Adverse Drug Event-Related Emergency Department Visits Associated With Complex Chronic Conditions

Abstract Background Antibiotics are among the most commonly prescribed medications for children; however, at least one-third of pediatric antibiotic prescriptions are unnecessary. National data on short-term antibiotic-related harms could inform efforts to reduce overprescribing and to supplement interventions that focus on the long-term benefits of reducing antibiotic resistance. Methods Frequencies and rates of emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children were estimated using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS (2011–2015). Results On the basis of 6542 surveillance cases, an estimated 69464 ED visits (95% confidence interval, 53488–85441) were made annually for antibiotic ADEs among children aged ≤19 years from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication. Two-fifths (40.7%) of ED visits for antibiotic ADEs involved a child aged ≤2 years, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic among children aged ≤9 years. When we accounted for dispensed prescriptions, the rates of ED visits for antibiotic ADEs declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim. Amoxicillin had the highest rate of ED visits for antibiotic ADEs among children aged ≤2 years, whereas sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10000 dispensed prescriptions, respectively). Conclusions Antibiotic ADEs lead to many ED visits, particularly among young children. Communicating the risks of antibiotic ADEs could help reduce unnecessary prescribing. Prevention efforts could target pediatric patients who are at the greatest risk of harm.

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Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review

Journal of Multimorbidity and Comorbidity ◽

10.1177/26335565211012876 ◽

2021 ◽

Vol 11 ◽

pp. 263355652110128

Author(s):

Carole E Aubert ◽

Eve A Kerr ◽

Mandi L Klamerus ◽

Timothy P Hofer ◽

Melissa Y Wei

Keyword(s):

Older Adults ◽

Adverse Drug Event ◽

Chronic Conditions ◽

Patient Perspective ◽

Inappropriate Prescribing ◽

Adverse Outcomes ◽

Drug Event ◽

Multiple Chronic Conditions ◽

Level Of Evidence ◽

Prescribing Quality

Background: Inappropriate prescribing is frequent in older adults and associated with adverse outcomes. Prescribing indications aim to optimize prescribing, but little is known about the focus and features of prescribing indications for the most common chronic conditions in older adults. Understanding the conditions, medications, and issues addressed (e.g., patient perspective, drug-disease interaction, adverse drug event) in current prescribing indications may help to identify missing indications and develop standardized measures to improve prescribing quality. Methods: We searched Ovid/MEDLINE and EMBASE for articles published between 2015 and 2020 reporting prescribing indications for older adults. Prescribing indication included 1) prescribing “criteria,” or statements that guide prescribing action, and 2) prescribing “measures,” or prescribing actions observed in a population. We categorized their focus by conditions, medications and issues addressed, as well as level of evidence provided. Results: Among 16 sets of prescribing indications, we identified 748 criteria and 47 measures. The most common addressed medications were antihypertensives, analgesics/antirheumatics, and antiplatelets/anticoagulants. The most frequently addressed issues were drug-disease interaction, adverse drug event, administration, better therapeutic alternative, and (co-)prescription omission (20.8–36.1%). Age/functioning, drug-drug interaction, monitoring, and efficacy/safety ratio were found in only 9.9–16.5% of indications. Indications rarely focused on the patient perspective or issues with multiple providers. Conclusion: Most prescribing indications for chronic conditions in older patients are criteria rather than measures. Indications accounting for patient perspective and multiple providers are limited. The gaps identified in this review may help improve the development of prescribing measures for older adults and ultimately improve quality of care.

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Emergency Department Visits and Primary Care Among Adults With Chronic Conditions

Medical Care ◽

10.1097/mlr.0b013e3181eaf86d ◽

2010 ◽

Vol 48 (11) ◽

pp. 972-980 ◽

Cited By ~ 39

Author(s):

Jane McCusker ◽

Danièle Roberge ◽

Jean-Frédéric Lévesque ◽

Antonio Ciampi ◽

Alain Vadeboncoeur ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Chronic Conditions ◽

Emergency Department Visits

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Adverse drug events leading to emergency department visits in elderly: the role of inappropriate prescription

Einstein (São Paulo) ◽

10.1590/s1679-45082010ao1473 ◽

2010 ◽

Vol 8 (2) ◽

pp. 175-179 ◽

Cited By ~ 4

Author(s):

José Marcelo Farfel ◽

Tarso Augusto Duenhas Accorsi ◽

Marcelo Franken ◽

Sueli Pinto Doudement ◽

Mariane Moran ◽

...

Keyword(s):

Emergency Department ◽

Adverse Drug Events ◽

Inappropriate Medication ◽

Albert Einstein ◽

The Elderly ◽

Emergency Department Visits ◽

Drug Event ◽

Inappropriate Prescription ◽

The Mean

ABSTRACT Objective: Adverse drug reactions are more incident among the elderly and are frequently associated to inappropriate prescription for this group. The objective of the current study was to investigate the incidence and the characteristics of emergency department visits, related to inappropriate prescription, at the Hospital Israelita Albert Einstein. Methods: Patients aged 60 years or older, admitted to the emergency department at Unidade Avançada Ibirapuera of Hospital Israelita Albert Einstein, were included in the study. Potentially inappropriate medication for the elderly was evaluated using updated 2003 Beers criteria. Results: Over a period of 6 months, 214 individuals were included in the study, being 53.7% male. The mean age was 70.8 years (60-107). A total of 48 registries of inappropriate prescription were recorded in 42 patients (19.6% of sample). An emergency visit related to adverse drug event was verified in 27 individuals (12.5% of the sample). From these patients, 34.5% were admitted to the emergency department because of an adverse event caused by an inappropriate medication. Conclusion: Inappropriate prescription is frequent among elderly patients admitted to emergency department. A surveillance system and a program to educate physicians on the most recent criteria of appropriate prescription may help reducing emergency visits and adverse drug events in the elderly population.

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