Hospitalization due to adverse drug reaction and discontinuation of drug treatment at the Clinicas Hospital (Teaching Hospital)
Keywords:
PHARMACEUTICAL PREPARATIONS, TREATMENT REFUSAL, HOSPITALIZATIONAbstract
Introduction: globally, drug-caused diseases are a public health issue. In Uruguay, the importance of this topic is unknown.
Objective: to describe the characteristics of hospitalization due to adverse drug reaction (ADR) and discontinuation of drug treatment at the Clinicas Hospital, and to estimate its frequency.
Methods: patients hospitalized at the Clinicas Hospital between 1 December 2006 and 15 May, 2007, due to suspect of ADR and discontinuation of drug treatment were included in the study. We conducted a simple randomized sampling twice a week, for 30 days. We analyzed age, sex, drugs implied, disease causes, duration of hospitalization and evolution.
Results: frequency of hospitalization due to ADR and discontinuation of drug treatment was 4.3% (Confidence interval was 95%, 2.8-5.3).
Average age was 57 years old. The ADR were caused by antibiotics (n=4 ), antineoplastic agents and immunemodulators (n=3),cardiovascular drugs (n=2), anticoagulants (n=1), Antithyroid drugs (ATDs) (n=1), Non-steroidal anti-inflammatory drugs NSAIDs (n=1) and antiandrogens (n=1).
Five out of 13 patients with ADR were in life risk. The main cause for discontinuation of drug treatment was: ADR (n=2), failure to understand indications or not knowing the importance of treatment, or both (n=8), economic reasons (n=3), unknown (n=5). Four out of 18 patients who had discontinued drug treatment were in like risk, and one of them died.
Conclusions: information collected in this study constitutes the first data about hospitalization due to adverse drug reaction and discontinuation of drug treatment at national level, in the public health sub sector. In order to fully assess the importance of the problem we need to expand observation and include other self-care providing centers. We stress the importance of the issue due to its seriousness and the fact that it prolongs hospital stay.
References
(2) Güemes Artiles M, Sanz Álvarez E, García Sánchez-Colomer M. Reacciones adversas y problemas relacionados con medicamentos en un servicio de urgencia. Rev Esp Salud Pública 1999; 73(3): 511-8.
(3) Pirmohamed M, Breckenridge A, Kitteringham N, Park BK. Adverse drug reactions. BMJ 1998; 316: 1295-8.
(4) WHO. Uppsala Monitoring Centre. Viewpoint: issues, controversies and science in the search for safer and more rational use of medicines. 2002. Part 1.Disponible en: http://www.who-umc.org/graphics/6996.pdf.
(5) Armijo J, González Ruiz M. Estudios de seguridad de medicamentos: método para detectar reacciones adversas y valoración de la relación causa-efecto. In: García A, Gandía L, eds. El ensayo clínico en España. Madrid: Farmaindustria, 2001: 163-91.
(6) Bates D, Boyle D, Vander M, Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med 1995; 10: 199-205.
(7) Suggested definitions and relationships among medication misadventures, medication errors, adverse drug events, and adverse drug reactions. Am J Health Syst Pharm 1998; 55(2):165-6.
(8) Alonso Hernández P, Otero López J, Maderuelo Fernández J. Ingresos hospitalarios causados por medicamentos: incidencia, características y coste. Farmacia Hosp 2002; 26(2): 77-89.
(9) Hitchen L. Adverse drug reactions result in 250000 UK admissions a year. BMJ 2006; 332: 1109.
(10) Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients a meta-analysis of prospective studies. JAMA 1998; 279: 1200-5.
(11) Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15-9.
(12) Carrara C, Gerometta P, Cuper P, Gonseski V, Rolli R, et al. Reacciones adversas a medicamentos en los servicios de emergencia hospitalarios de la ciudad de Corrientes. Reunión Anual de Comunicaciones Científicas y Tecnológicas de la SGCYT- UNNE 2004. Disponible en: http://www.unne.edu.ar/Web/cyt/com2004/3-Medicina/M-000.htm.
(13) Wiffen P, Gill M, Edwards J, Moore A. Adverse drug reactions in hospital patients. A systematic review of the prospective and retrospective studies. Bandolier Extra 2002; 1-15. Disponible en: www.jr2.ox.ac.uk/bandolier/Extraforbando/ADRPM.pdf.
(14) Decreto 57/2006. Disponible en: http://www.presidencia.gub.uy/_web/MEM_2006/MSP.pdf.
(15) Uruguay. Universidad de la República. Departamento de Registros Médicos del Hospital de Clínicas. Información estadística de producción, año 2005. Disponible en: http://www.hc.edu.uy.
(16) Gómez J, Sciuto J. Muestreo. In: Ketzoian C, Aguirrezábal X, Alonso R, Bezano D, Cáceres R, Gil J, et al. Estadística médica. Conceptos y aplicaciones al inicio de la formación médica. Montevideo: Oficina del Libro FEFMUR, 2004; 195-205.
(17) World Health Organization. Requirements for adverse reaction reporting. Geneva: WHO, 1975.
(18) Segundo Consenso de Granada sobre Problemas Relacionados con Medicamentos. Ars Pharmaceutica 2002;43 (3-4):179-187, 2002. Disponible en: http://www.colfacor.org.ar/2consens.pdf.
(19) Laporte JR, Carné X. Metodología epidemiológica básica en farmacovigilancia. In: Laporte JR, Tognoni G, eds. Principios de epidemiología del medicamento. 20 ed. Barcelona: Masson-Salvat, 1993: 111-30.
(20) Pfaffenbach G, Carvalho OM, Bergsten-Mendes G. Reacoes adversas a medicamentos como determinantes da admissao hospitalar. Rev Assoc Med Bras 2002; 48(3): 237-41.
(21) Miller G, Britt H, Valenti L. Adverse drug events in general practice patients in Australia. Med J Aust 2006 ;184(7): 321-4.
(22) Kurfees JF, Dotson RL. Drug interactions in the elderly. J Fam Pract 1987; 25: 477-88.
(23) Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation–executive summary: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol 2006; 48: 854-906.
(24) Figueiras A, Herdeiro M, Polonia J, Gestal-Otero J. An educational intervention to improve physician reporting of adverse drug reaction. A cluster-randomized controlled trial. JAMA 2006; 296: 1086-93.
(25) Vilà A. El impacto de la edad y la comorbilidad en la utilización adecuada de medicamentos. In: Reunión Paciente Pluripatológico y Edad Avanzada, 2. Huelva: 29-30 jun. 2006. Disponible en: http://www.fesemi.org/grupos/edad_avanzada/reuniones/index.php.
