Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Pharmacoepidemiol Drug Saf. 2024 Sep;33(9):e70012. doi: 10.1002/pds.70012.
The magnitude of repeat exposures to culprit medications after hospital discharge is not well studied. We combined prospective cohort data with administrative health data to understand the frequency of repeat exposures to culprit medications after discharge and the risk factors for their occurrence.
This was a retrospective analysis of three prospective cohorts of patients who presented to the hospital with an adverse drug event in British Columbia, from 2008 to 2015 (n = 849). We linked prospectively identified adverse drug events to administrative data to examine patterns of redispensing of culprit medications. We used Cox regression to assess risk factors for re-exposure, and conducted subgroup analyses for essential vs. nonessential medications.
Among 849 diagnosed adverse drug events, 45.2% had subsequent culprit medication redispensing within a year of hospital discharge. The factors associated with re-exposures included atrial fibrillation, adverse drug event type (e.g. adverse reaction), culprit medication type, and longer historical duration of medication use.
Re-exposures to culprit medications occurred in almost half of the adverse drug events diagnosed in emergency departments. Many of these were appropriate re-exposures to essential medications for indications in which the risk of uncontrolled disease likely outweighed the risk of a repeat adverse event. More research is needed to understand re-exposures to nonessential medications or medications with safer alternatives.
出院后反复暴露于致病药物的程度尚未得到充分研究。我们结合前瞻性队列数据和行政健康数据，了解出院后重复暴露于致病药物的频率及其发生的危险因素。
这是对 2008 年至 2015 年不列颠哥伦比亚省因药物不良反应就诊的三个前瞻性队列的患者进行的回顾性分析（n=849）。我们将前瞻性确定的药物不良反应与行政数据进行了关联，以检查致病药物再调配的模式。我们使用 Cox 回归评估再暴露的危险因素，并对必需药物与非必需药物进行亚组分析。
在 849 例确诊的药物不良反应中，45.2%在出院后一年内有后续的致病药物再调配。与再暴露相关的因素包括心房颤动、药物不良反应类型（如不良反应）、致病药物类型以及更长的药物使用历史时长。
在急诊科诊断的药物不良反应中，几乎有一半发生了再次暴露于致病药物。其中许多是对必需药物的合理再暴露，因为在这些情况下，疾病失控的风险很可能超过再次发生不良反应的风险。需要进一步研究来了解非必需药物或具有更安全替代品的药物的再暴露情况。
