Factors predicting hospital readmissions related to adverse drug reactions

ObjectiveTo analyse the contribution of adverse drug reactions (ADR) to hospital readmissions.MethodsThis was a case–control study in which unscheduled admissions of patients who had been admitted to the hospital during the two previous months were assessed during a 21-month period. The patient was considered a case when the main diagnosis of readmission complied with the World Health Organisation’s definition of an ADR. For each case, two controls were selected from those patients that had been admitted for ADR without readmission (n = 177). Information on drugs and other risk factors was obtained from cases by interview and from controls by clinical record review.ResultsThere were 26,559 unscheduled admissions of which 81 were readmissions associated with ADR (4.5% of the unscheduled readmissions). There were no statistically significant correlations with sex, age or medical history, with the exception of arterial hypertension. The main drug products causing readmission were acenocoumarol (15, 18.5%), antihypertensive-diuretics (14, 17.3%), anticancer drugs (11, 13.6%) and digoxin (seven, 8.6%). In the multivariate logistic analysis, the variables predicting readmission were acenocoumarol [odds ratio (OR) 12.2, 95% confidence interval (CI) 3.8–38.3, P < 0.0001], a record of diabetes mellitus (OR 2.6, 95% CI 1.3–5.5, P < 0.01), the number of drugs taken at the moment of ADR (OR 1.2, 95% CI 1.1–1.4, P < 0.001) and high blood pressure (OR 0.3, 95% CI 0.2–0.6, P < 0.001) even though the latter was a negative predictor, preventing readmission. Of the 81 readmissions associated with ADR, 28 (34.6%) were preventable.ConclusionA medical record of diabetes mellitus, polypharmacy and acenocoumarol treatment were risk factors predicting hospital readmission related to ADR.

[1]  N. Moore,et al.  Adverse drug reactions in a department of systemic diseases-oriented internal medicine: prevalence, incidence, direct costs and avoidability , 2000, European Journal of Clinical Pharmacology.

[2]  M. Pirmohamed,et al.  Which drugs cause preventable admissions to hospital? A systematic review. , 2007, British journal of clinical pharmacology.

[3]  J. García-Alegría,et al.  Análisis de las causas de los reingresos en un hospital de agudos y su evitabilidad potencial , 2002 .

[4]  C. Serra,et al.  Uso de analgésicos y ácido acetilsalicílico en un estudio multicéntrico en España , 2005 .

[5]  F Y Aoki,et al.  Drug‐Associated Hospital Admissions in Older Medical Patients , 1988, Journal of the American Geriatrics Society.

[6]  E. Hahn,et al.  Readmissions and adverse drug reactions in internal medicine: the economic impact , 2004, Journal of internal medicine.

[7]  P. McDonnell,et al.  Hospital Admissions Resulting from Preventable Adverse Drug Reactions , 2002, The Annals of pharmacotherapy.

[8]  P. Thürmann,et al.  Methods and Systems to Detect Adverse Drug Reactions in Hospitals , 2001, Drug safety.

[9]  T R Einarson,et al.  Drug-Related Hospital Admissions , 1993, The Annals of pharmacotherapy.

[10]  A. Carvajal,et al.  Gastroprotection during the administration of non-steroidal anti-inflammatory drugs. A drug-utilization study , 2004, European Journal of Clinical Pharmacology.

[11]  M. Pirmohamed,et al.  Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients , 2004, BMJ : British Medical Journal.

[12]  Z. T. Grapes,et al.  Factors associated with preventable adverse drug reactions. , 1994, American journal of hospital pharmacy.

[13]  O. Mj,et al.  Preventable adverse drug effects at an emergency department , 1999 .

[14]  P. Corey,et al.  Incidence of Adverse Drug Reactions in Hospitalized Patients , 2012 .

[15]  E. Roughead,et al.  Drug‐related hospital admissions: a review of Australian studies published 1988‐1996 , 1998, The Medical journal of Australia.

[16]  J Hasford,et al.  Adverse drug reaction monitoring--cost and benefit considerations. Part I: frequency of adverse drug reactions causing hospital admissions. , 1997, Pharmacoepidemiology and drug safety.

[17]  F. Haramburu,et al.  Admissions to hospital caused by adverse drug reactions: cross sectional incidence study , 2000, BMJ : British Medical Journal.

[18]  D. Bates,et al.  The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital , 2003, Annals of Internal Medicine.

[19]  T. Hampton.  New oral anticoagulants show promise. , 2006, JAMA.

[20]  S. Guharoy,et al.  Suspected Nafcillin-Induced Interstitial Nephritis , 1993, The Annals of pharmacotherapy.

[21]  L. Goldman,et al.  Preventability of emergent hospital readmission. , 1991, The American journal of medicine.

[22]  G. Schumock,et al.  Focusing on the preventability of adverse drug reactions. , 1992, Hospital pharmacy.

[23]  D. Bates,et al.  Incidence and preventability of adverse drug events among older persons in the ambulatory setting. , 2003, JAMA.

[24]  M. Stowasser,et al.  Identifying drug-related readmissions: is there a better way of assessing the contribution of adverse medication events? , 2000 .

[25]  J Hasford,et al.  Adverse drug reaction monitoring—cost and benefit considerations. Part II: cost and preventability of adverse drug reactions leading to hospital admission , 1997, Pharmacoepidemiology and drug safety.

[26]  C M Ashton,et al.  The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. , 1997, Medical care.

[27]  L. Bero,et al.  Characterization of Geriatric Drug-Related Hospital Readmissions , 1991, Medical care.