Showing papers by "Terry S. Field published in 2003"
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TL;DR: Adverse drug events are common and often preventable among older persons in the ambulatory clinical setting and prevention strategies should target the prescribing and monitoring stages of pharmaceutical care.
Abstract: ContextAdverse drug events, especially those that may be preventable, are among
the most serious concerns about medication use in older persons cared for
in the ambulatory clinical setting.ObjectiveTo assess the incidence and preventability of adverse drug events among
older persons in the ambulatory clinical setting.Design, Setting, and PatientsCohort study of all Medicare enrollees (30 397 person-years of
observation) cared for by a multispecialty group practice during a 12-month
study period (July 1, 1999, through June 30, 2000), in which possible drug-related
incidents occurring in the ambulatory clinical setting were detected using
multiple methods, including reports from health care providers; review of
hospital discharge summaries; review of emergency department notes; computer-generated
signals; automated free-text review of electronic clinic notes; and review
of administrative incident reports concerning medication errors.Main Outcome MeasuresNumber of adverse drug events, severity of the events (classified as
significant, serious, life-threatening, or fatal), and whether the events
were preventable.ResultsThere were 1523 identified adverse drug events, of which 27.6% (421)
were considered preventable. The overall rate of adverse drug events was 50.1
per 1000 person-years, with a rate of 13.8 preventable adverse drug events
per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized
as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events
were deemed preventable compared with 177 (18.7%) of the 945 significant adverse
drug events. Errors associated with preventable adverse drug events occurred
most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n
= 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also
were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%),
nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%)
were the most common medication categories associated with preventable adverse
drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic
(15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were
the most common types of preventable adverse drug events.ConclusionsAdverse drug events are common and often preventable among older persons
in the ambulatory clinical setting. More serious adverse drug events are more
likely to be preventable. Prevention strategies should target the prescribing
and monitoring stages of pharmaceutical care. Interventions focused on improving
patient adherence with prescribed regimens and monitoring of prescribed medications
also may be beneficial.
1,677 citations