Title: Hospital Admissions Related to Medication HARMstudy
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2Hospital Admissions Related to Medication(HARM-st
udy)
- Patricia van den Bemt
- Anne Leendertse
- Toine Egberts
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4 90.000 preventable admissions a year
5literature
6literature
- little information on Dutch situation
- often retrospectively
- often one hospital
- little information on risk factors
7HARM
- prospective
- multicenter
- all admissions (no selection of wards)
- representative
- all types of hospitals
- from all Dutch regions
8aim
costs
risk factors
frequency and potential preventability
9methods
10related to medication
- medication error preventable
- dosage
- drug-drug interaction
- contra-indication
- non-compliance
- adverse drug reaction
- not preventable
11admissions
elective surgery
acute admissions
No-HARM
HARM
preventable
not preventable
cases
controls
12methodsdata collection
- cases and controls
- medical record
- community pharmacy
- laboratory data
- informed consent
13HARM 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
14methodscausality assessment (Kramer)
- ADR known
- mentioned in drug information
- alternative explanation
- time relation
- classification
- probable
- possible
- unlikely
inclusion probable and possible
15methodsassessment of preventability (Schumock)
- indication
- co-medication
- dosage
- route of administration
- monitoring
- allergy
- drug-drug interaction
- contra-indication
- non-compliance
- dispensing error
16methodscosts
- costs per ward day (university/general)
- costs per ICU-day
- costs for one ER visit
17methodsdata-analysis
- Access, SPSS
- conditional logistic regression analysis
18results
19resultsfrequency
20resultsextrapolation to Dutch situation
- 5.6 of 600,000 acute admissions
- 34,000 admissions a year (2005)
- of which 16,000 potentially preventable
-
21reason for admissionpreventable HARMs
22drugs involved in HARMspreventable HARMs
23outcomepreventable HARMs
24costs potentially preventable HARMs
extrapolation per year in The Netherlands
25resultsdeterminants preventable HARMs
adjusted for polypharmacy and cognitive
dysfunction polypharmacy and living situation
polypharmacy, cognitive dysfunction,
non-compliance and renal function
26resultsdeterminants preventable HARMs
27resultsdeterminants preventable HARMs
28conclusion
- substantial frequency of HARMs
- almost 50 potentially preventable
- number of risk factors that are potential focus
for improvement
29recommendations
- expansion medication check pharmacist
- renal function
- patient support
- cognitive dysfunction
- multidisciplinary approach
- polypharmacy
- non-compliance (including patient!)
- follow-up study (grant by ZonMw)
- intervention
30key messages
- frequent
- often potentially preventable
- by
- multidisciplinary support of high risk patients
- medication review
- sharing information between doctors-pharmacists
- renal function
- comorbidity
31key 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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