Department of Health Care Administration, Oriental Institute of Technology, New Taipei City, Taiwan.
Int J Clin Pract. 2013 Jun;67(6):576-84. doi: 10.1111/ijcp.12097.
The aim of this study was to explore the factors associated with the occurrence, subsequent prognoses and need for additional medications following cutaneous adverse drug reactions (ADRs) among inpatients.
This is a case-control study, nested in a large cohort study of 473,446 inpatients hospitalised from 2005 to 2008, examined cutaneous ADRs. A 1 : 5 strategy of individually matching age and principal diagnosis was applied to the data of cases (n = 700) and corresponding controls (n = 3365).The severity of ADRs was evaluated using Naranjo algorithms by senior pharmacists in the medical centre. Medical chart reviews and claim data analyses were analysed to explore risk factors associated with the occurrence and impact of cutaneous ADRs. Economic impacts in terms of length of stay and medical expenses were also analysed.
The number of drug prescriptions and secondary diagnoses, and the department to which the patient was admitted, significantly contributed to the risk of cutaneous ADRs and subsequent prognosis. In addition to physician's seniority, the Naranjo score was also positively associated with patients' prognosis. Medical expenses associated with cutaneous ADRs patients ($US 916) were more than 2.5-fold higher than those patients who were not afflicted ($US 318).
The study identified risk factors for cutaneous ADRs in terms of both patient characteristics and drug complexity. The present analyses indicate characteristics and mechanisms of cutaneous ADRs among inpatients, which provide clues for future intervention strategies and management issues in healthcare settings.
本研究旨在探讨住院患者皮肤不良反应（ADR）发生、后续预后以及需要额外药物治疗的相关因素。
这是一项病例对照研究，嵌套在一项对 2005 年至 2008 年住院的 473446 名患者进行的大型队列研究中，研究了皮肤 ADR。采用 1:5 的年龄和主要诊断匹配策略，对病例（n=700）和相应对照（n=3365）的数据进行了分析。医疗中心的资深药剂师使用 Naranjo 算法评估 ADR 的严重程度。通过病历回顾和索赔数据分析，探讨与皮肤 ADR 发生和影响相关的风险因素。还分析了住院时间和医疗费用方面的经济影响。
药物处方和次要诊断的数量以及患者就诊的科室显著增加了皮肤 ADR 的发生风险和后续预后。除了医生的资历外，Naranjo 评分也与患者的预后呈正相关。患有皮肤 ADR 的患者的医疗费用（916 美元）是未患病患者的 2.5 倍以上（318 美元）。
本研究确定了患者特征和药物复杂性方面皮肤 ADR 的风险因素。本分析表明了住院患者皮肤 ADR 的特征和机制，为未来在医疗保健环境中制定干预策略和管理问题提供了线索。
