Objective:Most medications are prescribed, dispensed, and administered in ambulatory care settings, yet little information exists on the adverse effects of drugs in this setting. This review was conducted to estimate the prevalence of adverse drug events (ADEs) and the proportion of preventable ADEs in ambulatory care settings; compare data for different age groups including children, adults, and elderly patients; and review drug classes most commonly associated with ADEs.Data Sources:Four electronic databases–PubMed (1966-March 2011), International Pharmaceutical Abstracts (1970-March 2011), EMBASE (1980-March 2011), and the Cochrane Database of Systematic Reviews (1993-March 2011)—were systematically searched for published data. Bibliographies of retrieved articles were searched individually for additional relevant studies.Study Selection:A standardized definition of an ADE was used to select studies in populations living in the community, with medical visits to primary care facilities, nonspecialty amb...

Prevalence of Adverse Drug Events in Ambulatory Care: A Systematic Review

Prescripción inapropiada de medicamentos en los pacientes mayores: los criterios STOPP/START

Fundamento y objetivo Determinar la incidencia de acontecimientos adversos causados por medicamentos (AAM) en pacientes hospitalizados, diferenciando los potencialmente prevenibles, y describir los medicamentos implicados, las manifestaciones clinicas y los tipos de errores de medicacion asociados a los AAM prevenibles. Pacientes y metodo Estudio observacional de 6 meses de duracion que incluyo a los pacientes hospitalizados en los servicios de Medicina Interna, Neumologia, Gastroenterologia, Nefrologia y Neurologia de un hospital universitario. Los AAM se detectaron prospectivamente mediante comunicacion fomentada y retrospectivamente mediante revision de diagnosticos al alta utilizando codigos CIE-9. Resultados Se detectaron AAM en 191 (7,2%) pacientes de los 2.643 que estuvieron ingresados en ese periodo. De estos casos, 38 (19,9%) se clasificaron como prevenibles; en el 21,1% fueron leves, en el 60,5%, moderados y en el 18,4%, graves o potencialmente mortales. Los medicamentos asociados con mayor frecuencia a los AAM prevenibles fueron antiinfecciosos (22,9%), diureticos (18,8%) y digoxina (16,7%). Los principales tipos de errores que causaron los AAM prevenibles fueron la falta de seguimiento analitico o clinico del tratamiento (28,3%), la prescripcion de dosis elevadas (21,7%), la prescripcion de un medicamento inapropiado (15,0%) o la falta de prescripcion de un medicamento necesario (15,0%) y las interacciones medicamentosas (11,7%). Conclusiones Un 1,4% de los pacientes hospitalizados en unidades medicas presento AAM potencialmente prevenibles. Es preciso concienciar a los profesionales y a las autoridades sanitarias de la trascendencia de este problema e implantar en los hospitales practicas de seguridad efectivas para reducir los errores de medicacion, especialmente los errores de prescripcion y de seguimiento.

/pdf/acontecimientos-adversos-prevenibles-causados-por-3rj1sbhvpl.pdf

Acontecimientos adversos prevenibles causados por medicamentos en pacientes hospitalizados

Summary
Background and objective:  Due to drug-related problems (DRPs) that cause both unnecessary suffering and huge costs to society, many patients do not receive the intended beneficial effects of their treatment. Pharmacy practitioners have a key responsibility to respond to these problems, but more knowledge about the expected outcomes of their interventions is needed. The objective of the study was to assess the clinical and economic outcomes of community pharmacy interventions in patient DRPs.

Methods:  Drug-related problems in 13 different patient groups were identified and classified, according to the Westerlund System, by pharmacy practitioners from 89 Swedish pharmacies in 2006. The cases were documented in the pharmacy software and transferred to the national DRP database. An assessment model was developed and applied by the researchers (a pharmacist and a physician). This assessment was used to conduct a retrospective review by analysing the DRP and intervention documentation, in particular case descriptions from free text fields. Expected clinical patient outcomes of pharmacy interventions were judged in terms of improved therapeutic effects and prevented or relieved adverse drug reactions (ADRs). The review also assessed the expected patient outcomes with regard to initiated or avoided primary care contacts or avoided hospitalisations. The resulting hypothetically avoided direct societal costs and the estimated pharmacy personnel costs were calculated for the study and extrapolated to the Swedish nationwide level on an annual basis, to demonstrate the potential of national cost savings by pharmacy DRP-interventions.

Results and discussion:  In 358 cases (68%), the pharmacy interventions were judged to have produced an improved therapeutic effect in the patient, and in 172 cases (32%) to have prevented or relieved ADRs. Primary care contacts were initiated for 151 patients (29%), and pharmacy interventions were assessed to have saved 68 (13%) primary care contacts and 16 (3%) future hospitalisations. The potential societal cost savings extrapolated to Sweden at the national level were estimated at € 358 million. This is 37 times the expected pharmacy personnel costs for identifying and responding to the DRPs.

Conclusion:  Our study demonstrates that community pharmacy interventions in patient DRPs are most likely to lead to favourable clinical and economic outcomes. The convincing cost-benefit ratio should be presented to health care politicians and decision makers to encourage appropriate remuneration for these services.

Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems.

Potentially inappropriate drug prescription in older subjects across health care settings

https://revistafarmaciahospitalaria.sefh.es/gdcr/index.php/fh/article/download/1028/1028

P. Alonso Hernández

Papers

Prevalencia y factores asociados a los acontecimientos adversos prevenibles por medicamentos que causan el ingreso hospitalario

Ingresos hospitalarios causados por medicamentos: incidencia, características y coste

Seguimiento de la función tiroidea en pacientes tratados con amiodarona