Department of Health Care Administration, Oriental Institute of Technology, New Taipei City, Taiwan.
Department of Pharmacy, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
BMJ Open. 2019 May 10;9(5):e026771. doi: 10.1136/bmjopen-2018-026771.
Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients.
A nested case-control study.
A medical centre located in north Taiwan.
539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected.
Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses.
ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes.
The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively.
The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient's safety improvement in geriatric care.
老年患者的疾病复杂性可能更高，且开具的药物也更多，这与不良反应（ADR）的发生率较高有关。本研究旨在调查与老年住院患者 ADR 发生、预后和医疗费用相关的因素。
巢式病例对照研究。
位于中国台湾北部的一家医疗中心。
2006 年至 2012 年期间，从包含 108548 例老年住院患者的患者队列中收集了 539 例报告的 ADR 病例。共收集了 1854 例非 ADR 匹配对照，按年龄、性别和主要诊断最多 1:5 匹配。
多种药物治疗、处方药物数量、合并症和入院科室均与 ADR 以及随后不良预后、住院时间和医疗费用有关。
ADR 发生和不良预后（死亡率、在危急情况下拒绝出院或入住重症监护病房）为主要结局。额外的医疗费用和住院时间为次要结局。
入院科室、合并症数量和 ADR 前的药物处方数量与老年住院患者 ADR 的发生有关。ADR 严重程度是 ADR 病例的一个重要预后因素。随着合并症数量的增加，不良预后的多变量调整比值比（OR）为 1.63（95%CI 1.36 至 1.95）。与其他患者相比，处方≥11 种药物（包括精神活性药物）的患者预后较差的风险增加 2.45 倍（95%CI 1.40 至 4.28）。ADR 导致受影响的老年住院患者的总医疗费用、药物费用和住院时间分别增加了 1803.8 美元、360.8 美元和 5.6 天。
合并症数量和包括精神活性药物在内的多种药物治疗对老年住院患者 ADR 的发生和预后有显著影响。研究结果为老年护理中未来的处方调整和患者安全改善提供了线索。
