Query 16-03: Preventable adverse drug reactions (ADR) as percentage of total ADRs
This project was funded in June 2016 for two years. The query will be addressed in two phases: i) phase I, a retrospective chart review of patients who were diagnosed with an ADE; and ii) in phase II, linkage of phase I data to PharmaNet data in order to determine the specialty of the physician who prescribed the culprit drug. We are still waiting for data linkage for phase II. Two manuscripts have been submitted, one to the Annals of Internal Medicine and the other to BMC Medical Research Methodology.
At this point in time, we have completed phase I data collection. Data of 1234 patients were studied and 1356 ADEs were found. ADEs due to adverse drug reactions (35%) and non-adherence (19%) were most common, most moderate (65%) or severe (31%) and two-thirds required either major or minor interventions in hospital. We deemed 64% (95%CI:62-67%) of ADEs to be preventable and 29% (95%CI:26-31%) were repeat events. The most commonly implicated drug classes were coumarin derivatives (9%), and opiate agonists (9%), and common contributing factors included inadequate patient counselling (16%), lack of follow-up after a change in regimen (12%), and insufficient laboratory monitoring (11%). On multivariable patient-level analyses, mental health diagnoses, diabetes, and a prior ADE to the same drug were associated with patients having preventable ADEs. Diabetes and renal failure were significant in association with patients having repeat ADEs.
Hohl et al. Repeat exposures to culprit drugs contribute to adverse drug events in emergency department patients. 2017 (CAEP abstract).
Hohl et al. Preventable adverse drug events in Canadian emergency departments. 2017 (CAEP abstract).
Woo et al. Factors contributing to the development of adverse drug events treated in emergency departments. 2017 (CAEP abstract).
Wickham et al. Preventable and repeat adverse drug events in Canadian emergency department patients. 2017 (CAHSPR abstract).
Hohl et al. Repeat adverse drug events to outpatient medications. (Manuscript submitted May 2018 to Annals of Internal Medicine).
Woo SA, Cragg A, Wickham ME, Peddie D, Balka E, Scheuermeyer F, Villanyi D, Hohl CM. Methods for evaluating adverse drug event preventability in emergency department patients. BMC Red Res Methodol. 2018;18:160.