ABSTRACT
BACKGROUND: Drug-related problems (DRPs) are prevalent and avoidable disease that patients experience due to drug use or nonuse. However, secondary prevention policies have not yet been systematized. OBJECTIVE: To assess the clinical impact of a secondary prevention bundle for DRPs in patients who visited the emergency department (ED) for medicine-related problems. METHODS: A single-center randomized clinical trial was conducted from August 28, 2019, to January 28, 2021, with 1-month follow-up. We included 769 adult patients who visited ED with a DRP associated with cardiovascular, alimentary tract, and metabolic system medications. For the intervention group, a DRP prevention bundle, consisting of a combined strategy initiated in the ED was applied. Patients in the control group received standard pharmaceutical care. Intervention was evaluated in terms of 30-day hospital readmission due to any cause. RESULTS: Final analysis included 769 patients, of which 68 (8.8%) were readmitted within 30 days (control group, 40 of 386 [cumulative incidence: 10.4%]; intervention group, 28 of 383 [cumulative incidence, 7.3%]). After adjustment of the model for chronic heart failure, there was a lower incidence of hospital readmission among patients in the intervention group compared with those in the control group, odds ratio: 0.59 [95% confidence interval: 0.37-0.97]; number needed to treat (NNT) = 32. No significant differences in other outcomes were observed. CONCLUSION AND RELEVANCE: In this clinical trial, DRP prevention bundle in adjusted analysis decreased the rate of 30-day hospital readmission for any cause in patients who visited ED for a DRP. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT03607097).
Subject(s)
Patient Discharge , Patient Readmission , Adult , Humans , Emergency Service, HospitalABSTRACT
OBJECTIVE: Our aim was to estimate the prevalence of medicine-related problems, understood as negative clinical outcomes, that result in hospital emergency department (ED) visits and to establish relationships among risk factors and the appearance of pharmacotherapy negative outcomes. METHODS: Methods A stratified two-stage probabilistic sampling approach was used which consisted of stratified random sampling of patients visiting the ED followed up by interviews. A systematic appraisal tool was used to identify pharmacotherapy negative outcomes within the framework of the information gathered. Bivariate and multivariate analyses were carried out. Cost per process was estimated. RESULTS: The prevalence of pharmacotherapy negative outcomes producing ED visits was 33.17% (95%CI: 31.09-35.25). These negative outcomes could be divided into three categories: ineffectiveness (19.76%; 95%CI: 17.92-21.60), necessity/use (10.52%; 95%CI: 9.48-11.56), and lack of safety (2.89%). About 73% (95%IC: 70.03-76.23) of the negative outcomes were considered to be preventable. Average cost per negative outcome was 329.5 euros (95%CI: 185.4-473.5). Factors associated with the appearance of negative outcomes were age, number of medicines taken, and the combined effect of both of these factors. Compared with those participants younger than 18 years, patients between 45 and 64 years of age presented an odds ratio (OR) of 2.52 (95%CI: 1.1-5.78), while those older than 65 years had an OR of 3.63 (95%CI: 1.27-10.35). Compared with people not using medicine(s), patients using one to two different medicines presented with an OR = 19.91 (95%CI: 8.28-47.87), and those using more than three medicines had an OR = 22.71 (95%CI: 3.05-69.26). Finally, compared with patients younger than 18 years and not using medicines, patients aged 45-64 years taking three or more different medicines presented with an OR = 64.07, while those older than 65 years taking three or more medicines presented with an OR = 31.50. CONCLUSION: The prevalence of negative clinical outcomes was 33%, of which more than 73% of these were preventable. Factors associated with their appearance were age, number of medicines, and their combined effect.
