JOURNAL OF THE CZECH PHARMACEUTICAL SOCIETY AND THE SLOVAK PHARMACEUTICAL SOCIETY

Čes. slov. farm. 2024, 73(2):93-102 | DOI: 10.36290/csf.2024.015

Drug-related hospitalizations - insights from the Czech Republic

Zuzana Juhásová, Martina Maříková, Jiří Vlček
Katedra sociální a klinické farmacie, Farmaceutická fakulta Univerzity Karlovy v Hradci Králové

Background and objective: Drug-related hospitalizations represent a significant burden on healthcare. The aim of the study was to determine the prevalence of drug-related hospitalizations and identify medications and clinical manifestations associated with drug-related hospitalizations in patients admitted to hospital through the emergency department.

Methods: This cross-sectional study examined unplanned hospitalizations at the University Hospital Hradec Kralove through the Department of Emergency Medicine between August and November 2018. Data were obtained from electronic health records. The methodology for identifying drug-related hospitalizations was based on the guideline of the European project OPERAM. This article focuses on a subgroup of drug-related problems related to the medication safety.

Results: Of the total 1252 hospitalizations analyzed, 145 cases were identified as drug-related. The prevalence of drug-related hospitalizations was 12% (95% confidence interval 10-13). In 62% of cases, medications only contributed to the cause of hospitalization. Antithrombotics, cytostatics, diuretics, and systemic corticosteroids were the most common medication classes leading to drug-related hospitalizations. Gastrointestinal bleeding was the most common cause of drug-related hospitalizations. The potential preventability of drug-related hospitalizations was 34%.

Conclusion: Drug-related hospitalizations remain relatively common, while some of them could be potentially prevented. Pharmacists can contribute to enhancing patient safety by detecting drug-related problems and proposing measures to minimize risks.

Keywords: hospitalization, adverse drug reactions, adverse drug events, drug-related problems.

Accepted: June 7, 2024; Published: June 14, 2024  Show citation

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Juhásová Z, Maříková M, Vlček J. Drug-related hospitalizations - insights from the Czech Republic. Čes. slov. farm. 2024;73(2):93-102. doi: 10.36290/csf.2024.015.
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    References

