Lack of awareness of community-acquired adverse drug reactions upon hospital admission - Dimensions and consequences of a dilemma
Lack of awareness of community-acquired adverse drug reactions upon hospital admission - Dimensions and consequences of a dilemma
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DOI：
10.2165/00002018-200326050-00004
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发表时间：
2003-01-01
期刊：
影响因子：
4.2
通讯作者：
Brune, K
中科院分区：
文献类型：
--
作者：
Dormann, H;Criegee-Rieck, M;Brune, K
目的：药物不良反应（ADR）是众所周知的住院原因。然而，定量估计的可预防性和医生的认识，这些reactions.Study设计和方法：使用密集的床边和计算机辅助药物监测方法进行了为期13个月的前瞻性药物流行病学调查的病人入院两个内科病房的埃尔朗根-纽伦堡大学医院在埃尔兰根，德国。本研究旨在确定可预防和不可避免的ADR的发生率。此外，我们调查了认识的医生在入院时的ADRs和禁忌入院前prescriptions.Results率：在78（8.5%）的915（10.9%）的入场，共102（42个可预防）社区获得的ADRs入院检测。在45例（3.8%）住院患者中，ADR直接导致住院。56.9%的ADR在入院时未被主治医生识别。ADR的知晓率与其概率和严重程度评分之间存在显著相关性（r = 0.85和r = 0.94; p < 0.05）。最常检测到的ADR是由于直接毒性和继发药理学作用。特异质反应经常被遗漏，入院前处方的所有药物中有18.6%是禁忌的。领先的名单是利尿剂，镇痛药/NSAIDs和抗精神病药/sedatives.Conclusions：认识现有的药物不良反应入院和适当的处方入院前需要注意。通过使用计算机支持系统，可以在入院时早期发现ADR。许多ADR可以通过遵守适应症和禁忌症来预防。
Objective: Adverse drug reactions (ADRs) are a well-known cause of hospital admission. Nevertheless a quantitative estimate of the preventability of and physicians' awareness of these reactions is lacking.Study Design and Methods: Using intensive bedside and computer-assisted drug surveillance methods a 13-month prospective pharmacoepidemiological survey was carried out on patients admitted to two medical wards of the Erlangen-Nuremberg University Hospital in Erlangen, Germany. This study aimed to define the incidence of preventable and unavoidable ADRs. In addition we investigated the awareness of the physicians to ADRs at the time of admission and the rate of contraindicated pre-admission prescriptions.Results: In 78 (8.5%) of 915 (10.9%) admissions a total of 102 (42 preventable) community-acquired ADRs were detected on admission. In 45 (3.8%) of the admissions ADRs led directly to hospitalisation. 56.9% of the ADRs were not recognised by the attending physician on admission. Marked correlation was found between the awareness of ADRs and their probability and severity scores (r = 0.85 and r = 0.94, respectively; p < 0.05). The most frequently detected ADRs were due to direct toxicity and secondary pharmacological effects. Idiosyncratic reactions were often missed and 18.6% of all drugs prescribed prior to admission were contraindicated. Leading the list were diuretics, analgesics/NSAIDs and antipsychotics/sedatives.Conclusions: Awareness of existing ADRs on hospital admission and appropriate prescribing prior to hospital admission require attention. Early detection of ADRs on hospital admission can be achieved by the use of computer support systems. Many ADRs could be prevented by adhering to indications and contraindications.