Incidence and preventability of adverse drug events among older persons in the ambulatory setting
Incidence and preventability of adverse drug events among older persons in the ambulatory setting
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DOI：
10.1001/jama.289.9.1107
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发表时间：
2003-03-05
影响因子：
120.7
通讯作者：
Bates, DW
中科院分区：
文献类型：
--
作者：
Gurwitz, JH;Field, TS;Bates, DW
背景药物不良事件，特别是那些可能是可以预防的，是最严重的关注药物使用的老年人照顾在门诊临床setting.Objective评估的发病率和可预防性药物不良事件在老年人在门诊临床setting. Design，所有Medicare登记者的患者队列研究（30 397人-年的观察）在12个月的研究期间由多专业小组实践护理（1999年7月1日至2000年6月30日），其中使用多种方法检测在门诊临床环境中发生的可能的药物相关事件，包括来自卫生保健提供者的报告;审查医院出院摘要;审查急诊科记录;计算机生成的信号;电子诊所记录的自动自由文本审查;主要结果测量药物不良事件的数量，事件的严重程度（分为显著，严重，危及生命，或致命的），以及事件是否是可预防的。药物不良事件的总体发生率为50.1/1000人年，可预防的药物不良事件发生率为13.8/1000人年。在药物不良事件中，578例（38.0%）被归类为严重、危及生命或致死性;这些更严重的事件中有244例（42.2%）被认为是可预防的，而945例重大药物不良事件中有177例（18.7%）被认为是可预防的。与可预防的药物不良事件相关的错误最常发生在处方（n = 246，58.4%）和监测（n = 256，60.8%）阶段，涉及患者依从性的错误（n = 89，21.1%）也很常见。心血管药物（24.5%），其次是利尿剂（22.1%）、非阿片类镇痛剂（15.4%）、降糖药（10.9%）和抗凝剂（10.2%），是与可预防药物不良事件相关的最常见药物类别。电解质/肾脏（26.6%），胃肠道（21.1%），出血（15.9%），代谢/内分泌（13.8%），和神经精神（8.6%）事件是最常见的类型的可预防的药物不良事件。结论药物不良事件是常见的，往往是可预防的老年人在门诊临床设置。更严重的药物不良事件更有可能是可以预防的。预防策略应针对的处方和监测阶段。药学护理干预措施侧重于改善患者对处方方案的依从性和监测处方药物也可能是有益的。
Context Adverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting.Objective To assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting.Design, Setting, and Patients Cohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors.Main Outcome Measures Number of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable.Results There were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglytemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events.Conclusions Adverse drug events are common and often preventable among older persons in the ambulatory Clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of. pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.