Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.
Department of Pharmacology and Clinical Pharmacy, Center of Excellence for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia.
PLoS One. 2021 May 26;16(5):e0252161. doi: 10.1371/journal.pone.0252161. eCollection 2021.
Adverse drug reactions (ADRs) represent a major cause of iatrogenic morbidity and mortality in patient care. While a substantial body of work has been undertaken to characterise ADRs in the hospital setting, the overall burden of ADRs in the primary care remains unclear.
To investigate the prevalence of ADRs in the primary care setting and factors affecting the heterogeneity of the estimates.
Studies were identified through searching of Medline, Embase, CINAHL and IPA databases. We included observational studies that reported information on the prevalence of ADRs in patients receiving primary care. Disease and treatment specific studies were excluded. Quality of the included studies were assessed using Smyth ADRs adapted scale. A random-effects model was used to calculate the pooled estimate. Potential source of heterogeneity, including age groups, ADRs definitions, ADRs detection methods, study setting, quality of the studies, and sample size, were investigated using sub-group analysis and meta-regression.
Thirty-three studies with a total study population of 1,568,164 individuals were included. The pooled prevalence of ADRs in the primary care setting was 8.32% (95% CI, 7.82, 8.83). The percentage of preventable ADRs ranged from 12.35-37.96%, with the pooled estimate of 22.96% (95% CI, 7.82, 38.09). Cardiovascular system drugs were the most commonly implicated medication class. Methods of ADRs detection, age group, setting, and sample size contributed significantly to the heterogeneity of the estimates.
ADRs constitute a significant health problem in the primary care setting. Further research should focus on examining whether ADRs affect subsequent clinical outcomes, particularly in high-risk therapeutic areas. This information may better inform strategies to reduce the burden of ADRs in the primary care setting.
药物不良反应（ADR）是导致患者在医疗过程中产生医源性发病率和死亡率的主要原因。虽然已经有大量的工作致力于描述医院环境中的 ADR，但在初级保健中 ADR 的总体负担仍不清楚。
调查初级保健环境中 ADR 的流行情况，并分析影响估计异质性的因素。
通过搜索 Medline、Embase、CINAHL 和 IPA 数据库，我们确定了研究。我们纳入了报告初级保健患者 ADR 发生率信息的观察性研究。排除了特定疾病和治疗的研究。使用 Smyth ADRs 改编量表评估纳入研究的质量。使用随机效应模型计算汇总估计值。通过亚组分析和 meta 回归，调查了潜在的异质性来源，包括年龄组、ADR 定义、ADR 检测方法、研究环境、研究质量和样本量。
共纳入 33 项研究，总研究人群为 1,568,164 人。初级保健环境中 ADR 的总体发生率为 8.32%（95%CI，7.82，8.83）。可预防 ADR 的比例范围为 12.35-37.96%，汇总估计值为 22.96%（95%CI，7.82，38.09）。心血管系统药物是最常见的药物类别。ADR 检测方法、年龄组、环境和样本量对估计值的异质性有显著影响。
ADR 在初级保健环境中构成了一个重大的健康问题。进一步的研究应集中于检查 ADR 是否会影响后续的临床结局，特别是在高风险的治疗领域。这些信息可能会更好地指导减少初级保健环境中 ADR 负担的策略。