    1. Hazell L, Shakir SA. Under-reporting of adverse drug reactions: a systematic review. Drug Saf. 2006;29(5):385-96. Go to original source... Go to PubMed...
    2. Parameswaran Nair N, Chalmers L, Peterson GM, et al. Prospective identification versus administrative coding of adverse drug reaction-related hospitalizations in the elderly: A comparative analysis. Pharmacoepidemiol Drug Saf. 2018;27(11):1281-5. Go to original source... Go to PubMed...
    3. Reynolds M, Hickson M, Jacklin A, Franklin BD. A descriptive exploratory study of how admissions caused by medication-related harm are documented within inpatients' medical records. BMC Health Serv Res. 2014;14:257. Go to original source... Go to PubMed...
    4. Falconer N, Barras M, Martin J, Cottrell N. Defining and classifying terminology for medication harm: a call for consensus. Eur J Clin Pharmacol. 2019;75(2):137-45. Go to original source... Go to PubMed...
    5. Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795-801. Go to original source... Go to PubMed...
    6. Malý J. Lékové problémy v teorii a příkladech v podmínkách České republiky. Klin Farmakol Farm. 2020;34(3):116-21. Go to original source...
    7. Očovská Z. Lékové problémy jako potenciální příčina hospitalizací [dissertation]. Hradec Králové: Farmaceutická fakulta v Hradci Králové, Univerzita Karlova; 2024.
    8. Pharmaceutical Care Network Europe Association. The PCNE Classification V 9.1 2020 [Available from: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf.
    9. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-43. Go to original source...
    10. Thevelin S, Spinewine A, Beuscart JB, et al. Development of a standardized chart review method to identify drug-related hospital admissions in older people. Br J Clin Pharmacol. 2018;84(11):2600-14. Go to original source... Go to PubMed...
    11. WHOCC. The Anatomical Therapeutic Chemical classification system: WHO Collaborating Centre for Drug Statistics Methodology; [Available from: https://www.whocc.no/.
    12. BioPortal. MedDRA® the Medical Dictionary for Regulatory Activities terminology (MedDRA® trademark is registered by ICH): National Center for Biomedical Ontology; [Available from: https://bioportal.bioontology.org/ontologies/MEDDRA.
    13. Ayalew MB, Tegegn HG, Abdela OA. Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures. Bull Emerg Trauma. 2019;7(4):339-46. Go to original source... Go to PubMed...
    14. Očovská Z, Maříková M, Kočí J, Vlček J. Drug-Related Hospital Admissions via the Department of Emergency Medicine: A Cross-Sectional Study From the Czech Republic. Front Pharmacol. 2022;13:899151. Go to original source... Go to PubMed...
    15. Bouvy JC, De Bruin ML, Koopmanschap MA. Epidemiology of adverse drug reactions in Europe: a review of recent observational studies. Drug Saf. 2015;38(5):437-53. Go to original source... Go to PubMed...
    16. Linkens A, Milosevic V, van der Kuy PHM, et al. Medication-related hospital admissions and readmissions in older patients: an overview of literature. Int J Clin Pharm. 2020;42(5):1243-51. Go to original source... Go to PubMed...
    17. Laatikainen O, Sneck S, Turpeinen M. Medication-related adverse events in health care-what have we learned? A narrative overview of the current knowledge. Eur J Clin Pharmacol. 2022;78(2):159-170. Go to original source... Go to PubMed...
    18. Leendertse AJ, Visser D, Egberts AC, van den Bemt PM. The relationship between study characteristics and the prevalence of medication-related hospitalizations: a literature review and novel analysis. Drug Saf. 2010;33(3):233-44. Go to original source... Go to PubMed...
    19. Wallerstedt SM, Hoffmann M, Lönnbro J. Methodological issues in research on drug-related admissions - a meta-epidemiological review with focus on causality assessments. Br J Clin Pharmacol. 2022;88(2):541-550. Go to original source... Go to PubMed...
    20. Beijer HJ, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46-54. Go to original source... Go to PubMed...
    21. Langerová P, Vrtal J, Urbánek K. Adverse drug reactions causing hospital admissions in childhood: a prospective, observational, single-centre study. Basic Clin Pharmacol Toxicol. 2014;115(6):560-4. Go to original source... Go to PubMed...
    22. Patel NS, Patel TK, Patel PB, et al. Hospitalizations due to preventable adverse reactions-a systematic review. Eur J Clin Pharmacol. 2017;73(4):385-98. Go to original source... Go to PubMed...
    23. Zed PJ, Haughn C, Black KJ, et al. Medication-related emergency department visits and hospital admissions in pediatric patients: a qualitative systematic review. J Pediatr. 2013;163(2):477-83. Go to original source... Go to PubMed...
    24. Smyth RM, Gargon E, Kirkham J, et al. Adverse drug reactions in children--a systematic review. PLoS One. 2012;7(3):e24061. Go to original source... Go to PubMed...
    25. Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42(7):1017-25. Go to original source... Go to PubMed...
    26. Maříková M, Očovská Z, Nerad V, et al. Hospital admissions to geriatric ward related to adverse drug events: a cross-sectional study from the Czech Republic. Int J Clin Pharm. 2021;43(5):1218-26. Go to original source... Go to PubMed...
    27. Schmiedl S, Rottenkolber M, Szymanski J, et al. Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. Expert Opin Drug Saf. 2018;17(2):125-37. Go to original source... Go to PubMed...
    28. Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15-9. Go to original source... Go to PubMed...
