Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
Pharmacy Department, Centro de Ciências da Saúde, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
PLoS One. 2020 May 5;15(5):e0230215. doi: 10.1371/journal.pone.0230215. eCollection 2020.
To identify risk factors for potential Drug-Related Problems (DRP) at admission in hospitalized patients.
Prospective cohort study conducted in adults patients hospitalized (May 2016 to May 2018) in a general tertiary care hospital in Brazil. Potential DRP were detected by daily review of 100% of electronic medication orders by hospital pharmacists and classified by the Pharmaceutical Care Network Europe classification system (PCNE version 6.2). For the identification of risk factors of potential DRP, backward stepwise logistic regression was used to identify the set of independent predictors among over 120 variables collected in the initial 48 hours after admission in a training set consisting of 2/3 of the study population. The model was validated in the remaining sample.
The study population consisted of 1686 patients aged 52.0+/- 18.3 years-old, 51.4% females, with a median length of stay of 3.24 days, and 4.5% in-hospital mortality. The cumulative incidence of potential DRP was 14.5%. Admission for elective surgery and main diagnosis of disease of the circulatory system were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p<0.05). The independent risk factors of DRP are heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of more than seven drugs in day 2 (OR 1.63, p = 0.05), prescription in day 1 of drugs of the Anatomical Therapeutic Chemical Code (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription in day 2 of two or more ATC class A drugs (OR = 3.52, p<0.001), and in day 1 of ATC class J drugs (antiinfectives for systemic use, OR 1.97, p = 0.001). In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%.
This study identified seven independent risk factors of potential DRP in patients hospitalized in a general hospital that have fair predictive performance for utilization in clinical practice.
确定住院患者入院时潜在药物相关问题（DRP）的风险因素。
这是一项在巴西一家综合三级保健医院进行的成人住院患者前瞻性队列研究。通过医院药剂师对 100%电子医嘱的日常审查来发现潜在的 DRP，并使用欧洲药学保健网络分类系统（PCNE 版本 6.2）进行分类。为了确定潜在 DRP 的风险因素，使用向后逐步逻辑回归来确定在入院后 48 小时内收集的超过 120 个变量的独立预测因子集，该模型在研究人群的 2/3 组成的训练集中进行验证，然后在剩余的样本中进行验证。
研究人群包括 1686 名年龄为 52.0+/-18.3 岁的患者，其中 51.4%为女性，中位住院时间为 3.24 天，院内死亡率为 4.5%。潜在 DRP 的累积发生率为 14.5%。择期手术入院和主要诊断为循环系统疾病与 DRP 风险降低相关（OR 分别为 0.41 和 0.57，p<0.05）。DRP 的独立危险因素是心率≥80 次/分（OR 1.41，p=0.05）、第 2 天处方超过 7 种药物（OR 1.63，p=0.05）、第 1 天处方 ATC 分类 A（胃肠道和代谢）的药物（OR 2.24，p=0.003）、第 2 天处方两种或更多 ATC 分类 A 药物（OR=3.52，p<0.001）和第 1 天处方 ATC 分类 J 药物（全身用抗感染药物，OR 1.97，p=0.001）。在验证集中，预测模型的 c 统计量为 0.65，灵敏度为 56.1%，特异性为 65.2%。
本研究确定了在综合医院住院患者中潜在 DRP 的七个独立风险因素，该模型在临床实践中有较好的预测性能。
