Prevalence of adverse drug reactions in the primary care setting: A systematic review and meta-analysis.
Prevalence of adverse drug reactions in the primary care setting: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0252161
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Wei L
中科院分区：
文献类型：
--
作者：
Insani WN;Whittlesea C;Alwafi H;Man KKC;Chapman S;Wei L
药物不良反应（ADR）是患者护理中医源性发病率和死亡率的主要原因。虽然已经开展了大量的工作，以减少医院环境中的药物不良反应，但初级保健中药物不良反应的总体负担仍不清楚。调查初级保健环境中ADR的患病率和影响估计异质性的因素。通过检索Medline、Embase、CINAHL和IPA数据库识别研究。我们纳入了观察性研究，这些研究报告了接受初级保健的患者中ADR患病率的信息。排除了疾病和治疗特异性研究。采用Smyth ADRs量表评价纳入研究的质量。使用随机效应模型计算合并估计值。使用亚组分析和荟萃回归研究了异质性的潜在来源，包括年龄组、ADR定义、ADR检测方法、研究环境、研究质量和样本量。纳入了33项研究，总研究人群为1，568，164人。初级保健环境中ADR的汇总患病率为8.32%（95% CI，7.82，8.83）。可预防的ADR百分比范围为12.35- 37.96%，汇总估计值为22.96%（95% CI，7.82，38.09）。心血管系统药物是最常涉及的药物类别。ADR检测方法、年龄组、环境和样本量对估计值的异质性有显著影响。药物不良反应是初级保健环境中的一个重要健康问题。进一步的研究应该集中在检查ADR是否影响后续的临床结局，特别是在高风险的治疗领域。这些信息可以更好地为减少初级保健环境中ADR负担的策略提供信息。
Adverse drug reactions (ADRs) represent a major cause of iatrogenic morbidity and mortality in patient care. While a substantial body of work has been undertaken to characterise ADRs in the hospital setting, the overall burden of ADRs in the primary care remains unclear. To investigate the prevalence of ADRs in the primary care setting and factors affecting the heterogeneity of the estimates. Studies were identified through searching of Medline, Embase, CINAHL and IPA databases. We included observational studies that reported information on the prevalence of ADRs in patients receiving primary care. Disease and treatment specific studies were excluded. Quality of the included studies were assessed using Smyth ADRs adapted scale. A random-effects model was used to calculate the pooled estimate. Potential source of heterogeneity, including age groups, ADRs definitions, ADRs detection methods, study setting, quality of the studies, and sample size, were investigated using sub-group analysis and meta-regression. Thirty-three studies with a total study population of 1,568,164 individuals were included. The pooled prevalence of ADRs in the primary care setting was 8.32% (95% CI, 7.82, 8.83). The percentage of preventable ADRs ranged from 12.35–37.96%, with the pooled estimate of 22.96% (95% CI, 7.82, 38.09). Cardiovascular system drugs were the most commonly implicated medication class. Methods of ADRs detection, age group, setting, and sample size contributed significantly to the heterogeneity of the estimates. ADRs constitute a significant health problem in the primary care setting. Further research should focus on examining whether ADRs affect subsequent clinical outcomes, particularly in high-risk therapeutic areas. This information may better inform strategies to reduce the burden of ADRs in the primary care setting.
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