    29. Wawruch M, Zikavska M, Wsolova L, et al. Adverse drug reactions related to hospital admission in Slovak elderly patients. Arch Gerontol Geriatr. 2009;48(2):186-90. Go to original source... Go to PubMed...
    30. Giardina C, Cutroneo PM, Mocciaro E, et al. Adverse Drug Reactions in Hospitalized Patients: Results of the FORWARD (Facilitation of Reporting in Hospital Ward) Study. Front Pharmacol. 2018;9:350. Go to original source... Go to PubMed...
    31. Onder G, Pedone C, Landi F, et al. Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc. 2002;50(12):1962-8. Go to original source... Go to PubMed...
    32. Benard-Laribiere A, Miremont-Salame G, Perault-Pochat MC, et al. Incidence of hospital admissions due to adverse drug reactions in France: the EMIR study. Fundam Clin Pharmacol. 2015;29(1):106-11. Go to original source... Go to PubMed...
    33. Pouyanne P, Haramburu F, Imbs JL, Begaud B. Admissions to hospital caused by adverse drug reactions: Cross sectional incidence study. Br Med J. 2000;320(7241):1036. Go to original source... Go to PubMed...
    34. Conforti A, Costantini D, Zanetti F, et al. Adverse drug reactions in older patients: an Italian observational prospective hospital study. Drug, Healthcare and Patient Safety. 2012;4:75-80. Go to original source... Go to PubMed...
    35. Osanlou R, Walker L, Hughes DA, et al. Adverse drug reactions, multimorbidity and polypharmacy: a prospective analysis of 1 month of medical admissions. BMJ Open. 2022;12(7):e055551. Go to original source... Go to PubMed...
    36. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890-6.
    37. Komagamine J, Kobayashi M. Prevalence of hospitalisation caused by adverse drug reactions at an internal medicine ward of a single centre in Japan: a cross-sectional study. BMJ Open. 2019;9(8):e030515. Go to original source... Go to PubMed...
    38. Luttikhuis HM, Blomaard LC, van der Kaaij MAE, et al. Geriatric characteristics and the risk of drug-related hospital admissions in older Emergency Department patients. Eur Geriatr Med. 2022;13(2):329-337. Go to original source... Go to PubMed...
    39. Aldardeer N, Benslimane N, Khalifa M. Medications Related Emergency Admissions: Causes and Recommendations. Stud Health Technol Inform. 2017;238:169-72. Go to original source...
    40. Doucet J, Jego A, Noel D, et al. Preventable and non-preventable risk factors for adverse drug events related to hospital admissions in the elderly: A prospective study. Clin Drug Investig. 2002;22(6):385-92. Go to original source...
    41. Dormann H, Sonst A, Muller F, et al. Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS). Deutsches Arzteblatt International. 2013;110(13):213-9. Go to original source... Go to PubMed...
    42. Cahir C, Curran C, Walsh C, et al. Adverse drug reactions in an ageing PopulaTion (ADAPT) study: Prevalence and risk factors associated with adverse drug reaction-related hospital admissions in older patients. Front Pharmacol. 2022;13:1029067. Go to original source... Go to PubMed...
    43. Ahern F, Sahm LJ, Lynch D, McCarthy S. Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: A cross-sectional study. Emerg Med J. 2014;31(1):24-9. Go to original source... Go to PubMed...
    44. Alexopoulou A, Dourakis SP, Mantzoukis D, et al. Adverse drug reactions as a cause of hospital admissions: A 6-month experience in a single center in Greece. Eur J Intern Med. 2008;19(7):505-10. Go to original source... Go to PubMed...
    45. Cabre M, Elias L, Garcia M, et al. Avoidable hospitalizations due to adverse drug reactions in an acute geriatric unit. Analysis of 3,292 patients. Med Clin (Barc). 2018;150(6):209-14. Go to original source...
    46. Kaur U, Chakrabarti SS, Gupta GK, et al. Drug-related problems in older adults in outpatient settings: Results from a 6-year long prospective study in a tertiary hospital of north India. Geriatr Gerontol Int. 2023. Go to original source... Go to PubMed...
    47. Franceschi M, Scarcelli C, Niro V, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a Geriatric Unit - A prospective study of 1756 patients. Drug Saf. 2008;31(6):545-56. Go to original source... Go to PubMed...
    48. Laatikainen O, Sneck S, Bloigu R, et al. Hospitalizations due to adverse drug events in the elderly-a retrospective register study. Front Pharmacol. 2016;7(358). Go to original source... Go to PubMed...
    49. Helldén A, Bergman U, von Euler M, et al. Adverse drug reactions and impaired renal function in elderly patients admitted to the emergency department: a retrospective study. Drugs Aging. 2009;26(7):595-606. Go to original source... Go to PubMed...
    50. Alvarez PA, Bril F, Castro V, et al. Adverse drug reactions as a reason for admission to an internal medicine ward in Argentina. International Journal of Risk and Safety in Medicine. 2013;25(3):185-92. Go to original source... Go to PubMed...
    51. von Euler M, Eliasson E, Ohlen G, Bergman U. Adverse drug reactions causing hospitalization can be monitored from computerized medical records and thereby indicate the quality of drug utilization. Pharmacoepidemiol Drug Saf. 2006;15(3):179-84. Go to original source... Go to PubMed...
    52. Hopf Y, Watson M, Williams D. Adverse-drug-reaction related admissions to a hospital in Scotland. Pharm World Sci. 2008;30(6):854-62. Go to original source... Go to PubMed...
    53. Dechanont S, Jedsadayanmata A, Butthum B, Kongkaew C. Hospital Admissions Associated With Medication-Related Problems in Thai Older Patients: A Multicenter Prospective Observational Study. J Patient Saf. 2021;17(1):15-22. Go to original source... Go to PubMed...
