Abstract
ObjectiveTo identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients.MethodologyProspective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample.ResultsThe study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%.ConclusionThis study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.
Highlights
Drug-related problems (DRP) are defined as “events or circumstances involving drug therapy that or potentially interfere with desired health outcomes” [1]
Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP
This study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice
Summary
Drug-related problems (DRP) are defined as “events or circumstances involving drug therapy that or potentially interfere with desired health outcomes” [1]. DRP that are detected are classified as potential, if they have the prospective of causing harm to the patient regardless of whether a harm was observed, and manifest if they did have caused harm to the patient [1]. As reported in previous studies, the cumulative incidence of DRP in hospitalized patients showed large variation, from 27.8% [13] to 81% [14], mainly in relation to the characteristics of the target population [14], the methodology adopted for their detection and their classification [15]. Several classification systems of DRP have emerged, among them the Pharmaceutical Care Network (PCNE), which has been the most widely used internationally in hospital clinical practice [16]
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