Zed Peter J, Abu-Laban Riyad B, Balen Robert M, Loewen Peter S, Hohl Corinne M, Brubacher Jeffrey R, Wilbur Kerry, Wiens Matthew O, Samoy Leslie J, Lacaria Katie, Purssell Roy A
Department of Pharmacy, Queen Elizabeth II Health Sciences Centre, Capital Health, Halifax, NS.
CMAJ. 2008 Jun 3;178(12):1563-9. doi: 10.1503/cmaj.071594.
Medication-related visits to the emergency department are an important but poorly understood phenomenon. We sought to evaluate the frequency, severity and preventability of drug-related visits to the emergency department.
We performed a prospective observational study of randomly selected adults presenting to the emergency department over a 12-week period. Emergency department visits were identified as drug-related on the basis of assessment by a pharmacist research assistant and an emergency physician; discrepancies were adjudicated by 2 independent reviewers.
Among the 1017 patients included in the study, the emergency department visit was identified as drug-related for 122 patients (12.0%, 95% confidence interval [CI] 10.1%-14.2%); of these, 83 visits (68.0%, 95% CI 59.0%-76.2%) were deemed preventable. Severity was classified as mild in 15.6% of the 122 cases, moderate in 74.6% and severe in 9.8%. The most common reasons for drug-related visits were adverse drug reactions (39.3%), nonadherence (27.9%) and use of the wrong or suboptimal drug (11.5%). The probability of admission was significantly higher among patients who had a drug-related visit than among those whose visit was not drug-related (OR 2.18, 95% CI 1.46-3.27, p < 0.001), and among those admitted, the median length of stay was longer (8.0 [interquartile range 23.5] v. 5.5 [interquartile range 10.0] days, p = 0.06).
More than 1 in 9 emergency department visits are due to drug-related adverse events, a potentially preventable problem in our health care system.
因用药问题前往急诊科就诊是一个重要但了解不足的现象。我们试图评估因药物相关问题前往急诊科就诊的频率、严重程度及可预防性。
我们对在12周内随机选取的前往急诊科就诊的成年患者进行了一项前瞻性观察性研究。由药剂师研究助理和急诊科医生评估确定因药物相关问题前往急诊科就诊；分歧由2名独立评审员裁定。
在纳入研究的1017例患者中，122例患者（12.0%，95%置信区间[CI] 10.1%-14.2%）的急诊科就诊被确定为药物相关问题；其中，83次就诊（68.0%，95% CI 59.0%-76.2%）被认为是可预防的。在122例病例中，15.6%的严重程度被分类为轻度，74.6%为中度，9.8%为重度。因药物相关问题就诊的最常见原因是药物不良反应（39.3%）、不依从（27.9%）以及使用错误或次优药物（11.5%）。因药物相关问题就诊的患者入院概率显著高于非药物相关问题就诊的患者（比值比2.18，95% CI 1.46-3.27，p<0.001），且在入院患者中，中位住院时间更长（8.0[四分位间距23.5]天对5.5[四分位间距10.0]天，p = 0.06）。
超过九分之一的急诊科就诊是由药物相关不良事件导致的，这在我们的医疗保健系统中是一个潜在可预防的问题。