    54. Matanović SM, Vlahović-Palčevski V. Potentially inappropriate prescribing to the elderly: comparison of new protocol to Beers criteria with relation to hospitalizations for ADRs. Eur J Clin Pharmacol. 2014;70(4):483-90. Go to original source... Go to PubMed...
    55. Haerdtlein A, Debold E, Rottenkolber M, et al. Which Adverse Events and Which Drugs Are Implicated in Drug-Related Hospital Admissions? A Systematic Review and Meta-Analysis. J Clin Med. 2023;12(4). Go to original source... Go to PubMed...
    56. Marcum ZA, Amuan ME, Hanlon JT, et al. Prevalence of Unplanned Hospitalizations Caused by Adverse Drug Reactions in Older Veterans. J Am Geriatr Soc. 2012;60(1):34-41. Go to original source... Go to PubMed...
    57. Brandariz-Núñez D, Ferreiro-Gómez M, Suanzes J, et al. Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization. Farm Hosp. 2023;47(1):T20-t5. Go to original source...
    58. Hamilton H, Gallagher P, Ryan C, et al. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171(11):1013-9. Go to original source... Go to PubMed...
    59. Mouton JP, Njuguna C, Kramer N, et al. Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa. Medicine. 2016;95(19):e3437. Go to original source... Go to PubMed...
    60. Davies EC, Green CF, Mottram DR, et al. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol. 2010;70(5):749-55. Go to original source... Go to PubMed...
    61. Hohl CM, Karpov A, Reddekopp L, et al. ICD-10 codes used to identify adverse drug events in administrative data: a systematic review. J Am Med Inform Assoc. 2014;21(3):547-57. Go to original source... Go to PubMed...
    62. Wickham ME, McGrail KM, Law MR, et al. Validating use of diagnostic codes in Canadian administrative data for identification of adverse drug events. Br J Clin Pharmacol. 2024. Go to original source... Go to PubMed...
    63. Vlček J, Bártlová S, Brabcová I, et al. Minimalizace rizik a teorie tří pilířů u léčiv zvyšujících riziko pádů. Klin Farmakol Farm. 2019;33(4):30-4. Go to original source...
    64. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. Go to original source... Go to PubMed...
    65. De Schutter H, Hias J, Hellemans L, et al. Consensus validation of a screening tool for cardiovascular pharmacotherapy in geriatric patients: the RASP_CARDIO list (Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Eur Geriatr Med. 2022;13(6):1467-76. Go to original source... Go to PubMed...
    66. Aspirin in the primary prevention of cardiovascular disease and cancer (updated: Sep 13, 2023). In: Connor RF, editor. UpToDate: Wolters Kluwer; 2024.
    67. McQuilten ZK, Thao LTP, Pasricha SR, et al. Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly : A Secondary Analysis of the Aspirin in Reducing Events in the Elderly Trial. Ann Intern Med. 2023;176(7):913-21. Go to original source... Go to PubMed...
    68. Cloud GC, Williamson JD, Thao LTP, et al. Low-Dose Aspirin and the Risk of Stroke and Intracerebral Bleeding in Healthy Older People: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023;6(7):e2325803. Go to original source... Go to PubMed...
    69. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023;44(38):3720-826. Go to original source... Go to PubMed...
    70. Vrablík M, Cífková R, Tuka V, Linhart A. Doporučený postup Evropské kardiologické společnosti pro prevenci kardiovaskulárních onemocnění v klinické praxi 2021.Souhrn dokumentu připravený Českou kardiologickou společností. Cor Vasa. 2022;64(2):165-211. Go to original source...
    71. Wojszel ZB, Kasiukiewicz A. A retrospective cross-sectional study of type 2 diabetes overtreatment in patients admitted to the geriatric ward. BMC Geriatr. 2019;19(1):242. Go to original source... Go to PubMed...
    72. Lipska KJ, Ross JS, Miao Y, et al. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175(3):356-62. Go to original source... Go to PubMed...
    73. Lederle LI, Steinman MA, Jing B, et al. Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes. J Am Geriatr Soc. 2022;70(7):2019-28. Go to original source... Go to PubMed...
    74. Očovská Z, Maříková M, Vlček J. Potentially clinically significant drug-drug interactions in older patients admitted to the hospital: A cross-sectional study. Front Pharmacol. 2023;14:1088900. Go to original source... Go to PubMed...
    75. Wang GH, Morris EJ, Smith SM, et al. Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic. J Am Geriatr Soc. 2023;71(2):505-515. Go to original source... Go to PubMed...
    76. Watson KE, Dhaliwal K, Robertshaw S, et al. Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular Disease: A Modified Delphi Process. Am J Kidney Dis. 2023;81(5):564-74. Go to original source... Go to PubMed...
    77. Coppes T, Hazen ACM, Zwart DLM, et al. Characteristics and preventability of medication-related admissions for acute kidney injury and dehydration in elderly patients. Eur J Clin Pharmacol. 2024. doi: 10.1007/s00228-024-03704-7. Go to original source... Go to PubMed...
    78. Liamis G, Filippatos TD, Elisaf MS. Thiazide-associated hyponatremia in the elderly: what the clinician needs to know. J Geriatr Cardiol. 2016;13(2):175-82.
    79. International Pharmaceutical Federation (FIP). Medication review and medicines use review: A toolkit for pharmacists. The Hague: International Pharmaceutical Federation; 2022.

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