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Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study.

ABSTRACT: OBJECTIVE:To describe the drugs and types of medicine management problems most frequently associated with preventable drug related admissions to an acute medical admissions unit. DESIGN:Observation study. SETTING:Medical admissions unit in a teaching hospital in Nottingham, UK. PARTICIPANTS:4093 patients seen by pharmacists on the medical admissions unit between 1 January and 30 June 2001. MAIN OUTCOME MEASURES:Proportion of admissions that were drug related and preventable, classification of the underlying causes of preventable drug related admissions, and identification of drugs most commonly associated with preventable drug related admissions. RESULTS:Of the admissions seen by pharmacists, 265 (6.5%) were judged to be drug related and 178 (67%) of these were judged to be preventable. Preventable admissions were mainly due to problems with prescribing (63 cases (35%)), monitoring (46 cases (26%)), and adherence to medication (53 cases (30%)). The drugs most commonly implicated were NSAIDs, antiplatelets, antiepileptics, hypoglycaemics, diuretics, inhaled corticosteroids, cardiac glycosides, and beta-blockers. CONCLUSIONS:Potentially preventable drug related morbidity was associated with 4.3% of admissions to a medical admissions unit. In 91% of cases these admissions were related to problems with either prescribing, monitoring, or adherence.

SUBMITTER: Howard RL

PROVIDER: S-EPMC1743731 | biostudies-literature | 2003 Aug

REPOSITORIES: biostudies-literature

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Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study.

Howard R L RL Avery A J AJ Howard P D PD Partridge M M

Quality & safety in health care 20030801 4

<h4>Objective</h4>To describe the drugs and types of medicine management problems most frequently associated with preventable drug related admissions to an acute medical admissions unit.<h4>Design</h4>Observation study.<h4>Setting</h4>Medical admissions unit in a teaching hospital in Nottingham, UK.<h4>Participants</h4>4093 patients seen by pharmacists on the medical admissions unit between 1 January and 30 June 2001.<h4>Main outcome measures</h4>Proportion of admissions that were drug related a ...[more]

PMID: 12897361

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Project description:BackgroundThe proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding.MethodsThis was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes.ResultsThe study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5-13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09).ConclusionsPatients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C.

Project description:BackgroundCannabis policy liberalization has increased cannabis availability for medical or recreational purposes. Up-to-date trends in medical cannabis licensure can inform clinical policy and care.ObjectiveTo describe recent trends in medical cannabis licensure in the United States.DesignEcological study with repeated measures.SettingState registry data via state reports and data requests on medical cannabis licensure from 2016 to 2020.ParticipantsMedical cannabis patients (persons with medical cannabis licenses) in the United States.MeasurementsTotal patient volume, patients per 10 000 of total population, and patient-reported qualifying conditions (that is, symptoms or conditions qualifying patients for licensure)-including whether these symptoms align with current therapeutic evidence of cannabis-cannabinoid efficacy.ResultsIn 2020, 26 states and Washington, DC reported patient numbers, and 19 states reported patient-reported qualifying conditions. Total enrolled patients increased approximately 4.5-fold from 678 408 in 2016 to 2 974 433 in 2020. Patients per 10 000 total population generally increased from 2016 to 2020, most dramatically in Oklahoma (927.1 patients per 10 000 population). However, enrollment increased in states without recreational legalization (that is, medical-only states), whereas enrollment decreased in 5 of 7 with recreational legalization (that is, recreational states). In 2020, 68.2% of patient-reported qualifying conditions had substantial or conclusive evidence of therapeutic value versus 84.6% in 2016. Chronic pain was the most common patient-reported qualifying condition in 2020 (60.6%), followed by posttraumatic stress disorder (10.6%).LimitationMissing state data; lack of rationale for discontinuing medical cannabis licensure.ConclusionEnrollment in medical cannabis programs approximately increased 4.5-fold from 2016 to 2020, although enrollment decreased in recreational states. Use for conditions or symptoms without a strong evidence basis increased from 15.4% (2016) to 31.8% (2020). Thoughtful regulatory and clinical strategies are needed to effectively manage this rapidly changing landscape.Primary funding sourceNational Institute on Drug Abuse of the National Institutes of Health.

Project description:IntroductionDrug-related problems can affect the treatment outcomes of hospitalized patients and outpatients that lead to morbidity and mortality. Despite this, there were scanty of studies among patients with infectious diseases in Ethiopia. As the result, this study was tried to assess the magnitude and determinants of drug therapy problems among infectious disease patients admitted to the medical wards of Wollega University Referral Hospital.MethodsA prospective observational study was conducted from May to August 2019. The prevalence and types of drug- related therapy problems were studied using the Pharmaceutical Care Network Europe Foundation classification system, and adverse drug reaction was assessed by using the Naranjo algorithm. Multivariable logistic regression analysis was used to determine the predictors of drug-related problems, and a significant association was declared if p-value < 0.05.ResultOf the 172 study participants, 106 (61.6%) were males, and the patient's mean age was 39.1 ± 14.31 years. Over the study period, 123 (71.51%) patients had drug-related problems. Need for additional drug therapy was the widely occurred drug-related problem that accounts for 107 (22.77%), and the most common drug-associated with the drug therapy problem was ceftriaxone (77 (44.77%)). This inappropriate use of ceftriaxone might be due to the preference of physicians to prescribe this broad spectrum antibiotic in which it was prescribed for the majority of the infectious disease etiology. Polypharmacy (adjusted odds ratio (AOR) = 2.505, 95% confidence interval (CI): 1.863-11.131), length of hospital stay ⩾ 7 days (AOR = 4.396, 95% CI: 1.964-7.310), and presence of co-morbidity (AOR = 2.107, 95% CI: 1.185-4.158, p = 0.016) were determinants of drug-related problems.ConclusionThe magnitude of drug-related problems was found to be high. Hence, the clinical pharmacy service should be established to tackle inappropriate indications, ineffective drug therapy, and adverse drug events in the study area.

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Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study.

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Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study.

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