Identifying Adverse Drug Events in Older Community-Dwelling Patients
Identifying Adverse Drug Events in Older Community-Dwelling Patients
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DOI：
10.1370/afm.2359
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发表时间：
2019-03-01
影响因子：
4.4
通讯作者：
Fahey, Tom
中科院分区：
文献类型：
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作者：
Cabir, Caitriona;Wallace, Emma;Fahey, Tom
目的评价患者报告工具在社区多发病老年人群中识别不良药物事件(ADE)的方法。方法：对859名70岁的社区患者进行了一项回顾性队列研究，这些患者在15个初级保健机构接受治疗。患者被问及在过去6个月内是否经历过按生理系统分类的74种症状中的任何一种，是否(1)他们认为该症状与他们的药物有关，(2)该症状困扰他们，(3)他们与他们的家庭医生讨论过，(4)他们因该症状而需要住院治疗。自我报告的症状由2名临床医生独立审查，他们确定症状是ADE的可能性。结果ADE量表的准确性为75%(95%CI，77%-79%)，敏感性为29%(95%CI，27%-31%)，特异性为93%(95%CI，92%-94%)。报告有症状的老年人发生ADE的可能性增加(阳性似然比[LR+]：4.22；95%CI，3.78-4.72)。抗血栓药物是ADEs最常见的药物。患者最受困扰的是肌肉疼痛或虚弱(75%)、头晕或头晕(61%)、咳嗽(53%)和站立不稳(52%)。平均而言，患者向医生报告了39%的ADE。26例(3%)患者因ADE到医院门诊就诊，32例(4%)患者因ADE去急诊科就诊。结论社区老年患者对ADE的认识往往不正确。ADE量表显示了良好的预测价值，可用于区分ADE症状和社区慢性病。
PURPOSE To evaluate a patient-report instrument for identifying adverse drug events (ADEs) in older populations with multimorbidity in the community setting.METHODS This was a retrospective cohort study of 859 community-dwelling patients aged >= 70 years treated at 15 primary care practices. Patients were asked if they had experienced any of a list of 74 symptoms classified by physiologic system in the previous 6 months and if (1) they believed the symptom to be related to their medication, (2) the symptom had bothered them, (3) they had discussed it with their family physician, and (4) they required hospital care due to the symptom. Self-reported symptoms were independently reviewed by 2 clinicians who determined the likelihood that the symptom was an ADE. Family physician medical records were also reviewed for any report of an ADE.RESULTS The ADE instrument had an accuracy of 75% (95% CI, 77%-79%), a sensitivity of 29% (95% CI, 27%-31%), and a specificity of 93% (95% CI, 92%-94%). Older people who reported a symptom had an increased likelihood of an ADE (positive likelihood ratio [LR+]: 4.22; 95% CI, 3.78-4.72). Antithrombotic agents were the drugs most commonly associated with ADEs. Patients were most bothered by muscle pain or weakness (75%), dizziness or lightheadedness (61%), cough (53%), and unsteadiness while standing (52%). On average, patients reported 39% of ADEs to their physician. Twenty-six (3%) patients attended a hospital outpatient clinic, and 32 (4%) attended an emergency department due to ADEs.CONCLUSION Older community-dwelling patients were often not correct in recognizing ADEs. The ADE instrument demonstrated good predictive value and could be used to differentiate between symptoms of ADEs and chronic disease in the community setting.