • assessment criteria
  • first assessment by treating physician
  • structured central assessment
  • causality association drug - reason for
    admission
  • preventability medication error as cause
  • two assessors and consensus

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methodscausality assessment (Kramer)
  • ADR known
  • mentioned in drug information
  • alternative explanation
  • time relation
  • classification
  • probable
  • possible
  • unlikely

inclusion probable and possible
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methodsassessment of preventability (Schumock)
  • indication
  • co-medication
  • dosage
  • route of administration
  • monitoring
  • allergy
  • drug-drug interaction
  • contra-indication
  • non-compliance
  • dispensing error

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methodscosts
  • costs per ward day (university/general)
  • costs per ICU-day
  • costs for one ER visit

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methodsdata-analysis
  • Access, SPSS
  • conditional logistic regression analysis

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results
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resultsfrequency
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resultsextrapolation to Dutch situation
  • 5.6 of 600,000 acute admissions
  • 34,000 admissions a year (2005)
  • of which 16,000 potentially preventable

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reason for admissionpreventable HARMs
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drugs involved in HARMspreventable HARMs
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outcomepreventable HARMs
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costs potentially preventable HARMs
extrapolation per year in The Netherlands
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resultsdeterminants preventable HARMs
adjusted for polypharmacy and cognitive
dysfunction polypharmacy and living situation
polypharmacy, cognitive dysfunction,
non-compliance and renal function
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resultsdeterminants preventable HARMs
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resultsdeterminants preventable HARMs
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conclusion
  • substantial frequency of HARMs
  • almost 50 potentially preventable
  • number of risk factors that are potential focus
    for improvement

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recommendations
  • expansion medication check pharmacist
  • renal function
  • patient support
  • cognitive dysfunction
  • multidisciplinary approach
  • polypharmacy
  • non-compliance (including patient!)
  • follow-up study (grant by ZonMw)
  • intervention

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key messages
  • frequent
  • often potentially preventable
  • by
  • multidisciplinary support of high risk patients
  • medication review
  • sharing information between doctors-pharmacists
  • renal function
  • comorbidity

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key messages
  • frequent
  • often potentially preventable
  • by
  • multidisciplinary support of high risk patients
  • medication review
  • sharing information between doctors-pharmacists
  • renal function
  • comorbidity

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